Quality improvement strategies to prevent falls in older adults: a systematic review and network meta-analysis

Andrea C Tricco; Sonia M Thomas; Areti Angeliki Veroniki; Jemila S Hamid; Elise Cogo; Lisa Strifler; Paul A Khan; Kathryn M Sibley; Reid Robson; Heather MacDonald; John J Riva; Kednapa Thavorn; Charlotte Wilson; Jayna Holroyd-Leduc; Gillian D Kerr; Fabio Feldman; Sumit R Majumdar; Susan B Jaglal; Wing Hui; Sharon E Straus

doi:10.1093/ageing/afy219

Quality improvement strategies to prevent falls in older adults: a systematic review and network meta-analysis

Age Ageing. 2019 May 1;48(3):337-346. doi: 10.1093/ageing/afy219.

Authors

Andrea C Tricco^{1

2}, Sonia M Thomas¹, Areti Angeliki Veroniki¹, Jemila S Hamid¹, Elise Cogo¹, Lisa Strifler^{1

3}, Paul A Khan¹, Kathryn M Sibley^{4

5}, Reid Robson¹, Heather MacDonald¹, John J Riva^{6

7}, Kednapa Thavorn^{1

8}, Charlotte Wilson¹, Jayna Holroyd-Leduc⁹, Gillian D Kerr¹, Fabio Feldman¹⁰, Sumit R Majumdar¹¹, Susan B Jaglal¹², Wing Hui¹, Sharon E Straus^{1

13}

Affiliations

¹ Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, ON Canada.
² Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, ON, Canada.
³ Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, ON, Canada.
⁴ Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, 11th floor, Toronto, ON, Canada.
⁵ Department of Community Health Sciences, University of Manitoba, 379-753 McDermot Ave, Winnipeg, MB, Canada.
⁶ Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, 6th Floor, Hamilton, ON, Canada.
⁷ Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, Canada.
⁸ Clinical Epidemiology Program, The Ottawa Hospital Research Institute, 501 Smyth Road, PO Box 201B, Ottawa, ON, Canada.
⁹ Departments of Medicine and Community Health Sciences, University of Calgary, 1403 29th Street NW, Calgary, AB, Canada.
¹⁰ Patient Safety & Injury Prevention, Fraser Health, 13450-102nd Avenue, Surrey, BC, Canada.
¹¹ Department of Medicine, University of Alberta, 5-134 Clinical Sciences Building, 11350-83rd Avenue, Edmonton, AB, Canada.
¹² Department of Physical Therapy, University of Toronto, 160-500 University Ave, Toronto, ON, Canada.
¹³ Department of Geriatric Medicine, University of Toronto, 27 King's College Circle, Toronto, ON, Canada.

Abstract

Background: Falls are a common occurrence and the most effective quality improvement (QI) strategies remain unclear.

Methods: We conducted a systematic review and network meta-analysis (NMA) to elucidate effective quality improvement (QI) strategies for falls prevention. Multiple databases were searched (inception-April 2017). We included randomised controlled trials (RCTs) of falls prevention QI strategies for participants aged ≥65 years. Two investigators screened titles and abstracts, full-text articles, conducted data abstraction and appraised risk of bias independently.

Results: A total of 126 RCTs including 84,307 participants were included after screening 10,650 titles and abstracts and 1210 full-text articles. NMA including 29 RCTs and 26,326 patients found that team changes was statistically superior in reducing the risk of injurious falls relative to usual care (odds ratio [OR] 0.57 [0.33 to 0.99]; absolute risk difference [ARD] -0.11 [95% CI, -0.18 to -0.002]). NMA for the outcome of number of fallers including 61 RCTs and 40 128 patients found that combined case management, patient reminders and staff education (OR 0.18 [0.07 to 0.47]; ARD -0.27 [95% CI, -0.33 to -0.15]) and combined case management and patient reminders (OR, 0.36 [0.13 to 0.97]; ARD -0.19 [95% CI, -0.30 to -0.01]) were both statistically superior compared to usual care.

Conclusions: Team changes may reduce risk of injurious falls and a combination of case management, patient reminders, and staff education, as well as case management and patient reminders may reduce risk of falls. Our results can be tailored to decision-maker preferences and availability of resources.

Systematic review registration: PROSPERO (CRD42013004151).

Keywords: fall prevention; falling; falls; older people; quality improvement; systematic review.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Accidental Falls / prevention & control*
Aged
Case Management
Humans
Network Meta-Analysis
Quality Improvement*
Reminder Systems
Risk Factors

Grants and funding

CAPMC/ CIHR/Canada