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Systematic review
Multifactorial falls prevention programmes for older adults presenting to the emergency department with a fall: systematic review and meta-analysis
  1. Renata Teresa Morello1,
  2. Sze-Ee Soh1,2,
  3. Kate Behm1,
  4. Amy Egan1,
  5. Darshini Ayton1,
  6. Keith Hill3,
  7. Leon Flicker4,5,
  8. Christopher D Etherton-Beer4,5,
  9. Glenn Arendts6,
  10. Nicholas Waldron7,
  11. Julie Redfern8,
  12. Terrence Haines9,
  13. Judy Lowthian1,10,
  14. Samuel R Nyman11,
  15. Peter Cameron1,12,
  16. Nicola Fairhall13,
  17. Anna Lucia Barker1
  1. 1 Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
  2. 2 Department of Physiotherapy, Monash University, Melbourne, Victoria, Australia
  3. 3 School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
  4. 4 WA Centre for Health & Ageing, Medical School, University of Western Australia, Perth, Western Australia, Australia
  5. 5 Department of Geriatric Medicine, Royal Perth Hospital, Perth, Western Australia, Australia
  6. 6 School of Medicine, University of Western Australia, Perth, Western Australia, Australia
  7. 7 School of Medicine, University of Notre Dame Australia, Fremantle, Western Australia, Australia
  8. 8 University of Sydney, Westmead Applied Research Centre, Faculty of Medicine and Health, Sydney, New South Wales, Australia
  9. 9 Department of Physiotherapy, Monash University, and Allied Health Research Unit, Monash Health, Melbourne, Victoria, Australia
  10. 10 Bolton Clarke Research Institute, Bolton Clarke, Melbourne, Victoria, Australia
  11. 11 Department of Psychology and Ageing & Dementia Research Centre, Bournemouth University, Poole, UK
  12. 12 Alfred Health, Melbourne, Victoria, Australia
  13. 13 Institute for Musculoskeletal Health, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
  1. Correspondence to Renata Teresa Morello, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia; renata.morello{at}monash.edu

Abstract

Objective To determine whether multifactorial falls prevention interventions are effective in preventing falls, fall injuries, emergency department (ED) re-presentations and hospital admissions in older adults presenting to the ED with a fall.

Design Systematic review and meta-analyses of randomised controlled trials (RCTs).

Data sources Four health-related electronic databases (Ovid MEDLINE, CINAHL, EMBASE, PEDro and The Cochrane Central Register of Controlled Trials) were searched (inception to June 2018).

Study selection RCTs of multifactorial falls prevention interventions targeting community-dwelling older adults ( ≥ 60 years) presenting to the ED with a fall with quantitative data on at least one review outcome.

Data extraction Two independent reviewers determined inclusion, assessed study quality and undertook data extraction, discrepancies resolved by a third.

Data synthesis 12 studies involving 3986 participants, from six countries, were eligible for inclusion. Studies were of variable methodological quality. Multifactorial interventions were heterogeneous, though the majority included education, referral to healthcare services, home modifications, exercise and medication changes. Meta-analyses demonstrated no reduction in falls (rate ratio = 0.78; 95% CI: 0.58 to 1.05), number of fallers (risk ratio = 1.02; 95% CI: 0.88 to 1.18), rate of fractured neck of femur (risk ratio = 0.82; 95% CI: 0.53 to 1.25), fall-related ED presentations (rate ratio = 0.99; 95% CI: 0.84 to 1.16) or hospitalisations (rate ratio = 1.14; 95% CI: 0.69 to 1.89) with multifactorial falls prevention programmes.

Conclusions There is insufficient evidence to support the use of multifactorial interventions to prevent falls or hospital utilisation in older people presenting to ED following a fall. Further research targeting this population group is required.

  • accidental falls
  • systematic review
  • emergency department
  • fall prevention
  • elderly

https://doi.org/10.1136/injuryprev-2019-043214

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    Footnotes

    • Funding NHMRC Career Development Fellowship [APP1143538] to JR and National Institute for Health Research Career Development Fellowship [CDF-2015-08-030] to SRN.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.