Document Detail


Interventions for preventing falls in older people living in the community.
MedLine Citation:
PMID:  19370674     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Approximately 30% of people over 65 years of age living in the community fall each year.
OBJECTIVES: To assess the effects of interventions to reduce the incidence of falls in older people living in the community.
SEARCH STRATEGY: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, CENTRAL (The Cochrane Library 2008, Issue 2), MEDLINE, EMBASE, CINAHL, and Current Controlled Trials (all to May 2008).
SELECTION CRITERIA: Randomised trials of interventions to reduce falls in community-dwelling older people. Primary outcomes were rate of falls and risk of falling.
DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trial quality and extracted data. Data were pooled where appropriate.
MAIN RESULTS: We included 111 trials (55,303 participants).Multiple-component group exercise reduced rate of falls and risk of falling (rate ratio (RaR) 0.78, 95%CI 0.71 to 0.86; risk ratio (RR) 0.83, 95%CI 0.72 to 0.97), as did Tai Chi (RaR 0.63, 95%CI 0.52 to 0.78; RR 0.65, 95%CI 0.51 to 0.82), and individually prescribed multiple-component home-based exercise (RaR 0.66, 95%CI 0.53 to 0.82; RR 0.77, 95%CI 0.61 to 0.97).Assessment and multifactorial intervention reduced rate of falls (RaR 0.75, 95%CI 0.65 to 0.86), but not risk of falling.Overall, vitamin D did not reduce falls (RaR 0.95, 95%CI 0.80 to 1.14; RR 0.96, 95%CI 0.92 to 1.01), but may do so in people with lower vitamin D levels. Overall, home safety interventions did not reduce falls (RaR 0.90, 95%CI 0.79 to 1.03); RR 0.89, 95%CI 0.80 to 1.00), but were effective in people with severe visual impairment, and in others at higher risk of falling. An anti-slip shoe device reduced rate of falls in icy conditions (RaR 0.42, 95%CI 0.22 to 0.78).Gradual withdrawal of psychotropic medication reduced rate of falls (RaR 0.34, 95%CI 0.16 to 0.73), but not risk of falling. A prescribing modification programme for primary care physicians significantly reduced risk of falling (RR 0.61, 95%CI 0.41 to 0.91).Pacemakers reduced rate of falls in people with carotid sinus hypersensitivity (RaR 0.42, 95%CI 0.23 to 0.75). First eye cataract surgery reduced rate of falls (RaR 0.66, 95%CI 0.45 to 0.95).There is some evidence that falls prevention strategies can be cost saving.
AUTHORS' CONCLUSIONS: Exercise interventions reduce risk and rate of falls. Research is needed to confirm the contexts in which multifactorial assessment and intervention, home safety interventions, vitamin D supplementation, and other interventions are effective.
Authors:
Lesley D Gillespie; M Clare Robertson; William J Gillespie; Sarah E Lamb; Simon Gates; Robert G Cumming; Brian H Rowe
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Publication Detail:
Type:  Journal Article; Meta-Analysis; Review     Date:  2009-04-15
Journal Detail:
Title:  The Cochrane database of systematic reviews     Volume:  -     ISSN:  1469-493X     ISO Abbreviation:  Cochrane Database Syst Rev     Publication Date:  2009  
Date Detail:
Created Date:  2009-04-16     Completed Date:  2009-06-23     Revised Date:  2013-06-28    
Medline Journal Info:
Nlm Unique ID:  100909747     Medline TA:  Cochrane Database Syst Rev     Country:  England    
Other Details:
Languages:  eng     Pagination:  CD007146     Citation Subset:  IM    
Affiliation:
Department of Medical and Surgical Sciences, Dunedin School of Medicine, University of Otago, PO Box 913, Dunedin, Otago, New Zealand, 9054. lesley.gillespie@otago.ac.nz
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MeSH Terms
Descriptor/Qualifier:
Accidental Falls / prevention & control*
Accidents, Home / prevention & control*
Aged
Bone Density Conservation Agents / administration & dosage
Environment Design
Exercise
Humans
Patient Education as Topic
Randomized Controlled Trials as Topic
Tai Ji
Vitamin D / administration & dosage
Chemical
Reg. No./Substance:
0/Bone Density Conservation Agents; 1406-16-2/Vitamin D
Comments/Corrections
Comment In:
Ann Emerg Med. 2010 Mar;55(3):296-8   [PMID:  19615786 ]
Evid Based Med. 2009 Dec;14(6):176   [PMID:  19949178 ]
Update In:
Cochrane Database Syst Rev. 2012;9:CD007146   [PMID:  22972103 ]

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