IMPORTANCE: Falls are the most common cause of injury-related morbidity and mortality among older adults. OBJECTIVE: To systematically review literature on the effectiveness and harms of fall prevention interventions in community-dwelling older adults to inform the US Preventive Services Task Force. DATA SOURCES: Medline, PubMed, Cumulative Index for Nursing and Allied Health Literature, and Cochrane Central Register of Controlled Trials for relevant English-language literature published through August 2016, with ongoing surveillance through February 7, 2018. STUDY SELECTION: Randomized clinical trials of interventions to prevent falls in community-dwelling adults 65 years and older. DATA EXTRACTION AND SYNTHESIS: Independent critical appraisal and data abstraction by 2 reviewers. Random-effects meta-analyses using the method of der Simonian and Laird. MAIN OUTCOMES AND MEASURES: Number of falls (number of unexpected events in which a person comes to rest on the ground, floor, or lower level), people experiencing 1 or more falls, injurious falls, people experiencing injurious falls, fractures, people experiencing fractures, mortality, hospitalizations, institutionalizations, changes in disability, and treatment harms. RESULTS: Sixty-two randomized clinical trials (n = 35,058) examining 7 fall prevention intervention types were identified. This article focused on the 3 most commonly studied intervention types: multifactorial (customized interventions based on initial comprehensive individualized falls risk assessment) (26 trials (n = 15,506)), exercise (21 trials (n = 7,297)), and vitamin D supplementation (7 trials (n = 7,531)). Multifactorial intervention trials were associated with a reduction in falls (incidence rate ratio (IRR) 0.79 95% CI 0.68 to 0.91) but were not associated with a reduction in other fall-related morbidity and mortality outcomes. Exercise trials were associated with statistically significant reductions in people experiencing a fall (relative risk 0.89, 95% CI 0.81 to 0.97) and injurious falls (IRR 0.81, 95% CI 0.73 to 0.90) and with a statistically nonsignificant reduction in falls (IRR 0.87, 95% CI 0.75 to 1.00) but showed no association with mortality. Few exercise trials reported fall-related fractures. Seven heterogeneous trials of vitamin D formulations (with or without calcium) showed mixed results. One trial of annual high-dose cholecalciferol (500,000 IU), which has not been replicated, showed an increase in falls, people experiencing a fall, and injuries, while 1 trial of calcitriol showed a reduction in falls and people experiencing a fall; the remaining 5 trials showed no significant difference in falls, people experiencing a fall, or injuries. Harms of multifactorial and exercise trials were rarely reported but generally included minor musculoskeletal injuries. CONCLUSIONS AND RELEVANCE: Multifactorial and exercise interventions were associated with fall-related benefit, but evidence was most consistent across multiple fall-related outcomes for exercise. Vitamin D supplementation interventions had mixed results, with a high dose being associated with higher rates of fall-related outcomes.

Full text (sometimes free) may be available at these link(s):      help

• DOI
• PubMed
• PDF locator
• publisher