Gillespie, Lesley D., Robertson, M. Clare, Gillespie, William J. (William John), Lamb, S. E. (Sallie E.), Gates, Simon, Cumming, Robert G. and Rowe, Brian H. (2009) Interventions for preventing falls in older people living in the community (Review). Cochrane Database of Systematic Reviews (No.2). ISSN 1469-493X

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Abstract

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 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.

Item Type:	Journal Item
Subjects:	R Medicine > RA Public aspects of medicine
Divisions:	Faculty of Medicine > Warwick Medical School > Health Sciences Faculty of Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Falls (Accidents) in old age -- Prevention, Community health services for older people
Journal or Publication Title:	Cochrane Database of Systematic Reviews
Publisher:	John Wiley & Sons Ltd.
ISSN:	1469-493X
Date:	2009
Number:	No.2
Number of Pages:	327
Identification Number:	10.1002/14651858.CD007146.pub2
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Restricted or Subscription Access
Funder:	Canada Research Chairs (CRC), Accident Compensation Corporation (N.Z.) (ACC)
URI:	http://wrap.warwick.ac.uk/id/eprint/27655

Data sourced from Thomson Reuters' Web of Knowledge

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