Gates, Simon, Fisher, Joanne D., Cooke, Matthew, Carter, Yvonne and Lamb, S. E. (2008) Multifactorial assessment and targeted intervention for preventing falls and injuries among older people in community and emergency care settings : systematic review and meta-analysis. British Medical Journal, Vol.336 (No.7636). pp. 130-133. doi:10.1136/bmj.39412.525243.BE

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Abstract

Objective To evaluate the effectiveness of multifactorial assessment and intervention programmes to prevent falls and injuries among older adults recruited to trials in primary care, community, or emergency care settings.

Design Systematic review of randomised and quasi-randomised controlled trials, and meta-analysis

Data sources Six databases (Medline, Embase, CENTRAL, CINAHL, PsycINFO, Social Science Citation Index) to 22 March 2007, reference lists of included studies, and previous reviews.

Review methods Eligible studies were randomised or quasi-randomised trials that evaluated interventions to prevent falls that were based in emergency departments, primary care, or the community, that assessed multiple risk factors for falling and provided or arranged for treatments to address these risk factors.

Data extraction Outcomes were number of falters, fall related injuries, fall rate, death, admission to hospital, contacts with health services, move to institutional care, physical activity, and quality of life. Methodological quality assessment included allocation concealment, blinding, tosses and exclusions, intention to treat analysis, and reliability of outcome measurement.

Results 19 studies, of variable methodological quality, were included. The combined risk ratio for the number of falters during follow-up among 18 trials was 0.91 (95% confidence interval 0.82 to 1.02) and for fall. related injuries (eight trials) was 0.90 (0.68 to 1.20). No differences were found in admissions to hospital, emergency department attendance, death, or move to institutional care. Subgroup analyses found no evidence of different effects between interventions in different locations, populations selected for high risk of falls or unselected, and multidisciplinary teams including a doctor, but interventions that actively provide treatments may be more effective than those that provide only knowledge and referral.

Conclusions Evidence that multifactorial fall prevention programmes in primary care community or emergency care settings are effective in reducing the number of falters or fall related injuries is limited. Data were insufficient to assess fall and injury rates.

Item Type:	Journal Item
Subjects:	R Medicine > R Medicine (General) R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Falls (Accidents) in old age -- Prevention, Older people -- Wounds and injuries -- Prevention, Emergency medical services -- Evaluation, Systematic reviews (Medical research), Community health services -- Evaluation, Meta-analysis
Journal or Publication Title:	British Medical Journal
Publisher:	B M J Publishing Group
ISSN:	0959-8146
Official Date:	19 January 2008
Dates:	Date Event 19 January 2008 Published
Volume:	Vol.336
Number:	No.7636
Number of Pages:	6
Page Range:	pp. 130-133
DOI:	10.1136/bmj.39412.525243.BE
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Restricted or Subscription Access
Funder:	National Institute for Health Research (Great Britain) (NIHR)
Grant number:	SDO/ 139/2006 (NIHR)

Data sourced from Thomson Reuters' Web of Knowledge

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