TY  - JOUR
PY  - 2017//
TI  - Comparisons of interventions for preventing falls in older adults: a systematic review and meta-analysis
JO  - JAMA journal of the American Medical Association
A1  - Tricco, Andrea C.
A1  - Thomas, Sonia M.
A1  - Veroniki, Areti Angeliki
A1  - Hamid, Jemila S.
A1  - Cogo, Elise
A1  - Strifler, Lisa
A1  - Khan, Paul A.
A1  - Robson, Reid
A1  - Sibley, Kathryn M.
A1  - MacDonald, Heather
A1  - Riva, John J.
A1  - Thavorn, Kednapa
A1  - Wilson, Charlotte
A1  - Holroyd-Leduc, Jayna
A1  - Kerr, Gillian D.
A1  - Feldman, Fabio
A1  - Majumdar, Sumit R.
A1  - Jaglal, Susan B.
A1  - Hui, Wing
A1  - Straus, Sharon E.
SP  - 1687
EP  - 1699
VL  - 318
IS  - 17
N2  - IMPORTANCE: Falls result in substantial burden for patients and health care systems, and given the aging of the population worldwide, the incidence of falls continues to rise. <br><br>OBJECTIVE: To assess the potential effectiveness of interventions for preventing falls. DATA SOURCES: MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Ageline databases from inception until April 2017. Reference lists of included studies were scanned. STUDY SELECTION: Randomized clinical trials (RCTs) of fall-prevention interventions for participants aged 65 years and older. DATA EXTRACTION AND SYNTHESIS: Pairs of reviewers independently screened the studies, abstracted data, and appraised risk of bias. Pairwise meta-analysis and network meta-analysis were conducted. <br><br>MAIN OUTCOMES AND MEASURES: Injurious falls and fall-related hospitalizations. <br><br>RESULTS: A total of 283 RCTs (159 910 participants; mean age, 78.1 years; 74% women) were included after screening of 10 650 titles and abstracts and 1210 full-text articles. Network meta-analysis (including 54 RCTs, 41 596 participants, 39 interventions plus usual care) suggested that the following interventions, when compared with usual care, were associated with reductions in injurious falls: exercise (odds ratio [OR], 0.51 [95% CI, 0.33 to 0.79]; absolute risk difference [ARD], -0.67 [95% CI, -1.10 to -0.24]); combined exercise and vision assessment and treatment (OR, 0.17 [95% CI, 0.07 to 0.38]; ARD, -1.79 [95% CI, -2.63 to -0.96]); combined exercise, vision assessment and treatment, and environmental assessment and modification (OR, 0.30 [95% CI, 0.13 to 0.70]; ARD, -1.19 [95% CI, -2.04 to -0.35]); and combined clinic-level quality improvement strategies (eg, case management), multifactorial assessment and treatment (eg, comprehensive geriatric assessment), calcium supplementation, and vitamin D supplementation (OR, 0.12 [95% CI, 0.03 to 0.55]; ARD, -2.08 [95% CI, -3.56 to -0.60]). Pairwise meta-analyses for fall-related hospitalizations (2 RCTs; 516 participants) showed no significant association between combined clinic- and patient-level quality improvement strategies and multifactorial assessment and treatment relative to usual care (OR, 0.78 [95% CI, 0.33 to 1.81]). <br><br>CONCLUSIONS AND RELEVANCE: Exercise alone and various combinations of interventions were associated with lower risk of injurious falls compared with usual care. Choice of fall-prevention intervention may depend on patient and caregiver values and preferences.<p />  <p>Language: en</p>
LA  - en
SN  - 0098-7484
UR  - http://dx.doi.org/10.1001/jama.2017.15006
ID  - ref1
ER  -