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Oxford University Press, Physical Therapy & Rehabilitation Journal, 8(95), p. 1095-1110, 2015

DOI: 10.2522/ptj.20140461

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What Works to Prevent Falls in Community-Dwelling Older Adults? Umbrella Review of Meta-analyses of Randomized Controlled Trials

Journal article published in 2015 by Brendon Stubbs, Simone Brefka, Michael D. Denkinger ORCID
This paper was not found in any repository, but could be made available legally by the author.
This paper was not found in any repository, but could be made available legally by the author.

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Abstract

Background Preventing falls is an international priority. There is a need to synthesize the highest-quality falls prevention evidence in one place for clinicians. Purpose The aim of this study was to conduct an umbrella review of meta-analyses of randomized controlled trials (RCTs) of falls prevention interventions in community-dwelling older adults. Data Sources The MEDLINE, EMBASE, CINAHL, AMED, BNI, PsycINFO, Cochrane Library, PubMed, and PEDro databases were searched. Study Selection Meta-analyses with one pooled analysis containing ≥3 RCTs that investigated any intervention to prevent falls in community-dwelling older adults aged ≥60 years were eligible. Sixteen meta-analyses, representing 47 pooled analyses, were included. Data Extraction Two authors independently extracted data. Data Synthesis Data were narratively synthesized. The methodological quality of the meta-analyses was moderate. Three meta-analyses defined a fall, and 3 reported adverse events (although minor). There is consistent evidence that exercise reduces falls (including the rate, risk, and odds of falling), with 13/14 pooled analyses (93%) from 7 meta-analyses demonstrating a significant reduction. The methodological quality of meta-analyses investigating exercise were medium/high, and effect sizes ranged from 0.87 (relative risk 95% confidence interval=0.81, 0.94; number of studies=18; number of participants=3,568) to 0.39 (rate ratio 95% confidence interval=0.23, 0.66; number of meta-analyses=6). There is consistent evidence that multifactorial interventions reduce falls (5/6, 83% reported significant reduction). There is conflicting evidence regarding the influence of vitamin D supplementation (7/12, 58.3% reported significant reduction). Limitations Meta-analyses often used different methods of analysis, and reporting of key characteristics (eg, participants, heterogeneity, publication bias) was often lacking. There may be some overlap among included meta-analyses. Conclusions There is consistent evidence that exercise and individually tailored multifactorial interventions are effective in reducing falls in community-dwelling older adults.