Author(s): Choi M, Hector M
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Abstract OBJECTIVE: To examine the reported effectiveness of fall-prevention programs for older adults by reviewing randomized controlled trials from 2000 to 2009. DESIGN: Systematic review and meta-analysis of randomized controlled trials. DATA SOURCES: A systematic literature search of articles was conducted using 5 electronic databases (Medline, PubMed, PsycINFO, CINAHL, and RefWorks), including articles describing interventions designed to prevent falls, in English with full text availability, from 2000 through 2009. REVIEW METHODS: Of a potential 227 studies, we identified 17 randomized controlled trials with a duration of intervention of at least 5 months of follow-up. Inclusion and exclusion criteria were used to assess the methodological qualities of the studies. We excluded unidentified study design, quasi-experimental studies, and/or studies that were nonspecific regarding inclusion criteria. DATA EXTRACTION: Primary outcome measures were number of falls and fall rate. Methodological quality assessment included internal and external validity, reporting, and power. Data were extracted independently by 2 investigators and analyzed using a random-effects model. We analyzed the effectiveness of these fall intervention programs using their risk ratios (RR) in 2 single-intervention versus 15 multifactorial intervention trials, 3 nursing homes versus 14 community randomized controlled trials, and 8 Model 1 (initial intervention with subsequent follow up) versus 9 Model II (ongoing intervention throughout the follow-up) studies. RESULTS: The combined RR for the number of falls among 17 studies was 0.855 (z = -2.168; p = .030; 95\% CI = 0.742-0.985; Q = 196.204, df = 16, P = .000, I(2) = 91.845), demonstrating that fall-prevention programs across the studies were effective by reducing fall rates by 14\%, but with substantial heterogeneity. Subgroup analysis indicated that there was a significant fall reduction of 14\% in multifactorial intervention (RR = 0.856, z = -2.039, P = .041) with no variation between multifactorial and single-intervention groups (Q = 0.002, P = .961), 55\% in the nursing home setting (RR = 0.453, z = -9.366, P = .000) with significant variation between nursing home and community groups (Q = 62.788, P = .000), and no significant effect was gained by dividing studies into either in Model I or II. Sensitivity analysis found homogeneity (Q = 18.582, df = 12, P = .099, I(2) = 35.423) across studies with a 9\% overall fall reduction (RR = 0.906, 95\% CI = 0.853-0.963, z = -3.179, P = .001), including a fall-reduction rate of 10\% in multifactorial intervention (RR = 0.904, z = -3.036, P = .002), 9\% in community (RR = 0.909, z = -3.179, P = .001), and 12\% in Model I (RR = 0.876, z = -3.534, P = .000) with no variations among all the groups. Meta regression suggested that the model fit explained 68.6\% of the relevant variance. CONCLUSIONS: The meta-sensitivity analysis indicates that randomized controlled trials of fall-prevention programs conducted within the past 10 years (2000-2009) are effective in overall reduction of fall rates of 9\% with a reduction of fall rates of 10\% in multifactorial interventions, 9\% in community settings, and 12\% in Model I interventions (initial intervention efforts and then subsequent follow-up). Copyright © 2012 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.
This article was published in J Am Med Dir Assoc
and referenced in Journal of Gerontology & Geriatric Research