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Intervention characteristics associated with a reduction in fear of falling among community-dwelling older people: a systematic review and meta-analysis of randomized controlled trials
- Authors:
- KRUISBRINK Marlot, et al
- Journal article citation:
- Gerontologist, 61(6), 2021, pp.e269-e282.
- Publisher:
- Oxford University Press
Background and Objectives: Fear of falling (FoF) is associated with decreased physical functioning and an increased fall risk. Interventions generally demonstrate moderate effects and optimized interventions are needed. Intervention characteristics, such as setting or delivery method may vary. We investigated which overarching intervention characteristics are associated with a reduction in FoF in community-dwelling older people. Research Design and Methods: A systematic review and meta-analysis of randomized controlled trials (RCTs) in community-dwelling older people without specific diseases was performed. Associations between intervention characteristics and standardized mean differences (SMD) were determined by univariate meta-regression. Sensitivity analyses were performed. Results: Data on 62 RCTs were extracted, 50 intervention groups were included in the meta-analysis. Most intervention characteristics and intervention types were not associated with the intervention effect. Supervision by a tai chi instructor (SMD: −1.047, 95% confidence interval [CI]: −1.598; −0.496) and delivery in a community setting (SMD: −0.528, 95% CI: −0.894; −0.161) were—compared to interventions without these characteristics—associated with a greater reduction in FoF. Holistic exercise, such as Pilates or yoga (SMD: −0.823, 95% CI: −1.255; −0.392), was also associated with a greater reduction in FoF. Delivery at home (SMD: 0.384, 95% CI: 0.002; 0.766) or with written materials (SMD: 0.452, 95% CI: 0.088; 0.815) and tailoring were less effective in reducing FoF (SMD: 0.687, 95% CI: 0.364; 1.011). Discussion and Implications: Holistic exercise, delivery with written materials, the setting and tailoring potentially represent characteristics to take into account when designing and improving interventions for FoF in community-dwelling older people. PROSPERO international prospective register of systematic reviews, registration ID CRD42018080483. (Edited publisher abstract)
The ABC scale and fall risk: a systematic review
- Authors:
- STASNY Bernadette Marie, et al
- Journal article citation:
- Physical and Occupational Therapy in Geriatrics, 29(3), September 2011, pp.233-242.
- Publisher:
- Informa Healthcare
This systematic review focuses on the Activities-specific Balance Confidence (ABC) scale in order to assess how well it predicts falls in older adults living in the community. The evidence is from only three studies, all of which were judged to be good quality. The results suggest that the ABC scale is a useful measure of balance confidence in older adults, but research on its ability to predict falls is limited. Large, longer-term, prospective studies are needed.
A systematic review of the effectiveness of Tai Chi on fall reduction among the elderly
- Authors:
- LOW Serena, et al
- Journal article citation:
- Archives of Gerontology and Geriatrics, 48(3), May 2009, pp.325-331.
- Publisher:
- Elsevier
The seven randomised controlled trials in this review indicate that Tai Chi has the potential to reduce falls, or the risk of falls, among the elderly provided that they are relatively young and are not classed as frail. The searches, although not limited by language, did not reveal any non-English studies although the authors are aware from an earlier review that such studies are likely to exist. Further work may be needed to identify work published in Chinese.
Multifactorial and functional mobility assessment tools for fall risk among older adults in community, home-support, long-term and acute care settings
- Authors:
- SCOTT Vicky, et al
- Journal article citation:
- Age and Ageing, 36(2), 2007, pp.130-139.
- Publisher:
- Oxford University Press
This review focuses on studies that use prospective validation in examining the predictive value of fall assessment tools applied to people over 65. Thirty four studies reporting the testing of thirty eight tools are included, and cover community settings (14 studies, 23 tools); acute settings (12 studies, 8 tools); long term care (6 studies, 10 tools); and home support (4 studies, 4 tools). Eleven of the tools are multifactorial assessment tools covering a wide range of fall risk factors, and 27 are functional mobility assessment tools involving measures of physical activity related to gait, strength or balance. A number of tools were found to have moderate to good validity and reliability but few have been tested more than once, or in more than one setting. Thus no single tool can be recommended for implementation in all settings or with all sub-populations.
Effects of gait adaptability training on falls and fall-related fractures in older adults: a systematic review and meta-analysis
- Authors:
- NORGAARD Jens Eg, et al
- Journal article citation:
- Age and Ageing, 50(6), 2021, pp.1914-1924.
- Publisher:
- Oxford University Press
Objective: falls among older adults are common and can have devastating consequences. A novel task-specific exercise modality, gait adaptability training (GAT), has shown promising preventive effects. This systematic review and meta-analysis synthesise the evidence regarding GATs effect on falls and fall-related fractures in community-dwelling older adults. Methods: electronic databases (PubMed, EMBASE, CINAHL, CENTRAL) were systematically searched from inception to 18 June 2020. Additional sources include searches of trial registrations, manual screening of reference lists and requests to experts. We included randomised controlled trials (RCTs) evaluating the effect of GAT on falls with at least 6-month follow-up among community-dwelling people aged 60+ years. Two reviewers independently screened studies against eligibility criteria, extracted relevant information and appraised studies for bias. Random-effects meta-analytic models were employed to pool effect estimates. Results: eleven studies with 1,131 participants were included. A meta-analysis in which an outlier study was excluded showed that GAT reduces fall rates by 42% (incidence rate ratio 0.58, 95% confidence interval [CI] 0.39–0.81, I2 = 0.00%; moderate certainty; seven RCTs). Moreover, proportion with fall-related fractures and proportion of fallers was reduced by 81% (risk ratio [RR] 0.19, 95% CI 0.06–0.56, I2 = 0.00%; very low certainty; two RCTs) and 43% (RR 0.57, 95% CI 0.4–to 0.8, I2 = 47.08%; low certainty; 11 RCTs), respectively. Conclusions: our results show that GAT significantly reduces the number of falls and prevents fall-related fractures in older community dwellers. GAT is a promising and feasible exercise modality; however, studies of high quality should be conducted to support a robust conclusion. (Edited publisher abstract)
Factors included in adult fall risk assessment tools (FRATs): a systematic review
- Authors:
- DE CLERCQ Hendrika, NAUDE Alida, BORNMAN Juan
- Journal article citation:
- Ageing and Society, 41(11), 2021, pp.2558-2582.
- Publisher:
- Cambridge University Press
Falls often have severe financial and environmental consequences, not only for those who fall, but also for their families and society at large. Identifying fall risk in older adults can be of great use in preventing or reducing falls and fall risk, and preventative measures that are then introduced can help reduce the incidence and severity of falls in older adults. The overall aim of our systematic review was to provide an analysis of existing mechanisms and measures for evaluating fall risk in older adults. The 43 included FRATs produced a total of 493 FRAT items which, when linked to the ICF, resulted in a total of 952 ICF codes. The ICF domain with the most used codes was body function, with 381 of the 952 codes used (40%), followed by activities and participation with 273 codes (28%), body structure with 238 codes (25%) and, lastly, environmental and personal factors with only 60 codes (7%). This review highlights the fact that current FRATs focus on the body, neglecting environmental and personal factors and, to a lesser extent, activities and participation. This over-reliance on the body as the point of failure in fall risk assessment clearly highlights the need for gathering qualitative data, such as from focus group discussions with older adults, to capture the perspectives and views of the older adults themselves about the factors that increase their risk of falling and comparing these perspectives to the data gathered from published FRATs as described in this review. (Edited publisher abstract)
Predicting falls in community-dwelling older adults: a systematic review of prognostic models
- Authors:
- GADE Gustav Valentin, et al
- Journal article citation:
- BMJ Open, 11(5), 2021, p.e044170. Online only
- Publisher:
- BMJ Publishing Group
Objective To systematically review and critically appraise prognostic models for falls in community-dwelling older adults. Eligibility criteria Prospective cohort studies with any follow-up period. Studies had to develop or validate multifactorial prognostic models for falls in community-dwelling older adults (60+ years). Models had to be applicable for screening in a general population setting. Information source MEDLINE, EMBASE, CINAHL, The Cochrane Library, PsycINFO and Web of Science for studies published in English, Danish, Norwegian or Swedish until January 2020. Sources also included trial registries, clinical guidelines, reference lists of included papers, along with contacting clinical experts to locate published studies. Data extraction and risk of bias Two authors performed all review stages independently. Data extraction followed the Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies checklist. Risk of bias assessments on participants, predictors, outcomes and analysis methods followed Prediction study Risk Of Bias Assessment Tool. Results After screening 11 789 studies, 30 were eligible for inclusion (n=86 369 participants). Median age of participants ranged from 67.5 to 83.0 years. Falls incidences varied from 5.9% to 59%. Included studies reported 69 developed and three validated prediction models. Most frequent falls predictors were prior falls, age, sex, measures of gait, balance and strength, along with vision and disability. The area under the curve was available for 40 (55.6%) models, ranging from 0.49 to 0.87. Validated models’ The area under the curve ranged from 0.62 to 0.69. All models had a high risk of bias, mostly due to limitations in statistical methods, outcome assessments and restrictive eligibility criteria. Conclusions An abundance of prognostic models on falls risk have been developed, but with a wide range in discriminatory performance. All models exhibited a high risk of bias rendering them unreliable for prediction in clinical practice. Future prognostic prediction models should comply with recent recommendations such as Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis. (Edited publisher abstract)
Literature review and meta-analysis of risk factors for delayed post-traumatic stress disorder in older adults after a fall
- Author:
- BLOCH Frederic
- Journal article citation:
- International Journal of Geriatric Psychiatry, 32(2), 2017, pp.136-140.
- Publisher:
- Wiley
Objective: To test the hypothesis that post-traumatic stress disorder (PTSD) can appear after a fall and try to identify predictive factors for its development in older fallers. Methods: Systematic literature review and meta-analyses of studies on PTSD post fall in older subjects. Results: One hundred seventy-seven indexed articles were identified, of which three had complete data on PTSD post fall in older subjects. Only the odds ratio of the association between history of fall and occurrence of PTSD was significant. Conclusion: The trend in the results, even though limited, reveals two groups of subjects: frail subjects that are at risk of developing PTSD and subjects who seem to be resistant to its development. A clear description of these two groups may help identify the population at risk for delayed PTSD who could then benefit from dedicated treatment. (Edited publisher abstract)
Yoga-based exercise improves balance and mobility in people aged 60 and over: a systematic review and meta-analysis
- Authors:
- YOUKHANA Sabrina, et al
- Journal article citation:
- Age and Ageing, 45(1), 2016, pp.21-29.
- Publisher:
- Oxford University Press
Objective: One-third of community-dwelling older adults fall annually. Exercise that challenges balance is proven to prevent falls. The authors conducted a systematic review with meta-analysis to determine the impact of yoga-based exercise on balance and physical mobility in people aged 60+ years. Methods: Searches for relevant trials were conducted on the following electronic databases: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, CINAHL, Allied and Complementary Medicine Database and the Physiotherapy Evidence Database (PEDro) from inception to February 2015. Trials were included if they evaluated the effect of physical yoga (excluding meditation and breathing exercises alone) on balance in people aged 60+ years. We extracted data on balance and the secondary outcome of physical mobility. Standardised mean differences and 95% confidence intervals (CI) were calculated using random-effects models. Methodological quality of trials was assessed using the 10-point Physiotherapy Evidence Database (PEDro) Scale. Results: Six trials of relatively high methodological quality, totalling 307 participants, were identified and had data that could be included in a meta-analysis. Overall, yoga interventions had a small effect on balance performance (Hedges' g = 0.40, 95% CI 0.15–0.65, 6 trials) and a medium effect on physical mobility (Hedges' g = 0.50, 95% CI 0.06–0.95, 3 trials). Conclusion: yoga interventions resulted in small improvements in balance and medium improvements in physical mobility in people aged 60+ years. Further research is required to determine whether yoga-related improvements in balance and mobility translate to prevention of falls in older people. (Publisher abstract)
Translating falls prevention knowledge to community-dwelling older PLWD: a mixed-method systematic review
- Authors:
- MEYER Claudia, et al
- Journal article citation:
- Gerontologist, 55(4), 2015, pp.560-574.
- Publisher:
- Oxford University Press
Purpose of the Study: This mixed-method systematic review aimed to integrate evidence of falls prevention efficacy with views/experiences of people living with dementia (PLWD). Design and Methods: Eight electronic databases were searched. Inclusion criteria included quantitative or qualitative studies examining knowledge translation of falls prevention strategies in community-dwelling PLWD and/or their caregiver. Study quality was assessed, and findings are narratively described. Results: Six quantitative and five qualitative studies were included. Study quality was mixed. Quantitative studies showed limited evidence of effectiveness on reduction in falls risk, falls and hospitalization rates, nursing home admission, decline in activities of daily living, and adherence to strategies. Qualitative themes showed inclusion of caregiver and health professionals as key to programme success, but many factors influence participation. Implications: Synthesising the findings generated a new understanding of falls prevention for this high-risk group. A focus upon health professional and caregiver involvement and accommodation of individual preferences may result in increased engagement with falls prevention strategies. (Edited publisher abstract)