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Interventions to reduce fear of falling in community-living older people: a systematic review
- Authors:
- ZIJLSTRA G. A .R., et al
- Journal article citation:
- Journal of the American Geriatrics Society, 55(4), 2007, pp.603-615.
- Publisher:
- Blackwells Publishing
This review of 19 randomised controlled trials (12 judged to be of higher methodological quality) was conducted according to Cochrane principles and shows the following approaches to be effective in reducing the fear of falling: five fall-related multifactorial interventions (three home- and two group-based); three group-based tai chi programmes; two home-based exercise interventions; and a hip protector intervention. The primary aim of most of these interventions was to reduce falls rather than the fear of falling, and most also succeeded in this respect. The authors conclude that there is limited but fairly consistent evidence in favour of these interventions, and that more high quality, well reported and directly comparable research is needed.
Improvement in personal meaning mediates the effects of a life review intervention on depressive symptoms in a randomized controlled trial
- Authors:
- WESTERHOF Gerben J., et al
- Journal article citation:
- Gerontologist, 50(4), August 2010, pp.541-549.
- Publisher:
- Oxford University Press
This study investigated the impact of a life review intervention on personal meaning in life and the mediating effect of personal meaning on depressive symptoms as the primary outcome of this form of indicated prevention. A randomised controlled trial was conducted with 83 older people obtaining life review compared to 88 watching a video about the art of growing older. Measurements took place before and after the intervention as well as at a 6 month follow-up. Findings revealed that those who followed life review initially improved in personal meaning more than those in the control group, although at follow-up the difference was no longer significant. Improvements in meaning during the intervention predicted decreases in depressive symptoms later in time and mediated the effects of the programme on depressive symptoms. The authors concluded that personal meaning is important in contemporary society, which some older people find difficult to achieve. The findings show that it is possible to support older people in their search for meaning by means of life review and that this helps in alleviating depressive symptoms.
Mental health literacy, folic acid and vitamin B12, and physical activity for the prevention of depression in older adults: randomised controlled trial
- Authors:
- WALKER Janine G., et al
- Journal article citation:
- British Journal of Psychiatry, 197(1), July 2010, pp.45-54.
- Publisher:
- Cambridge University Press
Depression in later life is common with 3.6-4.8% of people over 60 years reporting 12-month major depression, and 8-37.4% reporting significant depressive symptoms. In order to minimise the adverse impact of depression, effective, economical and accessible prevention strategies that are scalable to a community-wide level need to be developed. This study investigated the effectiveness of promoting physical activity, mental health literacy, and combined folic acid plus vitamin B12 as preventative interventions for an older population with elevated psychological distress. The study comprised a randomised clinical trial with a completely crossed 2x2x2 factorial design: (400 mcg/d folic acid + 100 mcg/d vitamin B12 v. placebo) x (physical activity v. nutrition promotion control) x (mental health literacy v. pain information control). The 909 participants, aged 60-74 years, were randomised into 1 of 8 intervention programmes which were delivered over 24 months. The interventions were delivered by mail with telephone calls. The main outcome was depressive symptoms on the Patient Health Questionnaire at 6 weeks, 6, 12 and 24 months. The drop-out rate was low (13.5%) from randomisation to 24-month assessment. The results showed that neither folic acid plus B12 nor physical activity reduced depressive symptoms at any time point. At 6 weeks, depressive symptoms were lower for the mental health literacy intervention compared with its control condition. The article concludes that mental health literacy had a transient effect on depressive symptoms. Other than this, none of the interventions significantly reduced symptoms relative to their comparator at 6 weeks or subsequently.
Community falls prevention for people who call an emergency ambulance after a fall: randomised controlled trial
- Authors:
- LOGAN Philippa A., et al
- Journal article citation:
- British Medical Journal, 15.05.10, 2010, p.1070.
- Publisher:
- British Medical Association
Participants in this randomised controlled trial were 204 adults aged more than 60 living at home or in residential care who had fallen and called an emergency ambulance but were not taken to hospital. Participants were taken from four primary care trusts in England. Participants were referred to community fall prevention services or standard medical and social care. The primary outcome was the rate of falls over 12 months, ascertained from monthly diaries. Secondary outcomes were scores on the Barthel index, Nottingham extended activities of daily living scale, and falls efficacy scale at baseline and by postal questionnaire at 12 months. 102 people were allocated to each group. 99 (97%) participants in the intervention group received the intervention. Falls diaries were analysed for 88.6 person years in the intervention group and 84.5 person years in the control group. The incidence rates of falls per year were 3.46 in the intervention group and 7.68 in the control group. The intervention group achieved higher scores on the Barthel index and Nottingham extended activities of daily living and lower scores on the falls efficacy scale at the 12 month follow-up. The number of times an emergency ambulance was called because of a fall was significantly different during follow-up. It is concluded that a service to prevent falls in the community reduced the fall rate and improved clinical outcome in the high risk group of older people who call an emergency ambulance after a fall but are not taken to hospital.
Analysis of recurrent events: a systematic review of randomised controlled trials of interventions to prevent falls
- Authors:
- DONALDSON Meghan G., et al
- Journal article citation:
- Age and Ageing, 38(2), March 2009, pp.151-155.
- Publisher:
- Oxford University Press
The use of appropriate methods for analysing recurrent events is important in randomised controlled trials of fall prevention interventions. This review identified 83 RCTs published between 1994 and November 2006, and determined the proportion using the following methods: negative binomial regression; the Andersen-Gill extension of the Cox proportional hazards model; and the WLW (Wei, Lin and Weissfield) marginal model. Fewer than a third of the papers used one of these methods, and fewer than 15% used the mean cumulative function to represent falls data graphically. The authors recommend that researchers and clinicians in the field should consult statisticians with expertise in recurrent event methodology, and that guidance should be developed by bodies such as CONSORT.
Cluster randomised trial of a targeted multifactorial intervention to prevent falls among older people in hospital
- Authors:
- CUMMING Robert G., et al
- Journal article citation:
- British Medical Journal, 5.4.08, 2008, pp.758-760.
- Publisher:
- British Medical Association
This Australian study aimed to determine the efficacy of a targeted multifactorial falls prevention programme in elderly care wards with relatively short lengths of stay. Participants were 3,999 patients, mean age of 79 years, with a median hospital stay of seven days. Participants were from 24 elderly care wards in 12 hospitals in Sydney, Australia. A nurse and physiotherapist each worked for 25 hours a week for three months in all intervention wards. They provided a targeted multifactorial intervention that included a risk assessment of falls, staff and patient education, drug review, modification of bedside and ward environments, an exercise programme, and alarms for selected patients. The main outcome measure used was falls during hospital stay. Results found intervention and control wards were similar at baseline for previous rates of falls and individual patient characteristics. Overall, 381 falls occurred during the study. No difference was found in fall rates during follow-up between intervention and control wards: respectively, 9.26 falls per 1,000 bed days and 9.20 falls per 1000 bed days. The incidence rate ratio adjusted for individual lengths of stay and previous fall rates in the ward was 0.96 (95% confidence interval 0.72 to 1.28). A targeted multifactorial falls prevention programme was not effective among older people in hospital wards with relatively short lengths of stay.
Systematic review of definitions and methods of measuring falls in randomised controlled fall prevention trials
- Authors:
- HAUER Klaus, et al
- Journal article citation:
- Age and Ageing, 35(1), January 2006, pp.5-10.
- Publisher:
- Oxford University Press
Falls prevention among older people is an important public health and social care issue, and there have been many randomised controlled trials in the field. However, the definitions, data collection methods and outcome measures used in trials varies markedly, and there have been calls for greater standardisation. The authors, who are members of the European Commission-funded PROFANE (Prevention of Falls Network Europe) initiative, document this variability in 90 trials. They conclude that reporting practice is poor, significantly impeding comparison between studies and the consequent identification of effective interventions. The review has been used to inform the development of a core set of outcome measures for use in such trials.
Preventive home visits to elderly people in Denmark
- Authors:
- HENDRIKSEN Carsten, VASS Mikkel
- Journal article citation:
- Generations Review, 13(3), July 2003, pp.14-17.
- Publisher:
- British Society of Gerontology
Describes the process of individual preventive home visits in primary care. Presents details of randomised controlled trials published about preventive home visits during the last 20 years and looks at the experience of home visits in Denmark.
Multifactorial falls prevention programme compared with usual care in UK care homes for older people: multicentre cluster randomised controlled trial with economic evaluation
- Authors:
- LOGAN Pip A., et al
- Journal article citation:
- British Medical Journal, 375, 2021, p.n2952. Online only
- Publisher:
- British Medical Association
Objectives: To determine the clinical and cost effectiveness of a multifactorial fall prevention programme compared with usual care in long term care homes. Design: Multicentre, parallel, cluster randomised controlled trial. Setting: Long term care homes in the UK, registered to care for older people or those with dementia. Participants: 1657 consenting residents and 84 care homes. 39 were randomised to the intervention group and 45 were randomised to usual care. Interventions: Guide to Action for Care Homes (GtACH): a multifactorial fall prevention programme or usual care. Main outcome measures: Primary outcome measure was fall rate at 91-180 days after randomisation. The economic evaluation measured health related quality of life using quality adjusted life years (QALYs) derived from the five domain five level version of the EuroQoL index (EQ-5D-5L) or proxy version (EQ-5D-5L-P) and the Dementia Quality of Life utility measure (DEMQOL-U), which were self-completed by competent residents and by a care home staff member proxy (DEMQOL-P-U) for all residents (in case the ability to complete changed during the study) until 12 months after randomisation. Secondary outcome measures were falls at 1-90, 181-270, and 271-360 days after randomisation, Barthel index score, and the Physical Activity Measure-Residential Care Homes (PAM-RC) score at 91, 180, 270, and 360 days after randomisation. Results: Mean age of residents was 85 years. 32% were men. GtACH training was delivered to 1051/1480 staff (71%). Primary outcome data were available for 630 participants in the GtACH group and 712 in the usual care group. The unadjusted incidence rate ratio for falls between 91 and 180 days was 0.57 (95% confidence interval 0.45 to 0.71, P<0.001) in favour of the GtACH programme (GtACH: six falls/1000 residents v usual care: 10 falls/1000). Barthel activities of daily living indices and PAM-RC scores were similar between groups at all time points. The incremental cost was £108 (95% confidence interval −£271.06 to 487.58), incremental QALYs gained for EQ-5D-5L-P was 0.024 (95% confidence interval 0.004 to 0.044) and for DEMQOL-P-U was 0.005 (−0.019 to 0.03). The incremental costs per EQ-5D-5L-P and DEMQOL-P-U based QALY were £4544 and £20 889, respectively. Conclusions: The GtACH programme was associated with a reduction in fall rate and cost effectiveness, without a decrease in activity or increase in dependency. (Edited publisher abstract)
Advice by mail is as effective as targeted interventions at preventing fall-related injuries in older people
- Author:
- NATIONAL INSTITUTE FOR HEALTH RESEARCH
- Publisher:
- National Institute for Health Research
- Publication year:
- 2021
- Place of publication:
- London
This alert summarises the findings of study that found a booklet containing advice on falls prevention reduced fractures as effectively as more intensive interventions. In a large study, the booklet was sent to older people by post. This advice alone prevented as many fractures as an exercise programme, or as multiple assessments by a range of professionals. The Prevention of Fall Injury Trial (Pre-FIT) included more than 9,000 people over 70 years old living in the community. Over a period of 18 months, the study found that the three approaches (advice alone, exercises, multiple assessments) were similarly effective in reducing fractures. The exercise programme was linked with small gains in health-related quality of life, which made it the most cost-effective approach. An economic analysis of the programme looked at the NHS costs for a year of good health (cost/QALY) with each of the three approaches. The falls prevention programme (£3,941) was slightly less cost-effective than the other two approaches. Exercise was most likely to improve quality of life and was therefore slightly more cost-effective (£3,720) than advice alone (£3,737). This NIHR Alert is based on: Lamb S, and others. Screening and Intervention to Prevent Falls and Fractures in Older People. The New England Journal of Medicine 2020;383:19 (Edited publisher abstract)