Exercise alone and in combination with other interventions, including vision assessment and treatment and environmental assessment and modification, reduces the risk for injurious falls in individuals aged 65 years and older, a systematic review and meta-analysis found. The analysis provides “actionable” information, one expert says.
“The combination of exercise and vision assessment and treatment was probably the intervention most strongly associated with reduction in injurious falls,” the authors write.
Andrea C. Tricco, PhD, from Knowledge Translation Program at the Dalla Lana School of Public Health, University of Toronto, both in Ontario, Canada, and colleagues reported their findings online November 7 in JAMA.
“For people aged 65 years and older, falls are the leading cause of both fatal and nonfatal injuries and can have devastating effects. A fall is often a life-changing event, the start of a downward spiral of increasing frailty, dependency, and loss of self-worth,” Eric B. Larson, MD, MPH, from Kaiser Foundation Health Plan of Washington and Kaiser Permanente Washington Health Research Institute, both in Seattle, writes in an accompanying editorial.
To determine the relative effect of different interventions, Dr Tricco and colleagues performed a network meta-analysis using data from 54 randomized, controlled trials (RCTs), which included 41,596 individuals and 39 interventions plus usual care.
Several interventions reduced the risk for injurious falls, with an additive effect: exercise (odds ratio [OR], 0.51; 95% confidence interval [CI], 0.33 – 0.79); combined exercise and vision assessment and treatment (OR, 0.17; 95% CI, 0.07 – 0.38); and combined exercise, vision assessment and treatment, and environmental assessment and modification (OR, 0.30; 95% CI, 0.13 – 0.70).
The authors also found that a combination of clinic-level quality improvement strategies, multifactorial assessment and treatment, calcium supplementation, and vitamin D supplementation significantly reduced the risk for injurious falls (OR, 0.12; 95% CI, 0.03 – 0.55).
“For the 37 RCTs that had less than 75% women (20 354 participants), which examined 27 treatments plus usual care, the network meta-analysis results were consistent with the main analysis,” the authors note.
The researchers conducted pairwise meta-analyses for fall-related hospitalizations that included two RCTs with a total of 516 participants, and they found no significant relationship between combined clinic- and patient-level quality improvement strategies and multifactorial assessment and treatment compared with usual care (OR, 0.78; 95% CI, 0.33 – 1.81).
“This report…demonstrates the value of a superbly conducted information synthesis using the latest and most rigorous standards for systematic review and meta-analysis, such as following the PRISMA-P [Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols] statement and using a prospectively registered and published protocol,” Dr Larson writes.
“With the rigorous approach and the volume of studies that met standards for inclusion in the informative network meta-analysis, the authors present a substantial amount of evidence on the most effective ways to prevent falls, and the findings should prove helpful for clinicians, patients, caregivers, and those planning care programs to harness the power of a substantial amount of research to guide practice. Equally important is that unlike many critical reviews and meta-analyses that typically conclude with a statement about weak evidence and the need for more research, this article offers actionable findings,” Dr Larson explains.
The study highlights the importance of encouraging exercise in older adults; combining exercise with interventions “tailored to patients’ needs,” such as vision assessment; and implementing interventions that have been proven effective, he adds.
One author reports board membership with the Ontario Chiropractic Association. Dr Holyroyd-Leduc reports working as an associate editor for the Canadian Medical Association Journal. The remaining authors and Dr Larson have disclosed no relevant financial relationships.
JAMA. Published online November 7, 2017. Abstract, Editorial
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