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Morello R1, Soh S-E1, Ayton D1, Barker A1
1Monash University, Melbourne, Australia
Background: Falls are the leading cause of emergency department (ED) presentations in older adults, with the majority of fallers re-presenting within six months of discharge. Previous studies have shown multifactorial interventions may reduce the rate of falls in older people living in the community. However, there remains little evidence to guide falls prevention practices in the ED. This may be due to the challenging environment of the ED and the complexity and fragility of this population.
Purpose: To determine whether, and to what extent, multifactorial falls prevention interventions are effective in preventing falls, fall injuries, ED representations and hospital admissions in older adults presenting to the ED with a fall.
Methods: A systematic review and meta-analyses of randomised control trials (RCTs). Four health-related electronic databases were searched, from inception to June 2018, with two independent reviewers determining inclusion, assessing study quality using the PEDro scale and undertaking data extraction. Studies were included if they were RCTs of multifactorial falls prevention interventions targeting older adults (≥ 60 years) presenting to the ED with a fall and providing quantitative data on at least one of the review endpoints.
Results: Ten studies involving 3577 participants were eligible for inclusion. Studies were of variable methodological quality. The majority of multifactorial interventions included education, referral to relevant healthcare services, home modifications, exercise and medication changes. Meta-analyses demonstrated that multi-factorial falls prevention programs did not significantly affect the rate of falls (rate ratio=0.78, 95% CI 0.58 to 1.05), fall-related ED presentations (rate ratio=1.00, 95% CI 0.85 to 1.17), hospitalisations (rate ratio=1.14, 95% CI 0.69 to 1.89) or fractured neck of femurs (risk ratio=0.82, 95% CI 0.53-1.25).
Conclusion(s): There remains insufficient evidence to support the use of multifactorial falls interventions to prevent falls or hospital utilisation in this population. Further research involving this population group is required.
Implications: Falls remain a significant health burden in older adults who present to ED and further research needs to be conducted to determine the most effective method of reducing falls and their consequent complications. Patient-centred strategies may offer an opportunity to improve outcomes and reduce falls in patients attending ED.
Keywords: Falls, Fractures, Emergency Departments
Funding acknowledgements: None
Purpose: To determine whether, and to what extent, multifactorial falls prevention interventions are effective in preventing falls, fall injuries, ED representations and hospital admissions in older adults presenting to the ED with a fall.
Methods: A systematic review and meta-analyses of randomised control trials (RCTs). Four health-related electronic databases were searched, from inception to June 2018, with two independent reviewers determining inclusion, assessing study quality using the PEDro scale and undertaking data extraction. Studies were included if they were RCTs of multifactorial falls prevention interventions targeting older adults (≥ 60 years) presenting to the ED with a fall and providing quantitative data on at least one of the review endpoints.
Results: Ten studies involving 3577 participants were eligible for inclusion. Studies were of variable methodological quality. The majority of multifactorial interventions included education, referral to relevant healthcare services, home modifications, exercise and medication changes. Meta-analyses demonstrated that multi-factorial falls prevention programs did not significantly affect the rate of falls (rate ratio=0.78, 95% CI 0.58 to 1.05), fall-related ED presentations (rate ratio=1.00, 95% CI 0.85 to 1.17), hospitalisations (rate ratio=1.14, 95% CI 0.69 to 1.89) or fractured neck of femurs (risk ratio=0.82, 95% CI 0.53-1.25).
Conclusion(s): There remains insufficient evidence to support the use of multifactorial falls interventions to prevent falls or hospital utilisation in this population. Further research involving this population group is required.
Implications: Falls remain a significant health burden in older adults who present to ED and further research needs to be conducted to determine the most effective method of reducing falls and their consequent complications. Patient-centred strategies may offer an opportunity to improve outcomes and reduce falls in patients attending ED.
Keywords: Falls, Fractures, Emergency Departments
Funding acknowledgements: None
Topic: Health promotion & wellbeing/healthy ageing; Outcome measurement
Ethics approval required: No
Institution: Monash University
Ethics committee: Monash University Human Research Ethics Committee
Reason not required: Systematic review so a study involving published data which is publicly available.
All authors, affiliations and abstracts have been published as submitted.
