This is an update of a review assessing the benefits and harms of interventions designed to reduce falls in older people in care facilities. Implications for physiotherapists will be discussed.
We searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL and trial registers (WHO ICTRP and ClinicalTrials.gov) to December 2022 (with top-up search to 10 May 2024) plus citation searching and author contact. We included randomised controlled trials of any interventions for preventing falls in older people (aged over 65 years) in care facilities with any comparator, reporting outcomes of the rate of falls (falls per unit time) or risk of falling (number of people falling). Outcomes were pooled in meta-analyses and GRADE used to assess certainty of evidence.
This review included 103 trials with 68,793 participants.
Multifactorial Interventions: These interventions probably have little to no effect on falls rate (rate ratio, RaR 0.87, 95% CI 0.69 to 1.10; moderate-certainty) but probably reduces the risk of falling (risk ratio, RR 0.90, 95% CI 0.80 to 1.0; moderate-certainty). They may be cost-effective in reducing falls (£20,889 per quality-adjusted life-year; low-certainty). A subgroup analysis informed by Qualitative Comparative Analysis indicated that multifactorial interventions delivered in a tailored manner according to resident individual circumstances (e.g. living with dementia) with facility staff engagement have greater effects and probably have a large reduction in the rate of falls (RaR 0.61, 95% CI 0.54 to 0.69; moderate-certainty evidence) and risk of falling (RR 0.76, 95% CI 0.66 to 0.89; moderate-certainty evidence).
Exercise: Exercise likely reduces falls rate (RaR 0.71, 95% CI 0.53 to 0.94) and fallers (RR 0.87, 95% CI 0.76 to 1.0; moderate-certainty). After a period of post-intervention follow-up, if exercise is not sustained there is no effect on the rate of falls (RaR 1.01, 95% CI 0.80 to 1.28; high-certainty evidence) and probably no effect on the risk of falling (RR 1.05, 95% CI 0.92 to 1.20; moderate-certainty evidence). Exercise may be cost-effective ($AUS18 per fall avoided, low-certainty evidence). In cognitive impairment, exercise might reduce fall risk (low-certainty).
Vitamin D Supplementation: Likely reduces falls rate (RaR 0.63, 95% CI 0.46 to 0.86; moderate-certainty evidence) but probably makes little or no difference to the risk of falling (RR 0.99, 95% CI 0.90 to 1.08; moderate-certainty evidence) in low vitamin D populations.
Nutritional Therapy: Dairy supplementation may lower fall risk (RR 0.89; low-certainty).
Additional trials identified in the top-up search would not change these findings.
Falls significantly affect the health and safety of older residents in care facilities. Tailored multifactorial interventions involving staff (including physiotherapists) probably result in a large decrease in fall rates and risk. Exercise programs are probably beneficial but need to be maintained over time.
Physiotherapists in care facilities are key to fall prevention through tailored interventions and exercise. They should personalise approaches, particularly for residents with cognitive impairment and collaborate with staff to boost effectiveness.
Exercise
Gerontology
