Broad syntheses related to this topic

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Broad synthesis / Overview of systematic reviews

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Effectiveness of non-pharmacological interventions to prevent falls in older people: A systematic overview. The SENATOR project ONTOP series

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Journal PLoS ONE
Year 2016
Links Pubmed DOI PubMed Central

This article includes 62 Systematic reviews Systematic reviews (62 references) 4 Primary studies Primary studies (4 references)

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BACKGROUND: Falls are common events in older people, which cause considerable morbidity and mortality. Non-pharmacological interventions are an important approach to prevent falls. There are a large number of systematic reviews of non-pharmacological interventions, whose evidence needs to be synthesized in order to facilitate evidence-based clinical decision making. OBJECTIVES: To systematically examine reviews and meta-analyses that evaluated non-pharmacological interventions to prevent falls in older adults in the community, care facilities and hospitals. METHODS: We searched the electronic databases Pubmed, the Cochrane Database of Systematic Reviews, EMBASE, CINAHL, PsycINFO, PEDRO and TRIP from January 2009 to March 2015, for systematic reviews that included at least one comparative study, evaluating any non-pharmacological intervention, to prevent falls amongst older adults. The quality of the reviews was assessed using AMSTAR and ProFaNE taxonomy was used to organize the interventions. RESULTS: Fifty-nine systematic reviews were identified which consisted of single, multiple and multifactorial non-pharmacological interventions to prevent falls in older people. The most frequent ProFaNE defined interventions were exercises either alone or combined with other interventions, followed by environment/assistive technology interventions comprising environmental modifications, assistive and protective aids, staff education and vision assessment/correction. Knowledge was the third principle class of interventions as patient education. Exercise and multifactorial interventions were the most effective treatments to reduce falls in older adults, although not all types of exercise were equally effective in all subjects and in all settings. Effective exercise programs combined balance and strength training. Reviews with a higher AMSTAR score were more likely to contain more primary studies, to be updated and to perform meta-analysis. CONCLUSIONS: The aim of this overview of reviews of non-pharmacological interventions to prevent falls in older people in different settings, is to support clinicians and other healthcare workers with clinical decision-making by providing a comprehensive perspective of findings.

Broad synthesis / Overview of systematic reviews

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What Works to Prevent Falls in Community-Dwelling Older Adults? An Umbrella Review of Meta-analyses of Randomized Controlled Trials.

Authors Stubbs B , Brefka S , Denkinger MD
Journal Physical therapy
Year 2015
Links Pubmed DOI https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=109821088&lang=es&site=ehost-live

This article includes 16 Systematic reviews Systematic reviews (16 references)

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BACKGROUND: Preventing falls is an International priority. There is a need to synthesise the highest quality falls prevention evidence in one place for clinicians. PURPOSE: To conduct an umbrella review of meta-analyses (MA) of randomised controlled trials (RCTs) of falls prevention interventions in community dwelling older adults. DATA SOURCES: MEDLINE, EMBASE, CINAHL, AMED, BNI, PsycINFO, Cochrane Library, PubMed and the PEDro database. STUDY SELECTION: MA with one pooled analysis containing ≥ 3 RCTs investigating any intervention to prevent falls in community dwelling older adults aged ≥ 60 years of age were eligible. 16 MA representing 47 pooled analyses were included. DATA EXTRACTION: Two authors independently extracted data. DATA SYNTHESIS: Data was narratively synthesised. The methodological quality of the MA was moderate. 3 MA defined a fall and 3 reported adverse events (although minor). There is consistent evidence that exercise reduces falls (including the rate, risk and odds of falling) with 13/14 pooled analyses (93%) from 7 MA demonstrating a significant reduction. The methodological quality of meta-analyses investigating exercise were medium/ high and effect sizes ranged from 0.87 (relative risk (RR) 95% CI 0.81-0.94, N=18, n=3568) to 0.39 (rate ratio (RaR) 95% CI 0.23 - 0.66, N=6). There is consistent evidence that multifactorial interventions reduce falls (5/6, 83% reported significant reduction). There is conflicting evidence regarding the influence of vitamin d supplementation (7/12, 58.3% reported significant reduction). LIMITATIONS: MA often used different analysis and reporting of key characteristics was often lacking (e.g. participants, heterogeneity, publication bias). There may be some overlap between included MA. CONCLUSIONS: There is consistent evidence that exercise and individually tailored multifactorial interventions are effective in reducing falls in the community.

Broad synthesis

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Evidence Map of Tai Chi

Book VA Evidence-based Synthesis Program Reports
Year 2014
Links Pubmed

This article includes 29 Primary studies Primary studies (29 references) 106 Systematic reviews Systematic reviews (106 references)

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This evidence map provides an overview of Tai Chi research and describes its volume and focus. It combines a systematic review of systematic reviews with a scoping review for the VA priority areas pain, posttraumatic stress disorder, and fall prevention. The evidence map summarizes patient outcomes reported in reviews of studies in patients practicing Tai Chi for health-related indications. We searched PubMed, DARE, the Cochrane Library of Systematic Reviews, the Campbell Collaboration database, AMED, CINAHL, PsycInfo, Scopus, Web of Science, and PROSPERO; screened reviews of reviews; and consulted with topic experts. We used a bubble plot to graphically display the research field and summarized results narratively in an executive summary. Tai Chi has been investigated as a treatment for a number of clinical indications. The systematic review identified 107 systematic reviews. Reviews addressing general health effects, psychological wellbeing, or interventions in older adults included between 31 and 51 randomized controlled trials (RCTs). The topic areas balance, hypertension, falls, quality of life, cognitive performance, and vestibulopathy have also been the focus of research; included reviews identified 10 or more pertinent RCTs per topic. Statistically significant effects across existing studies were reported for hypertension, falls outside of institutions, cognitive performance, osteoarthritis, chronic obstructive pulmonary disease, pain, balance confidence, depression, and muscle strength. However, review authors cautioned that firm conclusions cannot be drawn due to methodological limitations in the original studies and/or an insufficient number of research studies.

Broad synthesis / Systematic review

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Prevention of falls in old people-a review

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Journal Reviews in Clinical Gerontology
Year 2013
Links DOI

This article includes 4 Systematic reviews Systematic reviews (4 references) 69 Primary studies Primary studies (69 references)

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Physical training, if including specific different training modalities, reduces the fall risk in healthy community-dwelling older people, as does a home hazards modification programme. Vitamin D supplementation in older individuals with low levels of vitamin D, adjustment of psychotropic medication, and structured modification of multi-pharmacy are all drug-focused programmes that reduce the number of falls. Anti-slip shoe devices during icy conditions for older people who walk outdoors and multifaceted podiatry in patients with specific foot disability reduce the fall risk. First eye cataract surgery and pacemakers in patients with cardio-inhibitory carotid sinus hypersensitivity are surgical interventions that reduce the fall risk. Multi-factorial preventive programmes that include training, both individually designed and generally prescribed, also reduce the fall frequency. With this in mind, we ought to initiate fall preventive programmes in older people, especially in high-risk groups, to reduce the number of falls and fallers in society. © 2013 Cambridge University Press.

Broad synthesis

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Non-pharmacological management of osteoporosis: a consensus of the Belgian Bone Club.

Journal Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA
Year 2011
Links Pubmed DOI PubMed Central

This article includes 140 Primary studies Primary studies (140 references) 32 Systematic reviews Systematic reviews (32 references)

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This consensus article reviews the various aspects of the non-pharmacological management of osteoporosis, including the effects of nutriments, physical exercise, lifestyle, fall prevention, and hip protectors. Vertebroplasty is also briefly reviewed. Non-pharmacological management of osteoporosis is a broad concept. It must be viewed as an essential part of the prevention of fractures from childhood through adulthood and the old age. The topic also includes surgical procedures for the treatment of peripheral and vertebral fractures and the post-fracture rehabilitation. The present document is the result of a consensus, based on a systematic review and a critical appraisal of the literature. Diets deficient in calcium, proteins or vitamin D impair skeletal integrity. The effect of other nutriments is less clear, although an excessive consumption of sodium, caffeine, or fibres exerts negative effects on calcium balance. The deleterious effects of tobacco, excessive alcohol consumption and a low BMI are well accepted. Physical activity is of primary importance to reach optimal peak bone mass but, if numerous studies have shown the beneficial effects of various types of exercise on bone mass, fracture data as an endpoint are scanty. Fall prevention strategies are especially efficient in the community setting, but less evidence is available about their effectiveness in preventing fall-related injuries and fractures. The efficacy of hip protectors remains controversial. This is also true for vertebroplasty and kyphoplasty. Several randomized controlled studies had reported a short-term advantage of vertebroplasty over medical treatment for pain relief, but these findings have been questioned by recent sham-controlled randomized clinical studies.

Broad synthesis / Guideline

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Guidelines for the prevention of falls in people over 65. The Guidelines' Development Group.

Authors Feder G , Cryer C , Donovan S , Carter Y
Journal BMJ (Clinical research ed.)
Year 2000
Links Pubmed DOI Pubmed Central

This article includes 21 Primary studies Primary studies (21 references) 1 Systematic review Systematic reviews (1 reference)

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