Background: Older adults are at increased risk of both falls and fall-related injuries. Falls have multiple causes and many interventions exist to try and prevent them, including educational and psychological interventions. Educational interventions aim to increase older people's understanding of what they can do to prevent falls and psychological interventions can aim to improve confidence/motivation to engage in activities that may prevent falls. This review is an update of previous evidence to focus on educational and psychological interventions for falls prevention in community-dwelling older people. Objectives: To assess the benefits and harms of psychological interventions (such as cognitive behavioural therapy; with or without an education component) and educational interventions for preventing falls in older people living in the community. Search methods: We searched CENTRAL, MEDLINE, Embase, four other databases, and two trials registries to June 2023. We also screened reference lists and conducted forward-citation searching. Selection criteria: We included randomised controlled trials of community-dwelling people aged 60 years and older exploring the effectiveness of psychological interventions (such as cognitive behavioural therapy) or educational interventions (or both) aiming to prevent falls. Data collection and analysis: We used standard methodological procedures expected by Cochrane. Our primary outcome was rate of falls. We also explored: number of people falling; people with fall-related fractures; people with falls that required medical attention; people with fall-related hospital admission; fall-related psychological outcomes (i.e. concerns about falling); health-related quality of life; and adverse events. Main results: We included 37 studies (six on cognitive behavioural interventions; three on motivational interviewing; three on other psychological interventions; nine on multifactorial (personalised) education; 12 on multiple topic education; two on single topic education; one with unclear education type; and one psychological plus educational intervention). Studies randomised 17,478 participants (71% women; mean age 73 years). Most studies were at high or unclear risk of bias for one or more domains. Cognitive behavioural interventions. Cognitive behavioural interventions make little to no difference to the number of fallers (risk ratio (RR) 0.92, 95% confidence interval (CI) 0.82 to 1.02; 4 studies, 1286 participants; low-certainty evidence), and there was a slight reduction in concerns about falling (standardised mean difference (SMD) −0.30, 95% CI −0.42 to −0.19; 3 studies, 1132 participants; low-certainty evidence). The evidence is very uncertain or missing about the effect of cognitive behavioural interventions on other outcomes. Motivational interviewing. The evidence is very uncertain about the effect of motivational interviewing on rate of falls, number of fallers, and fall-related psychological outcomes. No evidence is available on the effects of motivational interviewing on people experiencing fall-related fractures, falls requiring medical attention, fall-related hospital admission, or adverse events. Other psychological interventions. The evidence is very uncertain about the effect of health coaching on rate of falls, number of fallers, people sustaining a fall-related fracture, or fall-related hospital admission; the effect of other psychological interventions on these outcomes was not measured. The evidence is very uncertain about the effect of health coaching, guided imagery, and mental practice on fall-related psychological outcomes. The effect of other psychological interventions on falls needing medical attention or adverse events was not measured. Multifactorial education. Multifactorial (personalised) education makes little to no difference to the rate of falls (rate ratio 0.95, 95% CI 0.77 to 1.17; 2 studies, 777 participants; low-certainty evidence). The effect of multifactorial education on people experiencing fall-related fractures was very imprecise (RR 0.66, 95% CI 0.29 to 1.48; 2 studies, 510 participants; low-certainty evidence), and the evidence is very uncertain about its effect on the number of fallers. There was no evidence for other outcomes. Multiple component education. Multiple component education may improve fall-related psychological outcomes (MD −2.94, 95% CI −4.41 to −1.48; 1 study, 459 participants; low-certainty evidence). However, the evidence is very uncertain about its effect on all other outcomes. Single topic education. The evidence is very uncertain about the effect of single-topic education on rate of falls, number of fallers, and people experiencing fall-related fractures. There was no evidence for other outcomes. Psychological plus educational interventions. Motivational interviewing/coaching combined with multifactorial (personalised) education likely reduces the rate of falls (although the size of this effect is not clear; rate ratio 0.65, 95% CI 0.43 to 0.99; 1 study, 430 participants; moderate-certainty evidence), but makes little to no difference to the number of fallers (RR 0.93, 95% CI 0.76 to 1.13; 1 study, 430 participants; high-certainty evidence). It probably makes little to no difference to falls-related psychological outcomes (MD −0.70, 95% CI −1.81 to 0.41; 1 study, 353 participants; moderate-certainty evidence). There were no adverse events detected (1 study, 430 participants; moderate-certainty evidence). There was no evidence for psychological plus educational intervention on other outcomes. Authors' conclusions: The evidence suggests that a combined psychological and educational intervention likely reduces the rate of falls (but not fallers), without affecting adverse events. Overall, the evidence for individual psychological interventions or delivering education alone is of low or very-low certainty; future research may change our confidence and understanding of the effects. Cognitive behavioural interventions may improve concerns about falling slightly, but this may not help reduce the number of people who fall. Certain types of education (i.e. multiple component education) may also help reduce concerns about falling, but not necessarily reduce the number of falls. Future research should adhere to reporting standards for describing the interventions used and explore how these interventions may work, to better understand what could best work for whom in what situation. There is a particular dearth of evidence for low- to middle-income countries.
Background: Falls are one of the most common complications after stroke, with a reported incidence ranging between 7% in the first week and 73% in the first year post stroke. This is an updated version of the original Cochrane Review published in 2013. Objectives: To evaluate the effectiveness of interventions aimed at preventing falls in people after stroke. Our primary objective was to determine the effect of interventions on the rate of falls (number of falls per person-year) and the number of fallers. Our secondary objectives were to determine the effects of interventions aimed at preventing falls on 1) the number of fall-related fractures; 2) the number of fall-related hospital admissions; 3) near-fall events; 4) economic evaluation; 5) quality of life; and 6) adverse effects of the interventions. Search methods: We searched the trials registers of the Cochrane Stroke Group (September 2018) and the Cochrane Bone, Joint and Muscle Trauma Group (October 2018); the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 9) in the Cochrane Library; MEDLINE (1950 to September 2018); Embase (1980 to September 2018); CINAHL (1982 to September 2018); PsycINFO (1806 to August 2018); AMED (1985 to December 2017); and PEDro (September 2018). We also searched trials registers and checked reference lists. Selection criteria: Randomised controlled trials of interventions where the primary or secondary aim was to prevent falls in people after stroke. Data collection and analysis: Two review authors (SD and WS) independently selected studies for inclusion, assessed trial quality and risk of bias, and extracted data. We resolved disagreements through discussion, and contacted study authors for additional information where required. We used a rate ratio and 95% confidence interval (CI) to compare the rate of falls (e.g. falls per person-year) between intervention and control groups. For risk of falling we used a risk ratio and 95% CI based on the number of people falling (fallers) in each group. We pooled results where appropriate and applied GRADE to assess the quality of the evidence. Main results: We included 14 studies (of which six have been published since the first version of this review in 2013), with a total of 1358 participants. We found studies that investigated exercises, predischarge home visits for hospitalised patients, the provision of single lens distance vision glasses instead of multifocal glasses, a servo-assistive rollator and non-invasive brain stimulation for preventing falls. Exercise compared to control for preventing falls in people after stroke The pooled result of eight studies showed that exercise may reduce the rate of falls but we are uncertain about this result (rate ratio 0.72, 95% CI 0.54 to 0.94, 765 participants, low-quality evidence). Sensitivity analysis for single exercise interventions, omitting studies using multiple/multifactorial interventions, also found that exercise may reduce the rate of falls (rate ratio 0.66, 95% CI 0.50 to 0.87, 626 participants). Sensitivity analysis for the effect in the chronic phase post stroke resulted in little or no difference in rate of falls (rate ratio 0.58, 95% CI 0.31 to 1.12, 205 participants). A sensitivity analysis including only studies with low risk of bias found little or no difference in rate of falls (rate ratio 0.88, 95% CI 0.65 to 1.20, 462 participants). Methodological limitations mean that we have very low confidence in the results of these sensitivity analyses. For the outcome of number of fallers, we are very uncertain of the effect of exercises compared to the control condition, based on the pooled result of 10 studies (risk ratio 1.03, 95% CI 0.90 to 1.19, 969 participants, very low quality evidence). The same sensitivity analyses as described above gives us very low certainty that there are little or no differences in number of fallers (single interventions: risk ratio 1.09, 95% CI 0.93 to 1.28, 796 participants; chronic phase post stroke: risk ratio 0.94, 95% CI 0.73 to 1.22, 375 participants; low risk of bias studies: risk ratio 0.96, 95% CI 0.77 to 1.21, 462 participants). Other interventions for preventing falls in people after stroke We are very uncertain whether interventions other than exercise reduce the rate of falls or number of fallers. We identified very low certainty evidence when investigating the effect of predischarge home visits (rate ratio 0.85, 95% CI 0.43 to 1.69; risk ratio 1.48, 95% CI 0.71 to 3.09; 85 participants), provision of single lens distance glasses to regular wearers of multifocal glasses (rate ratio 1.08, 95% CI 0.52 to 2.25; risk ratio 0.74, 95% CI 0.47 to 1.18; 46 participants) and a servo-assistive rollator (rate ratio 0.44, 95% CI 0.16 to 1.21; risk ratio 0.44, 95% CI 0.16 to 1.22; 42 participants). Finally, transcranial direct current stimulation (tDCS) was used in one study to examine the effect on falls post stroke. We have low certainty that active tDCS may reduce the number of fallers compared to sham tDCS (risk ratio 0.30, 95% CI 0.14 to 0.63; 60 participants). Authors' conclusions: At present there exists very little evidence about interventions other than exercises to reduce falling post stroke. Low to very low quality evidence exists that this population benefits from exercises to prevent falls, but not to reduce number of fallers. Fall research does not in general or consistently follow methodological gold standards, especially with regard to fall definition and time post stroke. More well-reported, adequately-powered research should further establish the value of exercises in reducing falling, in particular per phase, post stroke.
BACKGROUND: Falls in care facilities and hospitals are common events that cause considerable morbidity and mortality for older people. This is an update of a review first published in 2010 and updated in 2012.
OBJECTIVES: To assess the effects of interventions designed to reduce the incidence of falls in older people in care facilities and hospitals.
SEARCH METHODS: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (August 2017); Cochrane Central Register of Controlled Trials (2017, Issue 8); and MEDLINE, Embase, CINAHL and trial registers to August 2017.
SELECTION CRITERIA: Randomised controlled trials of interventions for preventing falls in older people in residential or nursing care facilities, or hospitals.
DATA COLLECTION AND ANALYSIS: One review author screened abstracts; two review authors screened full-text articles for inclusion. Two review authors independently performed study selection, 'Risk of bias' assessment and data extraction. We calculated rate ratios (RaR) with 95% confidence intervals (CIs) for rate of falls and risk ratios (RRs) and 95% CIs for outcomes such as risk of falling (number of people falling). We pooled results where appropriate. We used GRADE to assess the quality of evidence.
MAIN RESULTS: Thirty-five new trials (77,869 participants) were included in this update. Overall, we included 95 trials (138,164 participants), 71 (40,374 participants; mean age 84 years; 75% women) in care facilities and 24 (97,790 participants; mean age 78 years; 52% women) in hospitals. The majority of trials were at high risk of bias in one or more domains, mostly relating to lack of blinding. With few exceptions, the quality of evidence for individual interventions in either setting was generally rated as low or very low. Risk of fracture and adverse events were generally poorly reported and, where reported, the evidence was very low-quality, which means that we are uncertain of the estimates. Only the falls outcomes for the main comparisons are reported here.Care facilitiesSeventeen trials compared exercise with control (typically usual care alone). We are uncertain of the effect of exercise on rate of falls (RaR 0.93, 95% CI 0.72 to 1.20; 2002 participants, 10 studies; I² = 76%; very low-quality evidence). Exercise may make little or no difference to the risk of falling (RR 1.02, 95% CI 0.88 to 1.18; 2090 participants, 10 studies; I² = 23%; low-quality evidence).There is low-quality evidence that general medication review (tested in 12 trials) may make little or no difference to the rate of falls (RaR 0.93, 95% CI 0.64 to 1.35; 2409 participants, 6 studies; I² = 93%) or the risk of falling (RR 0.93, 95% CI 0.80 to 1.09; 5139 participants, 6 studies; I² = 48%).There is moderate-quality evidence that vitamin D supplementation (4512 participants, 4 studies) probably reduces the rate of falls (RaR 0.72, 95% CI 0.55 to 0.95; I² = 62%), but probably makes little or no difference to the risk of falling (RR 0.92, 95% CI 0.76 to 1.12; I² = 42%). The population included in these studies had low vitamin D levels.Multifactorial interventions were tested in 13 trials. We are uncertain of the effect of multifactorial interventions on the rate of falls (RaR 0.88, 95% CI 0.66 to 1.18; 3439 participants, 10 studies; I² = 84%; very low-quality evidence). They may make little or no difference to the risk of falling (RR 0.92, 95% CI 0.81 to 1.05; 3153 participants, 9 studies; I² = 42%; low-quality evidence).HospitalsThree trials tested the effect of additional physiotherapy (supervised exercises) in rehabilitation wards (subacute setting). The very low-quality evidence means we are uncertain of the effect of additional physiotherapy on the rate of falls (RaR 0.59, 95% CI 0.26 to 1.34; 215 participants, 2 studies; I² = 0%), or whether it reduces the risk of falling (RR 0.36, 95% CI 0.14 to 0.93; 83 participants, 2 studies; I² = 0%).We are uncertain of the effects of bed and chair sensor alarms in hospitals, tested in two trials (28,649 participants) on rate of falls (RaR 0.60, 95% CI 0.27 to 1.34; I² = 0%; very low-quality evidence) or risk of falling (RR 0.93, 95% CI 0.38 to 2.24; I² = 0%; very low-quality evidence).Multifactorial interventions in hospitals may reduce rate of falls in hospitals (RaR 0.80, 95% CI 0.64 to 1.01; 44,664 participants, 5 studies; I² = 52%). A subgroup analysis by setting suggests the reduction may be more likely in a subacute setting (RaR 0.67, 95% CI 0.54 to 0.83; 3747 participants, 2 studies; I² = 0%; low-quality evidence). We are uncertain of the effect of multifactorial interventions on the risk of falling (RR 0.82, 95% CI 0.62 to 1.09; 39,889 participants; 3 studies; I² = 0%; very low-quality evidence).
AUTHORS' CONCLUSIONS: In care facilities: we are uncertain of the effect of exercise on rate of falls and it may make little or no difference to the risk of falling. General medication review may make little or no difference to the rate of falls or risk of falling. Vitamin D supplementation probably reduces the rate of falls but not risk of falling. We are uncertain of the effect of multifactorial interventions on the rate of falls; they may make little or no difference to the risk of falling.In hospitals: we are uncertain of the effect of additional physiotherapy on the rate of falls or whether it reduces the risk of falling. We are uncertain of the effect of providing bed sensor alarms on the rate of falls or risk of falling. Multifactorial interventions may reduce rate of falls, although subgroup analysis suggests this may apply mostly to a subacute setting; we are uncertain of the effect of these interventions on risk of falling.
OBJETIVO: revisiones sistemáticas anteriores sobre la terapia ocupacional para los estudios incluidos ancianos hasta 2003. La presente cartografía evidencia resume la evidencia reciente de la eficacia de la terapia ocupacional con personas mayores sobre la base de los ensayos controlados aleatorios 2.004 a 2.012.
MÉTODO: una búsqueda electrónica en las bases de datos Cochrane y Medline identificados publicaciones de ensayos controlados aleatorios sobre las intervenciones de terapia ocupacional para personas ≥ 65 años de edad. Dos autores extrajeron de forma independiente los datos y se analizan la calidad de las muestras, intervenciones y evalutations de resultados según los criterios PRISMA.
RESULTADOS: En total, se identificaron 136 resúmenes y 48 estudios analizados, de estos 12 en la carrera, 15 en las caídas y la movilidad, 7 en la demencia, 4 en la prevención y 10 en otras condiciones. Los informes de eventos adversos y las evaluaciones de los costos y los resultados a largo plazo son a menudo insuficientes.
CONCLUSIÓN: Los campos más prometedores para futuras investigaciones son la prevención primaria y secundaria en personas con accidente cerebrovascular, caídas o problemas de movilidad y prevención terciaria en las personas con demencia. Los ensayos futuros deben ser realizados y comunicados de acuerdo a las directrices de presentación de informes consentido de la red ecuador.
Objetivos Determinar las características y la eficacia de los programas de prevención en los resultados relacionados con caídas en un entorno definido. Diseño Revisión sistemática y meta-análisis. Configuración Un subgrupo claramente descrita de hogares de ancianos definidos como centros residenciales que proporcionan vigilancia las 24 horas del día, el cuidado personal y la atención clínica limitada para las personas que son normalmente ancianos y enfermos. Los participantes Enfermería residentes de hogares (N = 22.915). Mediciones Los resultados primarios fueron el número de caídas, que sufren caídas, y que sufren caídas recurrentes. Resultados Trece estudios cumplieron los criterios de inclusión. Seis programas de prevención de caídas eran individual (uno de componentes intervención proporcionó a los residentes), uno era múltiple (dos o más componentes de intervención no personalizar para el riesgo individual caída), y seis fueron multifactoriales (dos o mas componentes de intervención personalizados para el riesgo de caídas de cada residente) . Meta-análisis encontró una cantidad significativamente menor que sufren caídas recurrentes en los grupos de intervención (4 estudios, el riesgo relativo (RR) = intervalo de confianza 0,79, 95% (IC) = 0,65 a 0,97), pero no tiene efecto significativo de la intervención sobre sufren caídas (6 estudios, RR = 0,97; IC del 95% = 0,84-1,11) o caídas (10 estudios, RR = 0,93; IC del 95% = 0,76-1,13). Intervenciones multifactoriales reducen significativamente las caídas (4 estudios, RR = 0.67, IC 95% = 0,55 hasta 0,82) y el número de personas que sufren caídas recurrentes (4 estudios, RR = 0,79, IC = 0,65-0,97), mientras que las intervenciones individuales o múltiples no. Formación y educación mostraron un efecto perjudicial significativo en los grupos de intervención sobre el número de caídas (2 estudios, RR = 1,29; IC del 95% = 1,23-1,36). Conclusión Este meta-análisis no reveló un efecto significativo de las intervenciones de prevención de caídas en caídas o sufren caídas, pero, por primera vez, mostraron que las intervenciones de prevención de caídas reducen significativamente el número de personas que sufren caídas recurrentes en un 21%.
OBJETIVO: Numerosos estudios han informado de la prevención de caídas a través del ejercicio entre las personas mayores cognitivamente sanos. Este estudio tuvo como objetivo determinar si la evidencia actual apoya que el ejercicio físico también es eficaz en la prevención de las caídas en los adultos mayores con deterioro cognitivo.
MÉTODOS: Dos revisores independientes realizaron búsquedas en MEDLINE; EMBASE; PsycINFO; el Cumulative Index de Enfermería y Salud Aliada Literatura; el Registro Cochrane Central de Ensayos Controlados; la Cochrane Bone, Joint, y Muscle Trauma Registro Especializado del Grupo; ClinicalTrials.gov; y la Cartera de Estudio Reino Unido Red de Investigación Clínica hasta julio de 2013, sin restricciones de idioma. Se incluyeron ensayos controlados aleatorios que examinaron la eficacia del ejercicio físico en los adultos mayores con deterioro cognitivo. La calidad metodológica de los ensayos incluidos se evaluaron de acuerdo con los criterios desarrollados para la revisión Cochrane de ensayos de prevención de caídas. La medida de resultado primario fue la proporción de la tasa de caídas. Se realizó un metanálisis para estimar la proporción de la tasa combinada y resumir los resultados de los ensayos sobre la prevención de caídas a través del ejercicio físico.
RESULTADOS: Siete ensayos controlados aleatorios con 781 participantes fueron incluidos, 4 de las cuales examinó las personas únicamente mayores con deterioro cognitivo. Datos de los subgrupos de personas con deterioro cognitivo se obtuvieron de los otros 3 ensayos que tuvieron como objetivo las poblaciones mayores en general. El meta-análisis mostró que el ejercicio físico tuvo un efecto significativo en la prevención de las caídas en los adultos mayores con deterioro cognitivo, con una estimación combinada de proporción de la tasa de 0,68 (95% intervalo de confianza 0,51 hasta 0,91).
CONCLUSIONES: El presente análisis sugiere que el ejercicio físico tiene un efecto positivo en la prevención de caídas en los adultos mayores con deterioro cognitivo. Se requieren estudios adicionales para determinar la modalidad y frecuencia de ejercicio que sean óptimas para la prevención de caídas en esta población.
OBJETIVO: El objetivo de esta revisión sistemática y meta-análisis es evaluar la efectividad de los programas de ejercicio para reducir las caídas en personas de edad avanzada con demencia que viven en la comunidad.
MÉTODO: artículos revisados por pares (ensayos controlados aleatorios [ECA] y ensayos cuasi-experimentales) publicados en Inglés entre enero de 2000 y febrero de 2014, recuperados de seis bases de datos electrónicas - Medline (ProQuest), CINAHL, PubMed, PsycINFO, EMBASE y Scopus - de acuerdo con los criterios de inclusión predefinidos fueron incluidos. Siempre que sea posible, los resultados se agruparon y se realizó un metanálisis.
RESULTADOS: Cuatro artículos (tres ECA y un pre-solo grupo y después de la prueba del estudio piloto) fueron incluidos. La calidad de los estudios de los tres ECA fue alta; Sin embargo, los resultados de medición, las intervenciones y los períodos de seguimiento de tiempo diferían entre los estudios. Una vez finalizado el período de intervención, el número medio de caídas fue menor en el grupo de ejercicio en comparación con el grupo control (diferencia de medias [DM] [intervalo de confianza del 95% {CI}] = -1,06 [-1,67 a -0,46] cae) . Es importante destacar que la intervención de ejercicio reduce el riesgo de ser una fallera en un 32% (cociente de riesgos [IC 95%] = 0,68 [0,55 a 0,85]). Sólo otros dos resultados fueron reportados en dos o más de los estudios (prueba de paso y de evaluación de perfil fisiológico). No se observaron diferencias entre los grupos en los resultados de la prueba de la etapa (número de pasos) (MD [IC del 95%] = 0,51 [-1,77 a 2,78]) o la evaluación perfil fisiológico (MD [IC del 95%] = -0,10 [-0,62 a 0,42]).
CONCLUSIÓN: Los resultados de esta revisión indican que un programa de ejercicio puede potencialmente ayudar en la prevención de caídas de las personas mayores con demencia viven en la comunidad. Sin embargo, se necesita más investigación con los estudios que utilizan tamaños más grandes de la muestra, los resultados de medición estandarizados y períodos de seguimiento más largos, de informar a las recomendaciones basadas en la evidencia.
ANTECEDENTES: Es programas de ejercicios físicos conocidos pueden reducir las caídas en las personas mayores. Recientemente, varios estudios han evaluado el entrenamiento cognitivo-motor interactivo que combina componentes de ejercicio físico cognitiva y motora. El objetivo de esta revisión sistemática fue determinar los efectos de estas intervenciones cognitivo-motor interactivos sobre el riesgo de caídas en las personas mayores.
MÉTODOS: Los estudios se identificaron con las búsquedas de las bases de datos PubMed, EMBASE, y Cochrane Central, desde su inicio hasta el 31 de diciembre de 2013. Los criterios de inclusión fueron: a) al menos un brazo de tratamiento que contenía un componente interactivo intervención cognitiva-motor; b) una edad mínima de 60 años o una edad media de 65 años; c) caídas o al menos un factor de riesgo de caídas física, psicológica o cognitiva como una medida de resultado informada; d) publicado en holandés, Inglés o alemán. Se excluyeron los estudios de casos individuales y las intervenciones de capacitación asistidos por robot. Debido a la diversidad de las poblaciones incluidas, medidas de resultado y la heterogeneidad en los diseños del estudio, no se realizaron metanálisis.
RESULTADOS: Treinta y siete estudios cumplieron los criterios de inclusión. Presentación de informes y la calidad metodológica fueron a menudo deficiente y el tamaño de las muestras eran en su mayoría pequeñas. Un estudio piloto encontró formación tabla de equilibrio caídas reducidos y la mayoría de los estudios informó el entrenamiento mejoró física (por ejemplo, el equilibrio y la fuerza) y cognitiva (por ejemplo, atención, función ejecutiva) medidas. Se encontraron resultados contradictorios para las medidas psicológicas relacionadas con caídas-eficacia. Muy pocas diferencias entre los grupos fueron evidentes cuando las intervenciones cognitivo-motor interactivos se compararon con los programas de formación tradicionales.
CONCLUSIONES: Los resultados de la revisión proporcionan una evidencia preliminar de que las intervenciones cognitivo-motor interactivos pueden mejorar los factores de riesgo de caídas físicas y cognitivas en las personas mayores, pero que el efecto de este tipo de intervenciones sobre las caídas no se ha demostrado de manera definitiva. Intervenciones cognitivo-motor interactivos parecen ser de una eficacia equivalente en la mejora del riesgo de caídas como programas de formación tradicionales. Sin embargo, como la mayoría de los estudios tienen limitaciones metodológicas, más grandes, se necesitan ensayos de alta calidad.
FINES Y OBJETIVOS: Presentar los hallazgos de una investigación sobre la calidad metodológica de la investigación informar el uso de protectores de cadera para aquellos clientes en residencias de ancianos considerados de alto riesgo de caídas y de contribuir a la traducción de los datos de investigación a la práctica mediante la identificación cuestiones relacionadas con el uso de protectores de cadera en la práctica.
ANTECEDENTES: Caídas de riesgo es una preocupación predominante al amamantar a las personas mayores, especialmente las de residencias de ancianos. Caída relacionada con lesiones, perteneciente específicamente a la cadera, producir un alto costo para la persona, tanto física como psicológicamente. En consecuencia, los protectores de cadera se argumentan en la literatura relacionada como una forma de protección contra este tipo de lesiones.
DISEÑO: Una búsqueda de base de datos de acuerdo con una estrategia de búsqueda especificado se realizó para las publicaciones de investigación cuantitativa y ensayos controlados aleatorios.
MÉTODOS: publicaciones en idioma inglés se buscaron desde el año 2000 hasta 2011. Se hicieron búsquedas, usando combinaciones específicas de palabras clave, en las siguientes bases de datos: MEDLINE a través de OvidSP, CINAHL vía EBSCOhost, Ageline través de OvidSP, Cochrane Library, el Instituto Joanna Briggs y Google Scholar.
RESULTADOS: Seis artículos fueron seleccionados para su revisión. La calidad metodológica de las publicaciones de investigación recopiló variado, y el uso de protectores de cadera se consideró concluyente. El cumplimiento se planteó como una cuestión predominante.
CONCLUSIÓN: El problema de las lesiones relacionadas con caídas es significativo. Mientras que algunas pruebas no son concluyentes, se recomienda el uso de protectores de cadera como la mejor práctica.
IMPORTANCIA PARA LA PRÁCTICA CLÍNICA: La cuestión del cumplimiento, sin embargo, se identificó a afectar el uso de aparatos en residencias de ancianos. Abordar los problemas de cumplimiento deben abordarse si los protectores de cadera son para ser parte de un enfoque centrado en el residente.
Background: Older adults are at increased risk of both falls and fall-related injuries. Falls have multiple causes and many interventions exist to try and prevent them, including educational and psychological interventions. Educational interventions aim to increase older people's understanding of what they can do to prevent falls and psychological interventions can aim to improve confidence/motivation to engage in activities that may prevent falls. This review is an update of previous evidence to focus on educational and psychological interventions for falls prevention in community-dwelling older people. Objectives: To assess the benefits and harms of psychological interventions (such as cognitive behavioural therapy; with or without an education component) and educational interventions for preventing falls in older people living in the community. Search methods: We searched CENTRAL, MEDLINE, Embase, four other databases, and two trials registries to June 2023. We also screened reference lists and conducted forward-citation searching. Selection criteria: We included randomised controlled trials of community-dwelling people aged 60 years and older exploring the effectiveness of psychological interventions (such as cognitive behavioural therapy) or educational interventions (or both) aiming to prevent falls. Data collection and analysis: We used standard methodological procedures expected by Cochrane. Our primary outcome was rate of falls. We also explored: number of people falling; people with fall-related fractures; people with falls that required medical attention; people with fall-related hospital admission; fall-related psychological outcomes (i.e. concerns about falling); health-related quality of life; and adverse events. Main results: We included 37 studies (six on cognitive behavioural interventions; three on motivational interviewing; three on other psychological interventions; nine on multifactorial (personalised) education; 12 on multiple topic education; two on single topic education; one with unclear education type; and one psychological plus educational intervention). Studies randomised 17,478 participants (71% women; mean age 73 years). Most studies were at high or unclear risk of bias for one or more domains. Cognitive behavioural interventions. Cognitive behavioural interventions make little to no difference to the number of fallers (risk ratio (RR) 0.92, 95% confidence interval (CI) 0.82 to 1.02; 4 studies, 1286 participants; low-certainty evidence), and there was a slight reduction in concerns about falling (standardised mean difference (SMD) −0.30, 95% CI −0.42 to −0.19; 3 studies, 1132 participants; low-certainty evidence). The evidence is very uncertain or missing about the effect of cognitive behavioural interventions on other outcomes. Motivational interviewing. The evidence is very uncertain about the effect of motivational interviewing on rate of falls, number of fallers, and fall-related psychological outcomes. No evidence is available on the effects of motivational interviewing on people experiencing fall-related fractures, falls requiring medical attention, fall-related hospital admission, or adverse events. Other psychological interventions. The evidence is very uncertain about the effect of health coaching on rate of falls, number of fallers, people sustaining a fall-related fracture, or fall-related hospital admission; the effect of other psychological interventions on these outcomes was not measured. The evidence is very uncertain about the effect of health coaching, guided imagery, and mental practice on fall-related psychological outcomes. The effect of other psychological interventions on falls needing medical attention or adverse events was not measured. Multifactorial education. Multifactorial (personalised) education makes little to no difference to the rate of falls (rate ratio 0.95, 95% CI 0.77 to 1.17; 2 studies, 777 participants; low-certainty evidence). The effect of multifactorial education on people experiencing fall-related fractures was very imprecise (RR 0.66, 95% CI 0.29 to 1.48; 2 studies, 510 participants; low-certainty evidence), and the evidence is very uncertain about its effect on the number of fallers. There was no evidence for other outcomes. Multiple component education. Multiple component education may improve fall-related psychological outcomes (MD −2.94, 95% CI −4.41 to −1.48; 1 study, 459 participants; low-certainty evidence). However, the evidence is very uncertain about its effect on all other outcomes. Single topic education. The evidence is very uncertain about the effect of single-topic education on rate of falls, number of fallers, and people experiencing fall-related fractures. There was no evidence for other outcomes. Psychological plus educational interventions. Motivational interviewing/coaching combined with multifactorial (personalised) education likely reduces the rate of falls (although the size of this effect is not clear; rate ratio 0.65, 95% CI 0.43 to 0.99; 1 study, 430 participants; moderate-certainty evidence), but makes little to no difference to the number of fallers (RR 0.93, 95% CI 0.76 to 1.13; 1 study, 430 participants; high-certainty evidence). It probably makes little to no difference to falls-related psychological outcomes (MD −0.70, 95% CI −1.81 to 0.41; 1 study, 353 participants; moderate-certainty evidence). There were no adverse events detected (1 study, 430 participants; moderate-certainty evidence). There was no evidence for psychological plus educational intervention on other outcomes. Authors' conclusions: The evidence suggests that a combined psychological and educational intervention likely reduces the rate of falls (but not fallers), without affecting adverse events. Overall, the evidence for individual psychological interventions or delivering education alone is of low or very-low certainty; future research may change our confidence and understanding of the effects. Cognitive behavioural interventions may improve concerns about falling slightly, but this may not help reduce the number of people who fall. Certain types of education (i.e. multiple component education) may also help reduce concerns about falling, but not necessarily reduce the number of falls. Future research should adhere to reporting standards for describing the interventions used and explore how these interventions may work, to better understand what could best work for whom in what situation. There is a particular dearth of evidence for low- to middle-income countries.
