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.
OBJETIVOS: Determinar los efectos del ejercicio en la prevención de caídas en personas mayores y establecer si las características particulares de prueba o componentes de programas de ejercicio se asocian con mayores reducciones en las caídas.
DISEÑO: Revisión sistemática con metaanálisis. Ensayos controlados aleatorios que compararon las tasas de caídas en personas mayores que llevaron a cabo los programas de ejercicio con tasas de caídas en los que no hacían ejercicio se incluyeron.
AJUSTE: Las personas de edad.
PARTICIPANTES: Cuidados generales de la comunidad y residenciales.
MEDIDAS: las tasas de caída.
RESULTADOS: La estimación combinada del efecto del ejercicio fue que se redujo la tasa de caída de un 17% (44 ensayos con 9.603 participantes, razón de tasas (RR) = 0,83, IC del 95% intervalo de confianza (IC) = 0.75-0.91, p < .001, yo (2) = 62%). Los mayores efectos relativos del ejercicio sobre las tasas de caída (RR = 0,58, IC 95% = 0.48-0.69, el 68% de la variabilidad entre los estudios se explica) se observaron en los programas que incluyen una combinación de una dosis total más alta de ejercicio (más de 50 horas durante el período de prueba) y desafiantes ejercicios de equilibrio (ejercicios realizados, mientras que de pie en el que las personas objeto de pie con los pies más cerca o sobre una sola pierna, reducir al mínimo el uso de sus manos para ayudar, y practicar movimientos controlados del centro de masa) y lo hizo no incluye un programa de caminatas.
CONCLUSIÓN: El ejercicio físico puede prevenir las caídas en personas mayores. Mayores efectos relativos se ven en los programas que incluyen ejercicios que desafían el equilibrio, usar una dosis más alta de ejercicio, y no incluyen un programa de caminatas. Los proveedores de servicios pueden utilizar estos hallazgos para diseñar e implementar programas de ejercicio para la prevención de caídas.
OBJETIVO: Evaluar la eficacia de los programas de ejercicio en la prevención de caídas (y / o reducir el riesgo de caídas y lesiones relacionadas) en las personas mayores.
DISEÑO: Una revisión de ensayos clínicos controlados diseñados con el objetivo de reducir el riesgo de caídas y / o lesiones por caídas a través de una intervención de ejercicio sólo o una intervención que incluía un componente de ejercicio.
Principales medidas de resultado: caídas, las lesiones relacionadas con caída, el tiempo entre las caídas, los costos y la rentabilidad.
Sujetos: Un total de 4933 hombres y mujeres mayores de 60 años de edad y mayores.
RESULTADOS: Once estudios clínicos que cumplían los criterios de inclusión fueron revisados. Ocho de estos ensayos tenían las intervenciones de distintos ejercicios, y tres intervenciones utilizadas con un componente de un programa de ejercicio. Cinco ensayos mostraron una reducción significativa en la tasa de caídas o el riesgo de caer en el grupo de intervención.
CONCLUSIONES: El ejercicio es eficaz para reducir el riesgo de caídas en los grupos seleccionados y debe formar parte de los programas de prevención de caídas. La reducción de las lesiones por caídas relacionadas reducirá los costos de atención de la salud, pero hay poca información disponible sobre los costos asociados con la replicación del programa o la rentabilidad de los programas de ejercicios destinados a la prevención de caídas en personas mayores.
OBJETIVO: Para determinar si a corto plazo, el ejercicio reduce las caídas y lesiones relacionadas con caídas en los ancianos.
DISEÑO: Un planificada de antemano meta-análisis de la fragilidad de las siete y Lesiones: Estudios Cooperativos de Técnicas de Intervención (FICSIT) - Independiente, los ensayos clínicos randomizados y controlados que evaluaron la eficacia de la intervención en la reducción de las caídas y la fragilidad en los ancianos. Todo incluido un componente de ejercicio durante 10 a 36 semanas. Caída y lesión de seguimiento se obtuvo durante un máximo de 2 a 4 años.
Lugar: Dos hogares de ancianos y cinco sitios de la comunidad que habita (tres organizaciones de mantenimiento de la salud). Seis eran del grupo y basado en el centro, uno se llevó a cabo en el hogar.
Participantes: número de participantes oscilaba entre los 100 a 1.323 por estudio. Los sujetos eran en su mayoría ambulatorios e intactas cognitivamente, con edades mínimas de 60 a 75 años, aunque algunos estudios necesarios déficits adicionales, tales como funcionalmente dependiente en dos o más actividades de la vida diaria, déficits de la balanza o menor debilidad de las extremidades, o de alto riesgo de caer.
INTERVENCIONES: componentes de ejercicio variaron entre los estudios en la naturaleza, duración, frecuencia e intensidad. El entrenamiento fue realizado en un área o más de la resistencia, la flexibilidad, la plataforma de equilibrio, el Tai Chi (equilibrio dinámico), y la resistencia. Varios brazos de tratamiento incluye componentes adicionales sin ejercicios, tales como los componentes de comportamiento, cambios de medicación, la educación, la actividad funcional, o suplementos nutricionales.
Principales medidas de resultado: la hora de cada otoño (lesiones relacionadas con caídas) por la auto-informe y / o registros médicos.
RESULTADOS: El uso de la extensión de Andersen-Gill del modelo de Cox que permite a los resultados de múltiples caídas por paciente, la relación entre la caída de incidencia ajustada para los grupos de tratamiento, incluyendo el ejercicio en general fue de 0,90 (IC del 95% los límites de confianza [BC], 0,81, 0,99) y para las que incluyen el balance fue de 0,83 (IC del 95%, 0,70 a 0,98). Ninguno de los componentes del ejercicio fue significativa para las caídas perjudiciales, pero el poder es baja para la detección de este resultado.
CONCLUSIONES: Los tratamientos incluyen ejercicio para los adultos mayores a reducir el riesgo de caídas.
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.
