5 As such, preventing falls among older persons is increasingly important for health care systems. 8, 9 Given the aging of the population worldwide, the incidence of falls is expected to continue rising. 5 Not only can falls result in serious injury or death, 6, 7 but older adults who experience falls also report increased anxiety and depression and reduced quality of life. 2 - 4 In 2012, the cost of falls to Medicare was $31 billion. 1 Falls cause a substantial burden to patients and health care systems. Choice of fall-prevention intervention may depend on patient and caregiver values and preferences.ĭata from the National Institute on Aging showed that the 2-year prevalence of falls among individuals aged 65 years or older was 36% in 2010. ![]() Pairwise meta-analyses for fall-related hospitalizations (2 RCTs 516 participants) showed no significant association between combined clinic- and patient-level quality improvement strategies and multifactorial assessment and treatment relative to usual care (OR, 0.78 ).Ĭonclusions and Relevance Exercise alone and various combinations of interventions were associated with lower risk of injurious falls compared with usual care. Network meta-analysis (including 54 RCTs, 41 596 participants, 39 interventions plus usual care) suggested that the following interventions, when compared with usual care, were associated with reductions in injurious falls: exercise (odds ratio, 0.51 absolute risk difference, −0.12 ) combined exercise and vision assessment and treatment (OR, 0.17 ARD, −0.38 ) combined exercise, vision assessment and treatment, and environmental assessment and modification (OR, 0.30 ARD, −0.23 ) and combined clinic-level quality improvement strategies (eg, case management), multifactorial assessment and treatment (eg, comprehensive geriatric assessment), calcium supplementation, and vitamin D supplementation (OR, 0.12 ARD, −0.17 ). Results A total of 283 RCTs (159 910 participants mean age, 78.1 years 74% women) were included after screening of 10 650 titles and abstracts and 1210 full-text articles. Main Outcomes and Measures Injurious falls and fall-related hospitalizations. Pairwise meta-analysis and network meta-analysis were conducted. Study Selection Randomized clinical trials (RCTs) of fall-prevention interventions for participants aged 65 years and older.ĭata Extraction and Synthesis Pairs of reviewers independently screened the studies, abstracted data, and appraised risk of bias. ![]() Reference lists of included studies were scanned. Objective To assess the potential effectiveness of interventions for preventing falls.ĭata Sources MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Ageline databases from inception until April 2017. Importance Falls result in substantial burden for patients and health care systems, and given the aging of the population worldwide, the incidence of falls continues to rise. ![]() Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.
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