Several strategies appear to be effective in preventing falls in community-living elders

Référence

Dautzenberg L, Beglinger S, Tsokani S, et al. Interventions for preventing falls and fall-related fractures in community-dwelling older adults: A systematic review and network meta-analysis. J Am Geriatr Soc 2021;69(10):2973-2984.

Sommaire

These authors searched several databases and registries to identify randomized trials of various fall-prevention strategies for community dwelling persons aged at least 65 years. Two authors independently evaluated studies for inclusion and assessed their risk of bias; a third party resolved disagreements. The authors conducted a network meta-analysis (NMA) to assess the relative effectiveness of the various interventions. Ultimately, they identified 220 studies. Of those, 192 (98,388 participants) reported data in a manner suitable to the NMA. The studies evaluated 14 different categories of intervention, either singly or in combination. Most of the studies were at moderate to high risk of bias. Based on the NMA, the following were most strongly associated with a reduction in the number of people who fell: a combination of assistive technology and basic falls risk assessment; a combination of assistive technology and quality improvement strategies; standing on a whole-body vibration platform; and a combination of home modification, assistive technology, quality improvement strategies, management of orthostatic hypotension, and basic falls risk assessment. The authors also used the data to disentangle the individual effects of interventions and report that whole-body vibration (relative risk [RR] 0.61; 95% CI 0.42 - 0.90) and exercise (gait, balance, flexibility, and strength training; Tai Chi; Qigong, and so forth; RR 0.92; 0.88 - 0.97) were the only effective individual approaches. Managing urinary incontinence increased the number of persons who fell (RR 1.39; 1.08 - 1.79), which is not surprising in light of the potential for hazardous medication use. The authors did several subgroup analyses, but the most important one looked at fall-related fractures. Only basic falls risk assessment (RR 0.60; 0.39 - 0.94) and exercise (RR 0.62; 0.42 - 0.90) decreased the number of fall-related fractures, while assistive devices actually increased the number of fall-related fractures (RR 1.66; 1.07 - 2.59).