Primary care-relevant interventions to prevent falling in older adults: a systematic evidence review for the U.S. Preventive Services Task Force.

摘要

BACKGROUND: Falls among older adults are both prevalent and preventable. PURPOSE: To describe the benefits and harms of interventions that could be used by primary care practitioners to prevent falling among community-dwelling older adults. DATA SOURCES: The reviewers evaluated trials from a good-quality systematic review published in 2003 and searched MEDLINE, the Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and CINAHL from the end of that review's search date to February 2010 to identify additional English-language trials. STUDY SELECTion: Two reviewers independently screened 3423 abstracts and 638 articles to identify randomized, controlled trials (RCTs) of primary care-relevant interventions among community-dwelling older adults that reported falls or fallers as an outcome. Trials were independently critically appraised to include only good- or fair-quality trials; discrepancies were resolved by a third reviewer. DATA EXTRACTION: One reviewer abstracted data from 61 articles into standardized evidence tables that were verified by a second reviewer. DATA SYNTHESIS: Overall, the included evidence was of fair quality. In 16 RCTs evaluating exercise or physical therapy, interventions reduced falling (risk ratio, 0.87 [95% CI, 0.81 to 0.94]). In 9 RCTs of vitamin D supplementation, interventions reduced falling (risk ratio, 0.83 [CI, 0.77 to 0.89]). In 19 trials involving multifactorial assessment and management, interventions with comprehensive management seemed to reduce falling, although overall pooled estimates were not statistically significant (risk ratio, 0.94 [CI, 0.87 to 1.02]). Limited evidence suggested that serious clinical harms were no more common for older adults in intervention groups than for those in control groups. Limitations: Interventions and methods of fall ascertainment were heterogeneous. Data on potential harms of interventions were scant and often not reported. CONCLUSION: Primary care-relevant interventions exist that can reduce falling among community-dwelling older adults. PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality.