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  • Are multi-factorial interventions effective in reducing falls in community-dwelling older adults? A systematic review and meta-analysis.

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  • Introduction: By 2050, the global population of older adults (≥65 years) is to reach two billion people. Annually, one in three older adults fall. Current international guidelines for falls prevention recommend personalised multifactorial interventions for community-dwelling older adults. However, the current evidence base is conflicting in terms of the effectiveness of multifactorial interventions in community-dwelling older adults.  

    Aim: To explore the totality of evidence relating to the effectiveness of multifactorial interventions in reducing the falls rate in community-dwelling older adults.

    Methods: A literature search of Cochrane, Web of Science, Scopus, PubMed, CINAHL and MEDLINE databases was carried out. Randomised-control-trials or cluster randomised-control-trials providing a multifactorial intervention to community-dwelling older adults were included, and quality assessed using the Cochrane Risk of Bias Tool. The primary outcome measured was falls rate. Secondary outcomes were measured at impairment, activity limitation and participation restriction level. Data was analysed using the Cochrane Review-Manager 5 Software.

    Results: Ten studies met the inclusion criteria for narrative synthesis, nine were included in the meta-analysis. Statistically significant effects favouring the intervention were not seen for falls rate (REM, MD=0.18, 95%CI -0.79 to 1.16, I2=88%, P=0.71). Statistically significant effects were only seen in terms of activity limitation (REM, MD=1.53, 95%CI 0.50 to 2.56, I2=0%, P=0.003) and falls risk (REM, MD=-0.37, 95%CI -0.64 to -0.10, I2=35%, P=0.007). Studies were of unclear to high risk of biases, with high levels of heterogeneity throughout.

    Conclusion: Multifactorial interventions can have a significant effect on the falls risk and activity limitation of community-dwelling older adults, but not on the falls rate. There is a need for higher quality research, with standardised interventions and outcome measures used across the research.

    Keywords: accidental fall, multifactorial intervention, older adult, systematic review


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