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Age and Ageing Sep 2022our aim was to assess the effectiveness of medication review and deprescribing interventions as a single intervention in falls prevention. (Meta-Analysis)
Meta-Analysis
BACKGROUND
our aim was to assess the effectiveness of medication review and deprescribing interventions as a single intervention in falls prevention.
DESIGN
systematic review and meta-analysis.
DATA SOURCES
Medline, Embase, Cochrane CENTRAL, PsycINFO until 28 March 2022.
ELIGIBILITY CRITERIA
randomised controlled trials of older participants comparing any medication review or deprescribing intervention with usual care and reporting falls as an outcome.
STUDY RECORDS
title/abstract and full-text screening by two reviewers.
RISK OF BIAS
Cochrane Collaboration revised tool.
DATA SYNTHESIS
results reported separately for different settings and sufficiently comparable studies meta-analysed.
RESULTS
forty-nine heterogeneous studies were included.
COMMUNITY
meta-analyses of medication reviews resulted in a risk ratio (RR) of 1.05 (95% confidence interval, 0.85-1.29, I2 = 0%, 3 studies(s)) for number of fallers, in an RR = 0.95 (0.70-1.27, I2 = 37%, 3 s) for number of injurious fallers and in a rate ratio (RaR) of 0.89 (0.69-1.14, I2 = 0%, 2 s) for injurious falls.
HOSPITAL
meta-analyses assessing medication reviews resulted in an RR = 0.97 (0.74-1.28, I2 = 15%, 2 s) and in an RR = 0.50 (0.07-3.50, I2 = 72% %, 2 s) for number of fallers after and during admission, respectively.
LONG-TERM CARE
meta-analyses investigating medication reviews or deprescribing plans resulted in an RR = 0.86 (0.72-1.02, I2 = 0%, 5 s) for number of fallers and in an RaR = 0.93 (0.64-1.35, I2 = 92%, 7 s) for number of falls.
CONCLUSIONS
the heterogeneity of the interventions precluded us to estimate the exact effect of medication review and deprescribing as a single intervention. For future studies, more comparability is warranted. These interventions should not be implemented as a stand-alone strategy in falls prevention but included in multimodal strategies due to the multifactorial nature of falls.PROSPERO registration number: CRD42020218231.
Topics: Deprescriptions; Exercise; Hospitals; Humans; Medication Review
PubMed: 36153749
DOI: 10.1093/ageing/afac191 -
Sensors (Basel, Switzerland) Sep 2022Falls have been recognized as the major cause of accidental death and injury in people aged 65 and above. The timely prediction of fall risks can help identify older... (Review)
Review
Falls have been recognized as the major cause of accidental death and injury in people aged 65 and above. The timely prediction of fall risks can help identify older adults prone to falls and implement preventive interventions. Recent advancements in wearable sensor-based technologies and big data analysis have spurred the development of accurate, affordable, and easy-to-use approaches to fall risk assessment. The objective of this study was to systematically assess the current state of wearable sensor-based technologies for fall risk assessment among community-dwelling older adults. Twenty-five of 614 identified research articles were included in this review. A comprehensive comparison was conducted to evaluate these approaches from several perspectives. In general, these approaches provide an accurate and effective surrogate for fall risk assessment. The accuracy of fall risk prediction can be influenced by various factors such as sensor location, sensor type, features utilized, and data processing and modeling techniques. Features constructed from the raw signals are essential for predictive model development. However, more investigations are needed to identify distinct, clinically interpretable features and develop a general framework for fall risk assessment based on the integration of sensor technologies and data modeling.
Topics: Aged; Humans; Independent Living; Risk Assessment; Wearable Electronic Devices
PubMed: 36146103
DOI: 10.3390/s22186752 -
BMC Musculoskeletal Disorders Sep 2022Falls in older adults are a significant and growing public health concern. There are multiple risk factors associated with falls that may be addressed within the scope...
BACKGROUND
Falls in older adults are a significant and growing public health concern. There are multiple risk factors associated with falls that may be addressed within the scope of chiropractic training and licensure. Few attempts have been made to summarize existing evidence on multimodal chiropractic care and fall risk mitigation. Therefore, the broad purpose of this review was to summarize this research to date. BODY: Systematic review was conducted following PRISMA guidelines. Databases searched included PubMed, Embase, Cochrane Library, PEDro, and Index of Chiropractic Literature. Eligible study designs included randomized controlled trials (RCT), prospective non-randomized controlled, observational, and cross-over studies in which multimodal chiropractic care was the primary intervention and changes in gait, balance and/or falls were outcomes. Risk of bias was also assessed using the 8-item Cochrane Collaboration Tool. The original search yielded 889 articles; 21 met final eligibility including 10 RCTs. One study directly measured the frequency of falls (underpowered secondary outcome) while most studies assessed short-term measurements of gait and balance. The overall methodological quality of identified studies and findings were mixed, limiting interpretation regarding the potential impact of chiropractic care on fall risk to qualitative synthesis.
CONCLUSION
Little high-quality research has been published to inform how multimodal chiropractic care can best address and positively influence fall prevention. We propose strategies for building an evidence base to inform the role of multimodal chiropractic care in fall prevention and outline recommendations for future research to fill current evidence gaps.
Topics: Aged; Humans; Accidental Falls; Chiropractic; Gait; Controlled Clinical Trials as Topic
PubMed: 36064383
DOI: 10.1186/s12891-022-05783-y -
Frontiers in Endocrinology 2022Falls occur frequently among older individuals, leading to high morbidity and mortality. This study was to assess the efficacy of vitamin D in preventing older... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Falls occur frequently among older individuals, leading to high morbidity and mortality. This study was to assess the efficacy of vitamin D in preventing older individuals from falling.
METHODS
We searched the PubMed, Cochrane Library, and EMBASE databases systematically using the keywords "vitamin D" and "fall" for randomized controlled trials (RCTs) comparing the effects of vitamin D with or without calcium supplements with those of a placebo or no treatment on fall incidence in adults older than 50 years. A meta-analysis was performed to calculate risk ratios (RRs), absolute risk differences (ARDs) and 95% CIs with random-effects models.
RESULTS
A total of 38 RCTs involving 61 350 participants fulfilled the inclusion criteria. Compared with placebo, high-dose vitamin D (≥ 700 IU) can prevent falls [RR, 0.87 (95% CI 0.79 to 0.96); ARD, -0.06 (95% CI, -0.10 to -0.02)]. Low-dose vitamin D (<700 IU) was not significantly associated with falls. Subgroup analysis showed that supplemental calcium, 25(OH) D concentration and frequency influenced the effect of vitamin D in preventing falls. Sensitivity analysis showed that vitamin D prevented falls, which was consistent with the primary analysis. In addition, the active form of vitamin D also prevented falls.
CONCLUSION
In this meta-analysis of RCTs, doses of 700 IU to 2000 IU of supplemental vitamin D per day were associated with a lower risk of falling among ambulatory and institutionalized older adults. However, this conclusion should be cautiously interpreted, given the small differences in outcomes.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/, identifier CRD42020179390.
Topics: Accidental Falls; Aged; Calcium; Dietary Supplements; Humans; Vitamin D; Vitamins
PubMed: 36034418
DOI: 10.3389/fendo.2022.919839 -
BMC Geriatrics Jul 2022After a fall, more than half of older people living alone are unable to get up or get help independently. Fall-related recumbency makes affected individuals aware of... (Review)
Review
BACKGROUND
After a fall, more than half of older people living alone are unable to get up or get help independently. Fall-related recumbency makes affected individuals aware of functional status limitations and increased vulnerability. Patient-centered therapy is needed to manage physical, psychological, and social needs. This review summarizes the current evidence on care options for the special patient population.
METHODS
The scoping review used the six-step framework proposed by Arksey and O´Malley and was conducted in accordance with the modified Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework for scoping reviews. The literature searches were conducted in five databases and ten online archives. Articles were screened, assessed and selected using defined inclusion and exclusion criteria. Articles were included if they were published in either German or English and related to the care of long lies. Thematic synthesis was based on the literature review.
RESULTS
The search yielded 1047 hits, of which 19 research papers were included. Two themes were identified: (1) acute therapy, focused on prolonged recumbency and pronounced physical effects; and (2) preventive therapy, which examined standing up training, technical aids, and social control systems in the context of fall management.
CONCLUSIONS
There are a limited number of interventions that relate to the patient population. The interventions are predominantly presented independently, so there is a lack of structuring of the interventions in the form of a treatment pathway. In addition to pooling professional expertise and an interprofessional approach, it is important to continue inpatient treatment in the home setting, even though the effectiveness of interventions in a home setting has hardly been verified thus far. The solution for a missing treatment process is first of all a planned, interprofessional and intersectoral approach in therapy.
Topics: Accidental Falls; Aged; Hospitalization; Humans
PubMed: 35840883
DOI: 10.1186/s12877-022-03258-2 -
Frontiers in Physiology 2022Age-related decreases in physical activity (PA) and a decline in physical functioning lead to increased fall risk. As falls are a major cause of accidental deaths and...
Age-related decreases in physical activity (PA) and a decline in physical functioning lead to increased fall risk. As falls are a major cause of accidental deaths and hospitalization in older adults, PA promotion and fall prevention are important measures, especially in nursing homes (NH). With advances in information and communication technology, e- and m-health solutions have been developed to positively influence various health-related factors. To date, only little research exists on the implementation of these technologies to promote health in NH. Therefore, the objective of this systematic review was to provide an overview of the effectiveness, acceptability, and feasibility of e- and m-health interventions aimed at promoting PA and preventing falls in NH. Additionally, the effectiveness of such interventions regarding the secondary outcomes physical function, cognitive function, neuropsychiatric symptoms, and psychosocial status was examined. A systematic literature search was performed in five databases and studies published until 15 November 2021, were considered for inclusion. All studies that examined the effectiveness and/or the acceptability and feasibility of e- or m-health interventions in promoting PA and preventing falls in NH, without restriction on language or date of publication, were included in the final synthesis. Of the 1,358 records retrieved, 28 studies were included in this systematic review. Twenty-four studies contained digital exergaming as an intervention or as a part of the intervention, the four additional studies on e-health interventions only examined a small number of outcomes. No m-health intervention study was identified. Data synthesis indicates that exergaming may be effective in reducing the number of falls and fall risk in NH residents. Several significant improvements were also reported regarding secondary outcomes albeit not consistent across studies. No conclusion can be drawn about the effects of exergaming and other e-health interventions on PA, as data is scarce. E-health interventions were mostly reported as feasible and well accepted by NH residents. However, these findings may not be applicable to NH residents with advanced physical and/or cognitive impairments, since they were excluded in many studies. Therefore, more research examining other digital solutions besides exergaming to promote PA in this specific population is critical. https://www.crd.york.ac.uk/prospero/, identifier CRD42021289488.
PubMed: 35669573
DOI: 10.3389/fphys.2022.894397 -
International Journal of Environmental... May 2022Sports participation by children and adolescents often results in injuries. Therefore, injury prevention warm-up programs are imperative for youth sports safety. The... (Meta-Analysis)
Meta-Analysis Review
Sports participation by children and adolescents often results in injuries. Therefore, injury prevention warm-up programs are imperative for youth sports safety. The purpose of this paper was to assess the effectiveness of Warm-up Intervention Programs (WIP) on upper and lower limb sports injuries through a systematic review and meta-analysis. Searches for relevant studies were performed on PubMed, EMBASE, Web of Science, SPORTDiscus, and Cochrane databases. Studies selected met the following criteria: original data; analytic prospective design; investigated a WIP and included outcomes for injury sustained during sports participation. Two authors assessed the quality of evidence using Furlan’s criteria. Comprehensive Meta-Analysis 3.3 software was used to process and analyze the outcome indicators of the literature. Across fifteen studies, the pooled point estimated injury rate ratio (IRR) was 0.64 (95% CI = 0.54−0.75; 36% reduction) while accounting for hours of risk exposure. Publication bias assessment suggested a 6% reduction in the estimate (IRR = 0.70, 95% CI = 0.60−0.82), and the prediction interval intimated that any study estimate could still fall between 0.34 and 1.19. Subgroup analyses identified one significant moderator that existed in the subgroup of compliance (p < 0.01) and might be the source of heterogeneity. Compared with the control group, WIPs significantly reduced the injury rate ratio of upper and lower limb sports injuries in children and adolescents.
Topics: Accidental Falls; Adolescent; Athletic Injuries; Child; Humans; Prospective Studies; Warm-Up Exercise; Youth Sports
PubMed: 35627873
DOI: 10.3390/ijerph19106336 -
Age and Ageing May 2022Falls remain a common and debilitating problem in hospitals worldwide. The aim of this study was to investigate the effects of falls prevention interventions on falls... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Falls remain a common and debilitating problem in hospitals worldwide. The aim of this study was to investigate the effects of falls prevention interventions on falls rates and the risk of falling in hospital.
DESIGN
Systematic review and meta-analysis.
PARTICIPANTS
Hospitalised adults.
INTERVENTION
Prevention methods included staff and patient education, environmental modifications, assistive devices, policies and systems, rehabilitation, medication management and management of cognitive impairment. We evaluated single and multi-factorial approaches.
OUTCOME MEASURES
Falls rate ratios (rate ratio: RaR) and falls risk, as defined by the odds of being a faller in the intervention compared to control group (odds ratio: OR).
RESULTS
There were 43 studies that satisfied the systematic review criteria and 23 were included in meta-analyses. There was marked heterogeneity in intervention methods and study designs. The only intervention that yielded a significant result in the meta-analysis was education, with a reduction in falls rates (RaR = 0.70 [0.51-0.96], P = 0.03) and the odds of falling (OR = 0.62 [0.47-0.83], P = 0.001). The patient and staff education studies in the meta-analysis were of high quality on the GRADE tool. Individual trials in the systematic review showed evidence for clinician education, some multi-factorial interventions, select rehabilitation therapies, and systems, with low to moderate risk of bias.
CONCLUSION
Patient and staff education can reduce hospital falls. Multi-factorial interventions had a tendency towards producing a positive impact. Chair alarms, bed alarms, wearable sensors and use of scored risk assessment tools were not associated with significant fall reductions.
Topics: Humans; Cognitive Dysfunction; Exercise; Hospitals; Risk Assessment; Accidental Falls
PubMed: 35524748
DOI: 10.1093/ageing/afac077 -
Injury Prevention : Journal of the... Aug 2022Alcohol and other drug (AOD) use is a key preventable risk factor for serious injuries. Prevention strategies to date have largely focused on transport injuries, despite...
BACKGROUND
Alcohol and other drug (AOD) use is a key preventable risk factor for serious injuries. Prevention strategies to date have largely focused on transport injuries, despite AOD use being a significant risk factor for other injury causes, including falls. This systematic review aimed to report the prevalence of AOD use in patients presenting to hospital for fall-related injuries.
METHODS
This systematic review includes studies published in English after the year 2010 that objectively measured the prevalence of AOD use in patients presenting to hospital for a fall-related injury. Screening, data extraction and risk of bias assessments were completed by two independent reviewers. Data were presented using narrative synthesis and, where appropriate, meta-analyses.
RESULTS
A total of 12 707 records were screened. Full texts were retrieved for 2042 records, of which 29 were included. Four studies reported the combined prevalence of any alcohol and/or drug use, generating a pooled prevalence estimate of 37% (95% CI 25% to 49%). Twenty-two records reported on the prevalence of acute alcohol use alone and nine reported specifically on the prevalence of drugs other than alcohol, with prevalence ranging from 2% to 57% and 7% to 46%, respectively. The variation in prevalence estimates likely resulted from differences in toxicology testing methods across studies.
CONCLUSIONS
AOD exposure was common in hospitalised fall-related injuries. However, research addressing prevalence across different types of falls and the use of drugs other than alcohol was limited. Future research should address these areas to improve our understanding of which populations should be targeted in AOD and injury prevention strategies .
PROSPERO REGISTRATION NUMBER
CRD42020188746.
Topics: Accidental Falls; Alcohol Drinking; Hospitals; Humans; Prevalence; Substance-Related Disorders
PubMed: 35508365
DOI: 10.1136/injuryprev-2021-044513 -
BMC Geriatrics Apr 2022Comprehensive geriatric assessment (CGA) addresses the bio-psycho-social needs of older adults through multidimensional assessments and management. Synthesising evidence...
Health outcomes and implementation barriers and facilitators of comprehensive geriatric assessment in community settings: a systematic integrative review [PROSPERO registration no.: CRD42021229953].
BACKGROUND
Comprehensive geriatric assessment (CGA) addresses the bio-psycho-social needs of older adults through multidimensional assessments and management. Synthesising evidence on quantitative health outcomes and implementation barriers and facilitators would inform practice and policy on CGA for community-dwelling older adults.
METHODS
We systematically searched four medical and social sciences electronic databases for quantitative, qualitative, and mixed methods studies published from 1 January 2000 to 31 October 2020. Due to heterogeneity of articles, we narratively reviewed the synthesis of evidence on health outcomes and implementation barriers and facilitators.
RESULTS
We screened 14,151 titles and abstracts and 203 full text articles, and included 43 selected articles. Study designs included controlled intervention studies (n = 31), pre-post studies without controls (n = 4), case-control (n = 1), qualitative methods (n = 3), and mixed methods (n = 4). A majority of articles studied populations aged ≥75 years (n = 18, 42%). CGAs were most frequently conducted in the home (n = 25, 58%) and primary care settings (n = 8, 19%). CGAs were conducted by nurses in most studies (n = 22, 51%). There was evidence of improved functional status (5 of 19 RCTs, 2 of 3 pre-post), frailty and fall outcomes (3 of 6 RCTs, 1 of 1 pre-post), mental health outcomes (3 of 6 RCTs, 2 of 2 pre-post), self-rated health (1 of 6 RCTs, 1 of 1 pre-post), and quality of life (4 of 17 RCTs, 3 of 3 pre-post). Barriers to implementation of CGAs involved a lack of partnership alignment and feedback, poor acceptance of preventive work, and challenges faced by providers in operationalising and optimising CGAs. The perceived benefits of CGA that served to facilitate its implementation included the use of highly skilled staff to provide holistic assessments and patient education, and the resultant improvements in care coordination and convenience to the patients, particularly where home-based assessments and management were performed.
CONCLUSION
There is mixed evidence on the quantitative health outcomes of CGA on community-dwelling older adults. While there is perceived positive value from CGA when carried out by highly skilled staff, barriers such as bringing providers into a partnership, greater acceptance of preventive care, and operational issues could impede its implementation.
Topics: Accidental Falls; Aged; Geriatric Assessment; Humans; Independent Living; Outcome Assessment, Health Care; Quality of Life
PubMed: 35488198
DOI: 10.1186/s12877-022-03024-4