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Multi-component fall prevention interventions for older adults

Health Factors: Quality of Care Community Safety
Decision Makers: Federal Government Healthcare Professionals & Advocates Public Health Professionals & Advocates
Evidence Rating: Scientifically Supported
Population Reach: 10-19% of WI's population
Impact on Disparities: No impact on disparities likely

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Description

Health care providers, such as primary care physicians and physical therapists, often deliver a fixed, multi-component set of fall prevention interventions to older adults living in community settings, as well as long-term care or clinical settings (Goodwin 2014). Interventions can be provided without individual risk assessments and typically include various combinations of exercise (i.e., balance, strength, and endurance training), education, home or environmental modification, medication management, and vitamin D supplementation (Goodwin 2014). Fall prevention efforts are covered as part of the Medicare Annual Wellness Visit (Van Voast Moncada 2017); providers may also connect patients to local fall prevention programs (Phelan 2015). Falls can lead to physical injuries with long lasting effects, increased risk of early death, and psychological concerns such as fear of falling and loss of confidence (CDC-Falls, Cochrane-Gillespie 2012).

Expected Beneficial Outcomes

Reduced falls
Reduced injuries

Evidence of Effectiveness

There is strong evidence that multi-component fall prevention interventions reduce the rate of falls and the risk of falling among older adults (Tricco 2017, Stubbs 2015, Goodwin 2014, Cochrane-Gillespie 2012). 

Multi-component interventions have been shown to reduce falls in community and clinical settings (Goodwin 2014). Such efforts can reduce the rate and risk of falls for older adults who live independently in the community, and may also benefit those living in care facilities (Guo 2014, Goodwin 2014). Including an exercise component, particularly exercises that improve balance, may further reduce fall rates (Tricco 2017, Goodwin 2014). Combining exercise and vision assessments with treatment may reduce injury rates (Tricco 2017).

Multi-component interventions tailored to individual’s needs have consistently been shown to reduce falls for older adults in community settings (Stubbs 2015). Interventions that include home visits and correct home hazards also reduce fall risk for community-dwelling older adults without cognitive impairments (Guo 2014). Multi-component interventions that include calcium and vitamin D supplements have been shown to reduce falls (Tricco 2017, Guo 2014) and fractures for older adults in community settings (Tricco 2017).

Exercise-related multi-component interventions in care facilities benefit patients with cognitive impairments more than those without impairments (Guo 2014).

Implementation

United States

The National Council on Aging’s National Falls Prevention Resource Center supports fall prevention programs across the country and coordinates the Falls Free Initiative, which includes 43 state-level coalitions (NCOA-Falls prevention). The Centers for Disease Control and Prevention’s (CDC’s) older adult fall prevention program, STEADI (Stopping Elderly Accidents, Deaths, & Injuries), provides tools and educational materials for patients and providers on how to prevent falls (CDC-STEADI).

A Matter of Balance is a nationally recognized fall prevention program for older adults that teaches participants how to reduce their fall risk at home through exercises to improve strength and balance (MaineHealth-MOB).

Wisconsin

In 1991, the Wisconsin Falls Prevention Initiative (FPI) was developed to reduce falls and fall-related complications across the state. FPI includes health care providers, educators, researchers, organizations serving older adults, social service professionals, and state government officials. FPI promotes implementation of tested fall prevention interventions, including Stepping On, a multi-component, community-based workshop to help older adults develop specific knowledge and skills to prevent falls (WI DHS-Falls).

A Matter of Balance is offered in Wisconsin; information about specific programs is available through county and tribal aging offices (WIHA-MOB).

Implementation Resources

CDC-Fall guide - National Center for Injury Prevention and Control (NCIPC). Preventing falls: A guide to implementing effective community-based fall prevention programs. 2nd edition. Atlanta: Centers for Disease Control and Prevention (CDC). 2015. Accessed on April 3, 2018
CDC-STEADI - Centers for Disease Control and Prevention (CDC). STEADI (Stopping Elderly Accidents, Deaths & Injuries) tools for health care providers and patients. Accessed on April 3, 2018
CDC-Stevens 2015 - Stevens JA, Burns ER. CDC compendium of effective fall interventions: What works for community-dwelling older adults. 3rd edition. Atlanta: Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control (NCIPC). 2015. Accessed on April 3, 2018
IHI-TCAB - Institute for Healthcare Improvement (IHI). Transforming Care at the Bedside how-to guide: Reducing patient injuries from falls. Accessed on April 3, 2018
NCOA-Falls prevention - National Council on Aging (NCOA). National falls prevention resource center. Accessed on April 3, 2018

Citations - Description

CDC-Falls - Centers for Disease Control and Prevention (CDC). Older adult falls. Accessed on April 3, 2018
Cochrane-Gillespie 2012* - Gillespie LD, Robertson MC, Gillespie WJ, et al. Interventions for preventing falls in older people living in the community: Review. The Cochrane Database of Systematic Reviews. 2012;(9):CD007146. Accessed on April 3, 2018
Goodwin 2014 - Goodwin VA, Abbott RA, Whear R, et al. Multiple component interventions for preventing falls and fall-related injuries among older people: Systematic review and meta-analysis. BMC Geriatrics. 2014;14:15. Accessed on April 3, 2018
Phelan 2015 - Phelan EA, Mahoney JE, Voit JC, Stevens JA. Assessment and management of fall risk in primary care settings. Medical Clinics of North America. 2015;99(2):281-293. Accessed on April 3, 2018
Van Voast Moncada 2017* - Van Voast Moncada L, Mire LG. Preventing falls in older persons. American Family Physician. 2017;96(4):240-247. Accessed on April 3, 2018

Citations - Evidence

Cochrane-Gillespie 2012* - Gillespie LD, Robertson MC, Gillespie WJ, et al. Interventions for preventing falls in older people living in the community: Review. The Cochrane Database of Systematic Reviews. 2012;(9):CD007146. Accessed on April 3, 2018
Goodwin 2014 - Goodwin VA, Abbott RA, Whear R, et al. Multiple component interventions for preventing falls and fall-related injuries among older people: Systematic review and meta-analysis. BMC Geriatrics. 2014;14:15. Accessed on April 3, 2018
Guo 2014* - Guo JL, Tsai YY, Liao JY, Tu HM, Huang CM. Interventions to reduce the number of falls among older adults with/without cognitive impairment: An exploratory meta-analysis. International Journal of Geriatric Psychiatry. 2014;29(7):661-669. Accessed on April 3, 2018
Stubbs 2015* - Stubbs B, Brefka S, Denkinger MD. What works to prevent falls in community-dwelling older adults? Umbrella review of meta-analyses of randomized controlled trials. Physical Therapy. 2015;95(8):1095-1110. Accessed on April 3, 2018
Tricco 2017* - Tricco AC, Thomas SM, Veroniki AA, et al. Comparisons of interventions for preventing falls in older adults: A systematic review and meta-analysis. JAMA. 2017;318(17):1687-1699. Accessed on April 3, 2018

Citations - Implementation

CDC-STEADI - Centers for Disease Control and Prevention (CDC). STEADI (Stopping Elderly Accidents, Deaths & Injuries) tools for health care providers and patients. Accessed on April 3, 2018
MaineHealth-MOB - MaineHealth. A Matter of Balance (MOB): reduce the fear of falling and increase activity levels among older adults. Accessed on April 3, 2018
NCOA-Falls prevention - National Council on Aging (NCOA). National falls prevention resource center. Accessed on April 3, 2018
WI DHS-Falls - Wisconsin Department of Health Services (WI DHS). Falls prevention for older adults. Accessed on April 3, 2018
WIHA-MOB - Wisconsin Institute for Healthy Aging (WIHA). A Matter of Balance (MOB): reduce the fear of falling and increase activity levels among older adults. Accessed on April 3, 2018

Page Last Updated

March 26, 2018

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