Population‐Based Interventions for Preventing Falls and Fall‐Related Injuries in Older People: A Cochrane Review
What did we do?
The aim of this project was to review and synthesise current evidence on the effectiveness of population-based interventions in preventing falls and related injuries among older people. These interventions are defined as community-wide initiatives aimed at changing societal, cultural, or environmental conditions that increase the risk of falling.
Why was this important?
Falls are an important issue among older adults, with about one-third of those aged 65 or older experiencing a fall each year. To address this, interventions can be designed at the population level rather than targeting individuals. These interventions involve various healthcare, social care, and community agencies working together to address the factors that increase the risk of falls.
How did we do it?
We conducted comprehensive searches in several databases. Selection criteria included:
- Randomised controlled trials (RCTs)
- Cluster RCTs
- Trials with stepped-wedge designs
- Non-randomised, controlled studies
These studies evaluated population-level interventions aimed at preventing falls and fall-related injuries in adults aged 60 years or older. We excluded studies focusing solely on individual level interventions, individuals at high risk of falling, those with specific comorbidities, or residents in institutional settings. We rated the quality of the studies.
What did we find?
We included nine studies: two cluster RCTs and seven non-randomised trials (five Controlled Before and After studies (CBAs) and two Controlled Interrupted Time Series (CITS)). The studies involved 1200 to 137,000 older adults, with durations ranging from 14 months to eight years. Most studies used hospital records for outcome data, while three used questionnaires, and one used both methods.
- One cluster RCT reported lower fall rates and fewer fall-related injuries in the intervention area, but no difference in fall-related fractures.
- Another cluster RCT found no difference in hospital admissions for falls.
- CBAs and CITS reported no significant differences in fall rates, number of fallers, or fall-related injuries/fractures.
We used GRADE to assess the certainty of evidence. Overall, there is very low-certainty evidence, and thus we cannot be sure if population-based multicomponent or nutrition and medication interventions effectively reduce falls and fall-related injuries in older adults. To improve the evidence base, future studies should focus on:
- Conducting methodologically robust cluster RCTs with large communities and sufficient clusters.
- Establishing a sampling rate for population-based studies to determine appropriate community sizes.
- Providing detailed descriptions of interventions to investigate the effectiveness of individual components, using the ProFaNE (Prevention of Falls Network Europe) taxonomy for consistency.
This approach will help clarify the effectiveness of these interventions and improve study comparability.
Who did we work with?
- Queen Mary University of London, UK
- Robert Bosch Hospital, Germany
- University of Manchester, UK
- University of New England, Australia
- University of Queensland, Australia
- West Sussex County Council, UK
Downloadable Resources
Contact Information
Programme Manager
Alison Littlewood
alison.j.littlewood@manchester.ac.uk