Older people’s participation in falls prevention interventions in institutional settings: A supplement to the Cochrane Systematic Review

This source preferred by Samuel Nyman

Authors: Nyman, S.R. and Victor, C.R.

http://www.fallsbonehealth.ukevents.org/index.html

Start date: 9 September 2011

Introduction Low uptake and adherence from participants can threaten the effectiveness of interventions, but little is known about the issue in regard to falls prevention. Therefore, we conducted a review to collate the evidence on older people’s participation and engagement in falls prevention interventions.

Methodology The Cochrane systematic reviews of randomised controlled trials (RCTs) to prevent falls among older people have been recently updated and separated into those conducted in community and institutional settings. We supplemented the latter (Cameron et al., 2010) by re-analysing all of the 41 RCTs conducted in hospitals and nursing care facilities on four outcome variables: 1) recruitment into the RCT, 2) attrition from the RCT at 12 months, 3) adherence to the intervention, and 4) any tests for whether adherence moderated the effect of the intervention on falls. Descriptive statistics were conducted using medians, ranges, and interquartile ranges.

Results The median recruitment rate was 48.5% (38.9% - 84.5%). At 12 months the median attrition rate was 10.4% (3.9 – 12.3%, n = 10) or with the inclusion of mortality 16.2% (9.5 – 17.1%, n = 11). High adherence rates were reported for exercise that was home-based (e.g. 89% for physical therapy) and group-based (72% - 88%), and for medication interventions (68% - 88%). For multifactorial interventions, adherence rates varied widely from 11% for attending 60+/88 of exercise classes to 93% for use / repairs of aids. Tests for whether adherence moderated the effect of interventions was reported in six studies in nursing care facilities, of which three reported significant results in relation to medication and multifactorial interventions.

Conclusion(s) Median rates for recruitment (50%), attrition (15%), and adherence (80%), suggested that by 12 months, on average, only a third of nursing care facility residents are likely to be adhering to falls prevention interventions.

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