Quality improvement strategies to prevent falls in older adults: a systematic review and network meta-analysis Journal Articles uri icon

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  • BACKGROUND: Falls are a common occurrence and the most effective quality improvement (QI) strategies remain unclear. METHODS: We conducted a systematic review and network meta-analysis (NMA) to elucidate effective quality improvement (QI) strategies for falls prevention. Multiple databases were searched (inception-April 2017). We included randomised controlled trials (RCTs) of falls prevention QI strategies for participants aged ≥65 years. Two investigators screened titles and abstracts, full-text articles, conducted data abstraction and appraised risk of bias independently. RESULTS: A total of 126 RCTs including 84,307 participants were included after screening 10,650 titles and abstracts and 1210 full-text articles. NMA including 29 RCTs and 26,326 patients found that team changes was statistically superior in reducing the risk of injurious falls relative to usual care (odds ratio [OR] 0.57 [0.33 to 0.99]; absolute risk difference [ARD] -0.11 [95% CI, -0.18 to -0.002]). NMA for the outcome of number of fallers including 61 RCTs and 40 128 patients found that combined case management, patient reminders and staff education (OR 0.18 [0.07 to 0.47]; ARD -0.27 [95% CI, -0.33 to -0.15]) and combined case management and patient reminders (OR, 0.36 [0.13 to 0.97]; ARD -0.19 [95% CI, -0.30 to -0.01]) were both statistically superior compared to usual care. CONCLUSIONS: Team changes may reduce risk of injurious falls and a combination of case management, patient reminders, and staff education, as well as case management and patient reminders may reduce risk of falls. Our results can be tailored to decision-maker preferences and availability of resources. SYSTEMATIC REVIEW REGISTRATION: PROSPERO (CRD42013004151).


  • Tricco, Andrea C
  • Thomas, Sonia M
  • Veroniki, Areti Angeliki
  • Hamid, Jemila S
  • Cogo, Elise
  • Strifler, Lisa
  • Khan, Paul A
  • Sibley, Kathryn M
  • Robson, Reid
  • MacDonald, Heather
  • Riva, John
  • Thavorn, Kednapa
  • Wilson, Charlotte
  • Holroyd-Leduc, Jayna
  • Kerr, Gillian D
  • Feldman, Fabio
  • Majumdar, Sumit R
  • Jaglal, Susan B
  • Hui, Wing
  • Straus, Sharon E

publication date

  • May 1, 2019