Fall prevention interventions for older
community-dwelling adults: systematic reviews on benefits, harms, and patient values and
preferences
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AbstractBackgroundAn estimated 20–30% of community-dwelling Canadian adults aged
65 years or older experience one or more falls each year. Fall-related injuries
are a leading cause of hospitalization and can lead to functional independence.
Many fall prevention interventions, often based on modifiable risk factors, have
been studied. Apart from the magnitude of the benefits and harms from different
interventions, the preferences of older adults for different interventions as
well as the relative importance they place on the different potential outcomes
may influence recommendations by guideline panels. These reviews on benefits and
harms of interventions, and on patient values and preferences, will inform the
Canadian Task Force on Preventive Health Care to develop recommendations on fall
prevention for primary care providers.MethodsTo review the benefits and harms of fall prevention interventions,
we will update a previous systematic review of randomized controlled trials with
adaptations to modify the classification of interventions and narrow the scope
to community-dwelling older adults and primary-care relevant interventions. Four
databases (MEDLINE, Embase, Cochrane Central Register of Controlled Trials,
Ageline), reference lists, trial registries, and relevant websites will be
searched, using limits for randomized trials and date (2016 onwards). We will
classify interventions according to the Prevention of Falls Network Europe
(ProFANE) Group’s taxonomy. Outcomes include fallers, falls, injurious falls,
fractures, hip fractures, institutionalization, health-related quality of life,
functional status, and intervention-related adverse effects. For studies not
included in the previous review, screening, study selection, data extraction on
outcomes, and risk of bias assessments will be independently undertaken by two
reviewers with consensus used for final decisions. Where quantitative analysis
is suitable, network or pairwise meta-analysis will be conducted using a
frequentist approach in Stata. Assessment of the transitivity and coherence of
the network meta-analyses will be undertaken. For the reviews on patient
preferences and outcome valuation (relative importance of outcomes), we will
perform de novo reviews with searches in three databases (MEDLINE, PsycInfo, and
CINAHL) and reference lists for cross-sectional, longitudinal quantitative, or
qualitative studies published from 2000. Selection, data extraction, and risk of
bias assessments suitable for each study design will be performed in duplicate.
The analysis will be guided by a narrative synthesis approach, which may include
meta-analysis for health-state utilities. We will use the CINeMa approach to a
rate the certainty of the evidence for outcomes on intervention effects analyzed
using network meta-analysis and the GRADE approach for all other
outcomes.DiscussionWe will describe the flow of literature and characteristics of all
studies and present results of all analyses and summary of finding tables. We
will compare our findings to others and discuss the limitations of the reviews
and the available literature.Systematic review registrationThis protocol has not been registered.
