TY - JOUR
T1 - Non-pharmacological interventions to prevent falls in older patients
T2 - Clinical practice recommendations – the SENATOR ONTOP Series
AU - Rimland, J. M.
AU - Abraha, I.
AU - Dell'Aquila, G.
AU - Cruz-Jentoft, A.
AU - Soiza, R. L.
AU - Gudmundsson, A.
AU - Petrovic, M.
AU - O'Mahony, D.
AU - Cherubini, A.
N1 - This work was supported by the European Union Seventh Framework program (FP7/2007–2013) under grant agreement no 305930 (SENATOR; http://www.senator-project.eu/) and by the ICT PSP (Policy Support Program) as part of the Competitiveness and Innovation Framework Program of the EU under grant agreement no 325087 (ProFouND; http://profound.eu.com/). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
PY - 2017/11/1
Y1 - 2017/11/1
N2 - Objectives To develop explicit evidence-based recommendations for non-pharmacological interventions to prevent falls in older subjects using the GRADE approach to rate the quality of evidence and the strength of recommendations. Methods A multidisciplinary panel was constituted composed of geriatricians, a research nurse and a clinical epidemiologist. The GRADE approach was used to rate the evidence and to formulate recommendations. Results The critical outcomes were fall rate and number of fallers. Forty-five clinical questions and the associated recommendations were formulated for single, multiple and multifactorial non-pharmacological interventions in three different settings (home, care facilities and hospitals). Seven strong recommendations in favour, and one strong recommendation against, were formulated, all of which were supported by moderate-quality evidence. The remaining 37 clinical questions had weak recommendations. A strong recommendation was formulated in favour of exercise, as a single component, in groups and individually, for community-dwelling older people. Tai Chi was strongly recommended for older adults at risk of falling, living at home. Home safety assessment and modification was strongly recommended for older adults living at home and at high risk of falling. Multifactorial interventions were strongly recommended for older adults, at high risk of falling, living at home and, in older adults in care facilities and hospitals, while knowledge/education alone was strongly recommended against for older people at home. Conclusions Based on a systematic review of the evidence, 45 recommendations were formulated regarding non-pharmacological interventions to prevent falls in older adults living at home, in care facilities and in hospitals.
AB - Objectives To develop explicit evidence-based recommendations for non-pharmacological interventions to prevent falls in older subjects using the GRADE approach to rate the quality of evidence and the strength of recommendations. Methods A multidisciplinary panel was constituted composed of geriatricians, a research nurse and a clinical epidemiologist. The GRADE approach was used to rate the evidence and to formulate recommendations. Results The critical outcomes were fall rate and number of fallers. Forty-five clinical questions and the associated recommendations were formulated for single, multiple and multifactorial non-pharmacological interventions in three different settings (home, care facilities and hospitals). Seven strong recommendations in favour, and one strong recommendation against, were formulated, all of which were supported by moderate-quality evidence. The remaining 37 clinical questions had weak recommendations. A strong recommendation was formulated in favour of exercise, as a single component, in groups and individually, for community-dwelling older people. Tai Chi was strongly recommended for older adults at risk of falling, living at home. Home safety assessment and modification was strongly recommended for older adults living at home and at high risk of falling. Multifactorial interventions were strongly recommended for older adults, at high risk of falling, living at home and, in older adults in care facilities and hospitals, while knowledge/education alone was strongly recommended against for older people at home. Conclusions Based on a systematic review of the evidence, 45 recommendations were formulated regarding non-pharmacological interventions to prevent falls in older adults living at home, in care facilities and in hospitals.
KW - Evidence
KW - Falls
KW - GRADE
KW - Non-pharmacological interventions
KW - Prevention
KW - Recommendation
UR - http://www.scopus.com/inward/record.url?scp=85029660830&partnerID=8YFLogxK
U2 - 10.1016/j.eurger.2017.07.013
DO - 10.1016/j.eurger.2017.07.013
M3 - Article
AN - SCOPUS:85029660830
VL - 8
SP - 413
EP - 418
JO - European Geriatric Medicine
JF - European Geriatric Medicine
SN - 1878-7657
IS - 5-6
ER -