Evidence-based guidelines for the secondary prevention of falls in older adults.
BACKGROUND
Falls are a significant problem for older adults. Individuals who have sustained a fall come to the attention of health care providers and are at risk of further falls. To promote the highest quality of care and reduce variation in care, a practice guideline is needed. Summarization of evidence regarding falls may be useful to researchers in this field.


OBJECTIVE
To provide evidence-based guidelines of assessment and treatment to prevent falls in older adults and to provide researchers with tables of risk factor studies and randomized controlled trials of falls prevention.


METHODS
A template for the development of practice guidelines from the Agency for Health Care Policy and Research was used. Evidence for risk factors was accepted from prospective studies with more than 80% follow-up. Potentially modifiable risk factors were selected and a schema for evaluating the importance of each risk factor was used. Evidence for interventions was examined from randomized controlled trials and strength of the evidence was graded. Recommendations for aspects of care where judgment was required were made by panel consensus.


RESULTS
Information was drawn from 46 risk factor studies and 37 randomized controlled trials to develop a practice guideline consisting of assessment items and recommended interventions for community-dwelling and institution-dwelling older adults separately. For clinicians, a check list is provided. Summary tables of the results of studies are given to substantiate the recommendations.


CONCLUSIONS
For community-dwelling older adults, there is strong evidence for multi-factorial specific risk assessment and targeted treatment. Balance exercises are recommended for all individuals who have had a fall and there is evidence for a program of home physiotherapy for women over 80 years of age regardless of risk factor status. For institutional settings, the establishment of a falls program for safety checks, ongoing staff education and monitoring is substantiated by research. Residents who have fallen need to be assessed for specific risk factors and clinical indicators to determine relevant management options.
Moreland
Julie
J
St. Joseph's Healthcare, Hamilton, Ont., Canada. moreland@mcmaster.ca
Richardson
Julie
J
Chan
David  H
D
O'Neill
John
J
Bellissimo
Agostino
A
Grum
Rosa  Maria
R
Shanks
Lynne
L
D000058:Accidental Falls / Q000517:prevention & control* / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D019317:Evidence-Based Medicine / Q000379:methods*; D005260:Female; D015577:Geriatric Assessment / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D012307:Risk Factors