title: Interventions for the prevention of falls in older adults: systematic review and meta-analysis of randomised clinical trials.
abstract: OBJECTIVE
  To assess the relative effectiveness of interventions to prevent falls in older adults to either a usual care group or control group.
  
  
  METHODS
  Systematic review and meta-analyses.
  
  
  METHODS
  Medline, HealthSTAR, Embase, the Cochrane Library, other health related databases, and the reference lists from review articles and systematic reviews.
  
  
  METHODS
  Components of falls intervention: multifactorial falls risk assessment with management programme, exercise, environmental modifications, or education.
  
  
  RESULTS
  40 trials were identified. A random effects analysis combining trials with risk ratio data showed a reduction in the risk of falling (risk ratio 0.88, 95% confidence interval 0.82 to 0.95), whereas combining trials with incidence rate data showed a reduction in the monthly rate of falling (incidence rate ratio 0.80, 0.72 to 0.88). The effect of individual components was assessed by meta-regression. A multifactorial falls risk assessment and management programme was the most effective component on risk of falling (0.82, 0.72 to 0.94, number needed to treat 11) and monthly fall rate (0.63, 0.49 to 0.83; 11.8 fewer falls in treatment group per 100 patients per month). Exercise interventions also had a beneficial effect on the risk of falling (0.86, 0.75 to 0.99, number needed to treat 16) and monthly fall rate (0.86, 0.73 to 1.01; 2.7).
  
  
  CONCLUSIONS
  Interventions to prevent falls in older adults are effective in reducing both the risk of falling and the monthly rate of falling. The most effective intervention was a multifactorial falls risk assessment and management programme. Exercise programmes were also effective in reducing the risk of falling.
authors.affiliation: Department of Medicine, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California at Los Angeles, CA 90095, USA. johnchang@mednet.ucla.edu
authors.forename: John T
authors.initials: JT
authors.lastname: Chang
authors.forename: Sally C
authors.initials: SC
authors.lastname: Morton
authors.forename: Laurence Z
authors.initials: LZ
authors.lastname: Rubenstein
authors.forename: Walter A
authors.initials: WA
authors.lastname: Mojica
authors.forename: Margaret
authors.initials: M
authors.lastname: Maglione
authors.forename: Marika J
authors.initials: MJ
authors.lastname: Suttorp
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Roth
authors.forename: Paul G
authors.initials: PG
authors.lastname: Shekelle
mesh_terms: D000056:Accident Prevention; D000058:Accidental Falls / Q000517:prevention & control*; D000368:Aged; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012307:Risk Factors