title: Older people's recruitment, sustained participation, and adherence to falls prevention interventions in institutional settings: a supplement to the Cochrane systematic review.
abstract: BACKGROUND
  randomised controlled trials (RCTs) of falls prevention conducted in institutional settings have recently been systematically reviewed.
  
  
  OBJECTIVE
  to supplement this review by analysing older people's participation in the trials and engagement with the interventions.
  
  
  METHODS
  review of the 41 RCTs included in the Cochrane systematic review of falls prevention interventions.
  
  
  METHODS
  hospitals and nursing care facilities.
  
  
  METHODS
  adults aged/mean age of 65+.
  
  
  METHODS
  calculated aggregate data on recruitment (inclusion into the trial), attrition at 12-month follow-up (loss of participants from the trial), adherence (to intervention protocol), and whether adherence moderated the effect of interventions on trial outcomes.
  
  
  RESULTS
  the median inclusion rate was 48.5% (38.9-84.5%). At 12 months the median attrition rate was 10.4% (3.9-12.3%, n = 10) or with the inclusion of mortality 16.2% (9.5-17.1%, n = 11). Adherence was high for exercise that was individually targeted (e.g. 89% physical therapy) and group based (72-88%) and for medication interventions (68-88%). For multifactorial interventions, adherence ranged from 11% for attending 60+/88 of exercise classes to 93% for use/repairs of aids. Adherence as a moderator of treatment effectiveness was tested in nursing care facilities (n = 6) and positively identified in three studies for medication and multifactorial interventions.
  
  
  CONCLUSIONS
  using median rates for recruitment (50%), attrition (15%) and adherence (80%), by 12 months, it is estimated that on average only a third of nursing care facility residents are likely to be adhering to falls prevention interventions.
authors.affiliation: School of Health and Social Care, University of Reading, Berkshire, UK. snyman@bournemouth.ac.uk
authors.forename: Samuel R
authors.initials: SR
authors.lastname: Nyman
authors.forename: Christina R
authors.initials: CR
authors.lastname: Victor
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000367:Age Factors; D000368:Aged; D000375:Aging; D003131:Combined Modality Therapy; D019587:Dietary Supplements; D019317:Evidence-Based Medicine; D005081:Exercise Therapy; D006126:Group Processes; D006707:Homes for the Aged; D006760:Hospitalization; D006801:Humans; D009735:Nursing Homes; D010349:Patient Compliance; D010352:Patient Dropouts; D018579:Patient Selection; D016032:Randomized Controlled Trials as Topic / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome