title: Older people's participation in and engagement with falls prevention interventions in community settings: an augment to the Cochrane systematic review.
abstract: BACKGROUND
  Randomised controlled trials (RCTs) of fall prevention conducted in community settings have recently been systematically reviewed.
  
  
  OBJECTIVE
  To augment this review by analysing older people's participation in the trials and engagement with the interventions.
  
  
  METHODS
  Review of the 99 single and multifactorial RCTs included in the Cochrane systematic review of falls prevention interventions.
  
  
  METHODS
  Community.
  
  
  METHODS
  Adults aged 60+/mean age minus one standard deviation of 60+.
  
  
  METHODS
  Calculated aggregate data on recruitment (proportion who accepted the invitation to participate), attrition at 12 month follow-up (loss of participants), adherence (to intervention protocol) and whether adherence moderated the effect of interventions on trial outcomes.
  
  
  RESULTS
  The median recruitment rate was 70.7% (64.2-81.7%, n = 78). At 12 months the median attrition rate including mortality was 10.9% (9.1-16.0%, n = 44). Adherence rates (n = 69) were ≥80% for vitamin D/calcium supplementation; ≥70% for walking and class-based exercise; 52% for individually targeted exercise; approximately 60-70% for fluid/nutrition therapy and interventions to increase knowledge; 58-59% for home modifications; but there was no improvement for medication review/withdrawal of certain drugs. Adherence to multifactorial interventions was generally ≥75% but ranged 28-95% for individual components. The 13 studies that tested for whether adherence moderated treatment effectiveness produced mixed results.
  
  
  CONCLUSIONS
  Using median rates for recruitment (70%), attrition (10%) and adherence (80%), we estimate that, at 12 months, on average half of community-dwelling older people are likely to be adhering to falls prevention interventions in clinical trials.
authors.affiliation: School of Health and Social Care, University of Reading, 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*; D000368:Aged; D000369:Aged, 80 and over; D002118:Calcium / Q000627:therapeutic use; D019587:Dietary Supplements; D005081:Exercise Therapy; D006801:Humans; D008875:Middle Aged; D010349:Patient Compliance; D010358:Patient Participation; D016032:Randomized Controlled Trials as Topic; D012111:Residence Characteristics; D016896:Treatment Outcome; D014807:Vitamin D / Q000627:therapeutic use; D016138:Walking
chemical_list: D014807:Vitamin D; D002118:Calcium