title: Interventions to reduce the number of falls among older adults with/without cognitive impairment: an exploratory meta-analysis.
abstract: OBJECTIVE
  This exploratory meta-analysis aimed to examine and compare the effective interventions to prevent falls among institutionalized/non-institutionalized older adults without cognitive impairment with interventions to prevent falls for older adults with cognitive impairment.
  
  
  METHODS
  A database search identified 111 trials published between January 1992 and August 2012 that evaluated fall-prevention interventions among institutionalized/non-institutionalized older adults with and without cognitive impairment as measured by valid cognition scales.
  
  
  RESULTS
  Exercise alone intervention was similar effective on reducing the numbers of falls among older adults without cognitive impairment regardless of setting (non-institutionalized: OR = 0.783, 95% confidence interval (CI) = 0.656-0.936; p = 0.007 institutionalized: OR = 0.799, 95% CI = 0.646-0.988, p = 0.038). Vitamin D/calcium supplementation had a positive effect on the reduction of numbers of falls among non-institutionalized older adults without cognitive impairment (OR = 0.789, 95% CI = 0.631-0.985, p = 0.036), as did home visits and environment modification (OR = 0.751, 95% CI = 0.565-0.998, p = 0.048). Exercise alone, exercise-related multiple interventions, and multifactorial interventions were associated with positive outcomes among both institutionalized and non-institutionalized older adults with cognitive impairment, but studies are limited.
  
  
  CONCLUSIONS
  Single exercise interventions can significantly reduce numbers of falls among older adults with and without cognitive impairment in institutional or non-institutional settings. Vitamin D and calcium supplementation, home visits, and environment modification can reduce the risk of falls among older adults in non-institutional settings. Exercise-related multiple interventions and multifactorial interventions may only be effective for preventing falls in older adults with cognitive impairment.
authors: Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan.
authors: Jong-Long
authors: JL
authors: Guo
authors: Yi-Ying
authors: YY
authors: Tsai
authors: Jung-Yu
authors: JY
authors: Liao
authors: Hsiu-Mei
authors: HM
authors: Tu
authors: Chiu-Mieh
authors: CM
authors: Huang
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000061:Accidents, Home / Q000517:prevention & control; D000368:Aged; D002136:Calcium, Dietary / Q000627:therapeutic use; D003072:Cognition Disorders / Q000150:complications*; D004779:Environment Design; D005081:Exercise Therapy / Q000706:statistics & numerical data; D006699:Home Care Services / Q000706:statistics & numerical data; D006801:Humans; D007326:Institutionalization; D014807:Vitamin D / Q000627:therapeutic use
chemical_list: D002136:Calcium, Dietary; D014807:Vitamin D
keywords: accidental falls; cognitive impairment; elderly; exercise intervention; fall prevention; meta-analysis