title: What Works to Prevent Falls in Community-Dwelling Older Adults? Umbrella Review of Meta-analyses of Randomized Controlled Trials.
abstract: BACKGROUND
  Preventing falls is an international priority. There is a need to synthesize the highest-quality falls prevention evidence in one place for clinicians.
  
  
  OBJECTIVE
  The aim of this study was to conduct an umbrella review of meta-analyses of randomized controlled trials (RCTs) of falls prevention interventions in community-dwelling older adults.
  
  
  METHODS
  The MEDLINE, EMBASE, CINAHL, AMED, BNI, PsycINFO, Cochrane Library, PubMed, and PEDro databases were searched.
  
  
  METHODS
  Meta-analyses with one pooled analysis containing ≥3 RCTs that investigated any intervention to prevent falls in community-dwelling older adults aged ≥60 years were eligible. Sixteen meta-analyses, representing 47 pooled analyses, were included.
  
  
  METHODS
  Two authors independently extracted data.
  
  
  RESULTS
  Data were narratively synthesized. The methodological quality of the meta-analyses was moderate. Three meta-analyses defined a fall, and 3 reported adverse events (although minor). There is consistent evidence that exercise reduces falls (including the rate, risk, and odds of falling), with 13/14 pooled analyses (93%) from 7 meta-analyses demonstrating a significant reduction. The methodological quality of meta-analyses investigating exercise were medium/high, and effect sizes ranged from 0.87 (relative risk 95% confidence interval=0.81, 0.94; number of studies=18; number of participants=3,568) to 0.39 (rate ratio 95% confidence interval=0.23, 0.66; number of meta-analyses=6). There is consistent evidence that multifactorial interventions reduce falls (5/6, 83% reported significant reduction). There is conflicting evidence regarding the influence of vitamin D supplementation (7/12, 58.3% reported significant reduction).
  
  
  CONCLUSIONS
  Meta-analyses often used different methods of analysis, and reporting of key characteristics (eg, participants, heterogeneity, publication bias) was often lacking. There may be some overlap among included meta-analyses.
  
  
  CONCLUSIONS
  There is consistent evidence that exercise and individually tailored multifactorial interventions are effective in reducing falls in community-dwelling older adults.
authors: B. Stubbs, PT, MSc, MCSP, Faculty of Education and Health, University of Greenwich, Southwood Site, Avery Hill Road, Eltham, London, United Kingdom SE9 2UG. brendonstubbs@hotmail.com.
authors: Brendon
authors: B
authors: Stubbs
authors: S. Brefka, MD, AGAPLESION Bethesda Clinic, Department of Geriatrics, Ulm University, Ulm, Germany.
authors: Simone
authors: S
authors: Brefka
authors: M.D. Denkinger, MD, Competence Centre of Geriatrics and Aging Research Ulm/Alb-Donau, Ulm, Germany.
authors: Michael D
authors: MD
authors: Denkinger
mesh_terms: D000056:Accident Prevention; D000058:Accidental Falls / Q000517:prevention & control*; D000368:Aged; D006801:Humans; D057187:Independent Living; D015201:Meta-Analysis as Topic; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic