title: Prehospital emergency services screening and referral to reduce falls in community-dwelling older adults: a systematic review.
abstract: BACKGROUND
  Falls represent an increasing source of geriatric morbidity and mortality. Prehospital emergency services may be uniquely suited to screen and refer subsets of high-risk older adults to fall prevention programmes. This systematic review assesses the effectiveness of such screening and referral programmes.
  
  
  METHODS
  We searched PubMed, Embase, CINAHL, Web of Science, Scopus, the Cochrane Library and OTseeker for English-language peer-reviewed randomised trials, non-randomised trials and cohort studies evaluating prehospital fall risk screening and referral programmes for community-dwelling adults ≥60 years of age. Risk of bias was assessed using the Cochrane Collaboration's tool. Primary outcomes included the risk and rate of falling. Secondary outcomes included successful follow-up to address fall risks and adverse events.
  
  
  RESULTS
  From 6187 unique records, 6 studies were included. Screening varied from using semistructured risk assessments to recording chief complaints. All studies were at high risk of bias. One unblinded trial of a multifactorial fall prevention programme demonstrated a 14.3% (95% CI 6.1% to 22.5%) absolute reduction in annual fall risk and a relative fall incidence of 0.45 (95% CI 0.35 to 0.58). The probability of successful follow-up varied from 9.8% to 81.0%. No studies demonstrated any attributable adverse events.
  
  
  CONCLUSIONS
  No high-quality evidence demonstrates that prehospital services reduce falls in community-dwelling older adults. Screening by prehospital personnel using semistructured risk assessments appears feasible, but it is unclear whether this is superior to referral based on fall-related chief complaints.
  
  
  BACKGROUND
  PROSPERO 2012:CRD42012002782.
authors.affiliation: Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA.
authors.forename: Alexander
authors.identifier: http://orcid.org/0000-0001-7121-4194
authors.initials: A
authors.lastname: Zozula
authors.affiliation: Division of Emergency Medicine, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Christopher R
authors.identifier: http://orcid.org/0000-0002-2603-7157
authors.initials: CR
authors.lastname: Carpenter
authors.affiliation: Becker Medical Library, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Kim
authors.initials: K
authors.lastname: Lipsey
authors.affiliation: Program in Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Susan
authors.identifier: http://orcid.org/0000-0002-2816-7158
authors.initials: S
authors.lastname: Stark
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control* / Q000706:statistics & numerical data; D000368:Aged; D015982:Bias; D003153:Community Health Services / Q000379:methods; D004632:Emergency Medical Services; D006299:Health Services for the Aged / Q000458:organization & administration; D006801:Humans; D008403:Mass Screening / Q000458:organization & administration*; D012017:Referral and Consultation / Q000458:organization & administration*; D018570:Risk Assessment / Q000379:methods*
keywords: accident prevention; accidental falls; geriatrics; paramedics, extended roles; prehospital care