Providing fall prevention services in the emergency department: Is it effective? A systematic review and meta‐analysis

Abstract

Objective: To assess the effects of fall prevention services initiated in the emergency department (ED) to support patients after discharge. Methods: A systematic review and meta-analysis were conducted. Analysis of pooled data used random-effects modelling with results presented as a risk ratio (RR). Results: Eleven studies were identified (n = 4,018). The proportion of older adults who fell did not differ between the intervention and control groups (RR 0.93; 95% CI, 0.82-1.06, I 2 68%, P = 0.28). There was a significant (P = 0.01) reduction in the monthly rate of falling (RR 0.69; 95% CI, 0.52-0.91, I 2 93%), fall-related injuries (RR 0.72; 95% CI, 0.59-0.88, I 2 0%, P = 0.001), and hospital admissions (RR 0.76; 95% CI, 0.64-0.90, I 2 0%, P = 0.002). Conclusions: ED fall prevention services did not significantly reduce the proportion of older adults who had future falls. However, multifactorial intervention significantly reduced fall-related injuries and hospital admissions with low heterogeneity.

Simulation Versus Written Fall Prevention Education in Older Hospitalized Adults: A Randomized Controlled Study

“…No previous reports used simulated education to reduce patients falls post-discharge. However, in systematic reviews, when single interventions were compared to multifactorial interventions, outcomes were mixed; in one report, there was no improvement in any fall risk outcomes (Harper et al, 2021) and in another report, fall rates were lower and the number of people experiencing falls were lower (Lee & Yu, 2020). In our research, the simulation education intervention was a single intervention, providing evidence that the intervention delivery method (simulation) and the focus of the education (home environment fall risk assessment) may be a winning combination.…”

“…Patient education about fall risks is an important intervention; however, to date, there are no standardized education, assessment and intervention strategies known to be most important in relation to knowledge attainment. In two systematic reviews of 11 and 45 papers respectively (Harper et al, 2021; Lee & Yu, 2020) that assessed fall risk reduction interventions, multifactorial interventions were important, although each review paper used a different variety of interventions to achieve results. Patient education was a common theme in five of 11 papers (Harper et al, 2021) and 17 of 45 papers (Lee & Yu, 2020), and importantly, home fall risk assessment was a component of a multifactorial intervention in nine of 11 papers (Harper et al, 2021) and 39 of 45 papers (Lee & Yu, 2020).…”

“…In two systematic reviews of 11 and 45 papers respectively (Harper et al, 2021; Lee & Yu, 2020) that assessed fall risk reduction interventions, multifactorial interventions were important, although each review paper used a different variety of interventions to achieve results. Patient education was a common theme in five of 11 papers (Harper et al, 2021) and 17 of 45 papers (Lee & Yu, 2020), and importantly, home fall risk assessment was a component of a multifactorial intervention in nine of 11 papers (Harper et al, 2021) and 39 of 45 papers (Lee & Yu, 2020). Our intervention was educational and involved awareness and modification of environmental factors in the home.…”

Association between toileting and falls in older adults admitted to the emergency department and hospitalised: a cross-sectional study

“…We designed a structured questionnaire to survey the risk factors of falls through panel meetings and literature review 2 25–27. The survey questionnaire was divided into three sections: demographic information, fall characteristics and an assessment of comprehensive geriatric syndromes.…”

A physiotherapy‐led review of guideline‐based care for community‐dwelling older people presenting to a metropolitan hospital with accidental falls

“…5,[8][9][10] Evidence indicates that the implementation of multidisciplinary and patient-centred management, including comprehensive geriatric and allied health assessment, can significantly reduce fall and fracture rates. [10][11][12][13][14] Despite existing guidelines and evidence, it is commonly reported that the management of falls in EDs and acute care is not consistent with guideline-based care. 2,3,15,16 Multiple barriers to guideline-based care have been reported by clinicians including lack of clinician knowledge of guidelines, ED time-related pressures, lack of access to allied health services or community referral options and low rates of patient uptake.…”