The Effect of Individualized Fall Prevention Programs on Community-Dwelling Older Adults: A Scoping Review

Abstract

An alarming rate of injurious falls among older adults warrants proactive measures to reduce falls and fall risk. The purpose of this article was to examine and synthesize the literature as it relates to programmatic components and clinical outcomes of individualized fall prevention programs on community-dwelling older adults. A literature search of four databases was performed using search strategies and terms unique to each database. Title, abstract, and full article reviews were performed to assure inclusion and exclusion criteria were met. Data were analyzed for type of study, program providers, interventions and strategies used to deliver the program, assessments used, and statistically significant outcomes. Queries resulted in 410 articles and 32 met all inclusion criteria (19 controlled trials and 13 quasi-experimental). Physical therapists were part of the provider team in 23 (72%) studies and the only provider in 10 (31%). There was substantial heterogeneity in procedures and outcome measures. Most common procedures were balance assessments (n=30), individualized balance exercises (n=29), cognition (n=21), home and vision assessments (n=16), specific educational modules (n=15), referrals to other providers/community programs (n=8), and motivational interviewing (n=7). Frequency of falls improved for eight of 13 (61.5%) controlled trials and four of five (80%) quasi-experimental studies. Balance and function improved in six of 11 (54.5%) controlled trials and in each of the six (100%) quasi-experimental studies. Strength improved in three of seven (43%) controlled trials and four of five (75%) quasi-experimental studies. While many programs improved falls and balance of older adults, there was no conclusive evidence as to which assessments and interventions were optimal to deliver as individualized fall prevention programming. The skill of a physical therapist and measures of fall frequency, balance, and function were common among the majority of studies reviewed. Despite the variability among programs, there is emerging evidence that individualized, multimodal fall prevention programs may improve fall risk of community-dwelling older adults and convenient access to these programs should be emphasized.

Eight-year longitudinal falls trajectories and associations with modifiable risk factors: evidence from The Irish Longitudinal Study on Ageing (TILDA)

“…Regarding appropriate prescribing for falls prevention, studies have reported moderate success in reducing psychotropic medication use [ 28 ], and careful optimisation of psychotropic and non-psychotropic prescriptions can contribute to OH reductions in older people [ 37 ]. Given evidence that multifactorial assessment and intervention programmes can reduce the rate [ 45 ] and risk [ 46 ] of falls, access to these interventions should be promoted and underpinned by an overarching public health message that falling in older people should not be stigmatised as being a sign of inevitable decline and loss of independence.…”

Exploring Population Characteristics and Recruitment Challenges in Older People Experiencing Falls at Home without Hospitalization or with an Emergency Department Visit: Insights from the RISING-DOM Experience

“…3,[5][6][7][8][9] Therefore, this population represents an interesting target for delivering appropriate fall prevention interventions. 6,9,10 Even though, there is an emerging evidence that personalized multifactorial fall prevention programs are successful in decreasing fall rate, [11][12][13][14][15] results in particular from randomized controlled trials are mixed 12,16 and evidence of implementing appropriate fall prevention interventions in community-dwelling is limited. 17 In addition, the recruitment of older people in fall prevention trials and strategies is a critical step and could result in limiting data on assessing their effectiveness.…”