Draft Research Plan
Draft Research Plan for Falls Prevention in Community-Dwelling Older Adults: Interventions
This opportunity for public comment expired on September 2, 2015 at 8:00 PM EST
Note: This is a Draft Research Plan. This draft is distributed solely for the purpose of receiving public input. It has not been disseminated otherwise by the USPSTF. The final Research Plan will be used to guide a systematic review of the evidence by researchers at an Evidence-based Practice Center. The resulting Evidence Review will form the basis of the USPSTF Recommendation Statement on this topic.
Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.
Draft: Proposed Analytic Framework
Note: The numbers in the figure correspond to the Key Questions.
Figure 1 is an analytic framework for the key questions of this report that depicts community-dwelling adults age 65 years or older (at average or high risk for falls) receiving falls prevention interventions and the impact of those interventions on falls, falls-related morbidity, and mortality. The figure also depicts the possibility of harms or adverse events occurring as a result of falls prevention interventions.
Draft: Proposed Key Questions to Be Systematically Reviewed
- Is there direct evidence that primary care interventions to prevent falls in community-dwelling older adults at average or high risk for falls, used alone or in combination, reduce falls or falls-related injury, improve quality of life, reduce disability, or reduce mortality?
- How is high risk assessed in the included trials?
- What are the adverse effects associated with primary care interventions to prevent falls in community-dwelling older adults?
Draft: Proposed Research Approach
The proposed Research Approach identifies the study characteristics and criteria that the Evidence-based Practice Center will use to search for publications and to determine whether identified studies should be included or excluded from the Evidence Review. Criteria are overarching as well as specific to each of the key questions (KQs).
|Aim||Trials with the primary or secondary aim of reducing falls or falls-related injuries||Comparative effectiveness trials of fall interventions|
|Populations||Community-dwelling adults age ≥65 years (including those residing in independent living facilities). Includes older adults who are at average and high risk for falls; participants may be recruited from settings both within and outside of the community or primary care (e.g., community-dwelling adults recruited from emergency department visits for falls-related injuries).||
Categories of included interventions*:
Interventions may be delivered alone (single) or in combination (multifactorial, multiple). Multifactorial assessment and management is an included intervention.
|KQs 1, 2:
|Comparators||KQ 1: Placebo, minimal control (i.e., provision of education via written materials, video, lecture), usual care|
KQ 2: Harm outcomes as reported in studies, including psychological outcomes
KQ 2: Minor adverse events that are reported using nonvalidated, nongeneralizable measures
|Study Designs||KQ 1: Randomized, controlled trials
KQ 2: Randomized, controlled trials; cohort studies; observational studies
|All KQs: Editorials, letters, nonsystematic reviews, opinions, comparative effectiveness trials
KQ 1: Clinical controlled trials, case-control studies, cohort studies
KQ 2: Convenience surveys, qualitative studies
|Setting||Interventions conducted in primary care or that are referable from primary care||Interventions not conducted in primary care or other settings with a community-dwelling, primary care–comparable population (e.g., hospital, rehabilitation center, long-term care facility, emergency department)|
|Country||Countries categorized as “Very High” on the 2014 Human Development Index (as defined by the United Nations Development Programme)|
|Language||English only||Non-English language publications|
|Quality||Fair or good, according to design-specific criteria||Poor, according to design-specific criteria|
* Based on ProFaNE intervention descriptors (Lamb SE, Becker C, Gillespie LD, et al. Reporting of complex interventions in clinical trials: development of a taxonomy to classify and describe fall-prevention interventions. Trials. 2011;12:125).
Internet Citation: Draft Research Plan: Falls Prevention in Community-Dwelling Older Adults: Interventions. U.S. Preventive Services Task Force. August 2015.