Draft Research Plan

Falls Prevention in Community-Dwelling Older Adults: Interventions

August 06, 2015

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.

Expand All

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.

Note: The numbers in the figure correspond to the Key Questions.

Text Description.

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.

  1. 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?
    1. How is high risk assessed in the included trials?
  2. What are the adverse effects associated with primary care interventions to prevent falls in community-dwelling older adults?
  1. What is the prognostic accuracy of falls risk assessment tools that are feasible for administration in primary care?

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).

  Included Excluded
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).
  • Trials conducted exclusively in populations living in special settings outside of the community (e.g., hospitals, nursing or care homes, rehabilitation centers, or other long-term care facilities)
  • Trials conducted exclusively in adults with major neurocognitive disorders, for whom interventions may be considered disease management (e.g., moderate to severe dementia, Parkinson’s disease)
  • Trials conducted in adults age ≤65 years or with a mean study age of ≤65 years
Interventions KQ 1:
  • Interventions that are primary care feasible or referable
  • Studies with a minimum followup of 6 months

Categories of included interventions*:

  • Exercise (supervised or unsupervised, individual or group)
  • Physical therapy
  • Medications (e.g., medical management, supplements [vitamin D, calcium])
  • Psychological (individual or group)
  • Environmental/assistive technology
  • Knowledge (e.g., educational materials)

Interventions may be delivered alone (single) or in combination (multifactorial, multiple). Multifactorial assessment and management is an included intervention.

 KQs 1, 2:
  • Community interventions that are not generally accessible (e.g., senior residence program)
  • Social marketing (e.g., media campaign)
  • Policy (e.g., local and State public or health policy)
  • Institutional methods (e.g., use of restraints)
  • Surgery (e.g., cataract extraction, pacemaker placement, podiatry surgery)
  • Fluid or nutrition therapy
  • Management of urinary incontinence
  • Hip protectors
Comparators KQ 1: Placebo, minimal control (i.e., provision of education via written materials, video, lecture), usual care  
Outcomes KQ 1:
  • Falls
  • Mortality (all-cause and falls-related)
  • Falls-related morbidity, defined as:
    • Disability (activities of daily life and/or instrumental activities of daily life)
    • Falls-related fracture injuries
    • Quality of life (as measured on the 12-, 20-, or 36-item Short-Form Health Survey; EuroQol; Sickness Impact Profile; Health Utilities Index; Dartmouth COOP Charts; Nottingham Health Profile)
    • Hospitalizations for falls-related injuries
    • Emergency department visits for falls-related injuries
    • Institutionalizations (e.g., transition from community dwelling to nursing or care homes, or other long-term care facilities)

KQ 2: Harm outcomes as reported in studies, including psychological outcomes

 KQ 1:
  • Falls-related injuries other than fractures that do not lead to an emergency department visit or hospitalization
  • Quality of life measures not listed in the inclusion criteria
  • Disability measures other than activities of daily life and/or instrumental activities of daily life
  • Falls Efficacy Scale
  • Function measures (e.g., Performance-Oriented Mobility Assessment, Timed Get Up & Go Test, 6-meter timed walk, Functional Reach Test, and Berg Balance Scale)

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).