in progress

Draft Research Plan

Falls Prevention in Community-Dwelling Older Adults: Interventions

April 21, 2022

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.

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Figure 1 is the analytic framework that depicts the two Key Questions to be addressed in the systematic review. The figure illustrates how interventions to prevent falls for community-dwelling older adults (age 65 years or older) may have an impact on falls, fall-related morbidity, mortality (key question 1), and adverse effects (key question 2).

  1. Do interventions to prevent falls in community-dwelling older adults at average or increased risk reduce falls, falls-related morbidity, or mortality?
    1. How is “increased risk” defined in the included trials?
  2. Do interventions to prevent falls in community dwelling older adults at average or increased risk result in any adverse effects?

Contextual Questions will not be systematically reviewed and are not shown in the Analytic Framework.

  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).

Category Included Excluded
Aim Trials with the primary or secondary aim of reducing falls or falls-related injuries Comparative effectiveness trials of fall interventions
Population Community-dwelling, ambulatory adults age 65 years or older at average or increased risk for falls 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 special populations (e.g., adults with neurocognitive disorders, such as moderate to severe dementia or Parkinson’s disease) in which interventions may be considered disease management

Trials conducted exclusively in a population with pre-existing social ties
Interventions

Interventions that are primary care-feasible or referable

Categories of included interventions:

  • Exercise (supervised or unsupervised, individual or group)
  • Multifactorial assessment and intervention
  • Medication management
  • Psychological (individual or group)
  • Environmental assessment and modification
  • Knowledge/education

Interventions may be delivered alone or in combination

Categories of excluded interventions:

  • Social marketing
  • Policy
  • Surgery
  • Fluid or nutrition therapy
  • Management of urinary incontinence
  • Assistive technology
  • Vitamin D, supplements
Comparators Placebo, minimal control (i.e., provision of education via written materials, video, or lecture), or usual care Active comparators
Outcomes KQ 1:
  • Falls
  • Mortality (all-cause and falls-related)
  • Falls-related morbidity, defined as:
    • Falls-related fracture injuries
    • Disability (as measured by instrumental activities of daily life instruments)
    • Quality of life (validated instruments)
    • 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

 KQ 1:
  • Basic activities of daily living
  • 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
Followup Minimum of 6 months followup  
Study Designs Randomized, controlled trials Editorials, letters, systematic and nonsystematic reviews, opinions, nonrandomized studies of interventions, convenience surveys, and qualitative studies
Setting Interventions conducted in primary care or that are referable from primary care  
Country Countries categorized as “Very High” on the 2019 Human Development Index (as defined by the United Nations Development Programme) Countries that are not categorized as “Very High” on the 2019 Human Development Index
Language English only Non-English language publications
Quality Fair or good, according to design-specific criteria Poor, according to design-specific criteria