scholarly journals Multifactorial falls prevention programmes for older adults presenting to the emergency department with a fall: systematic review and meta-analysis

2019 ◽  
Vol 25 (6) ◽  
pp. 557-564 ◽  
Author(s):  
Renata Teresa Morello ◽  
Sze-Ee Soh ◽  
Kate Behm ◽  
Amy Egan ◽  
Darshini Ayton ◽  
...  
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Emergency Department ◽  
Rate Ratio ◽  
Data Extraction ◽  
Falls Prevention ◽  
Controlled Trials ◽  
Prevention Interventions ◽  
Prevention Programmes ◽  
Meta Analyses

ObjectiveTo determine whether multifactorial falls prevention interventions are effective in preventing falls, fall injuries, emergency department (ED) re-presentations and hospital admissions in older adults presenting to the ED with a fall.DesignSystematic review and meta-analyses of randomised controlled trials (RCTs).Data sourcesFour health-related electronic databases (Ovid MEDLINE, CINAHL, EMBASE, PEDro and The Cochrane Central Register of Controlled Trials) were searched (inception to June 2018).Study selectionRCTs of multifactorial falls prevention interventions targeting community-dwelling older adults ( ≥ 60 years) presenting to the ED with a fall with quantitative data on at least one review outcome.Data extractionTwo independent reviewers determined inclusion, assessed study quality and undertook data extraction, discrepancies resolved by a third.Data synthesis12 studies involving 3986 participants, from six countries, were eligible for inclusion. Studies were of variable methodological quality. Multifactorial interventions were heterogeneous, though the majority included education, referral to healthcare services, home modifications, exercise and medication changes. Meta-analyses demonstrated no reduction in falls (rate ratio = 0.78; 95% CI: 0.58 to 1.05), number of fallers (risk ratio = 1.02; 95% CI: 0.88 to 1.18), rate of fractured neck of femur (risk ratio = 0.82; 95% CI: 0.53 to 1.25), fall-related ED presentations (rate ratio = 0.99; 95% CI: 0.84 to 1.16) or hospitalisations (rate ratio = 1.14; 95% CI: 0.69 to 1.89) with multifactorial falls prevention programmes.ConclusionsThere is insufficient evidence to support the use of multifactorial interventions to prevent falls or hospital utilisation in older people presenting to ED following a fall. Further research targeting this population group is required.

scholarly journals Motivation as a mechanism underpinning exercise-based falls prevention programmes for older adults with cognitive impairment: a realist review

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e024982 ◽  
Author(s):  
Vicky Booth ◽  
Rowan Harwood ◽  
Jennie E Hancox ◽  
Victoria Hood-Moore ◽  
Tahir Masud ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Exercise Intervention ◽  
Data Extraction ◽  
Realist Review ◽  
Falls Prevention ◽  
Cochrane Library ◽  
Programme Theory ◽  
Eligibility Criteria ◽  
Prevention Programmes

ObjectivesThis review aimed to identify mechanisms underlying participation in falls prevention interventions, in older adults with cognitive impairment. In particular we studied the role of motivation.DesignA realist review of the literature.Data sourcesEMBASE, MEDLINE, CINAHL, the Cochrane Library, PsycINFO and PEDRO.Eligibility criteriaPublications reporting exercise-based interventions for people with cognitive impairment, including dementia, living in the community.Data extraction and synthesisA ‘rough programme theory’ (a preliminary model of how an intervention works) was developed, tested against findings from the published literature and refined. Data were collected according to elements of the programme theory and not isolated to outcomes. Motivation emerged as a key element, and was prioritised for further study.ResultsAn individual will access mechanisms to support participation when they think that exercise will be beneficial to them. Supportive mechanisms include having a ‘gate-keeper’, such as a carer or therapist, who shares responsibility for the perception of exercise as beneficial. Lack of access to support decreases adherence and participation in exercise. Motivational mechanisms were particularly relevant for older adults with mild-to-moderate dementia, where the exercise intervention was multicomponent, in a preferred setting, at the correct intensity and level of progression, correctly supported and considered, and flexibly delivered.ConclusionMotivation is a key element enabling participation in exercise-based interventions for people with cognitive impairment. Many of the mechanisms identified in this review have parallels in motivational theory. Clinically relevant recommendations were derived and will be used to further develop and test a motivationally considered exercise-based falls intervention for people with mild dementia.PROSPERO registration numberCRD42015030169.

Dietary patterns and depression risk in older adults: systematic review and meta-analysis

2020 ◽  
Author(s):  
Pei-Yu Wu ◽  
Kuei-Min Chen ◽  
Frank Belcastro
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Dietary Patterns ◽  
Data Extraction ◽  
Meta Analysis ◽  
Screening Tools ◽  
Inverse Association ◽  
Depression Risk ◽  
Study Heterogeneity ◽  
Meta Analyses

Abstract Context Diet may be one of the modifiable environmental factors that could reduce depressive symptoms or abate the development of depression without side effects. However, previous reviews mainly focused on general adult populations. Objective The aim of this systematic review and meta-analysis was to explore the association between healthy dietary patterns and depression risk in older adults. Data Sources Eight databases were searched up to September 2019. The inclusion criteria were older adults aged ≥ 65 years, healthy dietary patterns, depression assessed by a physician or by validated screening tools, and quantitative study design. Data Extraction Data were extracted independently by 2 researchers, and the Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline was followed. Data Analysis Meta-analysis was conducted by calculating the pooled odds ratio (OR) and 95% CIs. A total of 18 eligible studies were meta-analyzed. Results showed that a healthy dietary pattern is associated with a reduced risk of depression in older adults (OR, 0.85; 95%CI, 0.78–0.92; P < 0.001). There was high heterogeneity (I2 = 64.9%; P < 0.001) among the studies. Subgroup analyses indicated that sample size and depression screening tools were the main sources of study heterogeneity. Conclusions An inverse association between healthy dietary patterns and depression risk in older adults was found. However, the high heterogeneity among the studies should be considered. Systematic Review Registration PROSPERO registration no. CRD 42020169195.

scholarly journals A systematic review of older people's perceptions of facilitators and barriers to participation in falls-prevention interventions

2008 ◽  
Vol 28 (4) ◽  
pp. 449-472 ◽  
Author(s):  
FRANCES BUNN ◽  
ANGELA DICKINSON ◽  
ELAINE BARNETT-PAGE ◽  
ELIZABETH MCINNES ◽  
KHIM HORTON
Keyword(s):  
Systematic Review ◽  
Older People ◽  
Fear Of Falling ◽  
Previous History ◽  
Falls Prevention ◽  
Barriers To Participation ◽  
Prevention Services ◽  
Prevention Interventions ◽  
Prevention Programmes ◽  
People’S Perceptions

ABSTRACTThe prevention of falls is currently high on the health policy agenda in the United Kingdom, which has led to the establishment of many falls-prevention services. If these are to be effective, however, the acceptability of services to older people needs to be considered. This paper reports a systematic review of studies of older people's perceptions of these interventions. The papers for review were identified by searching electronic databases, checking reference lists, and contacting experts. Two authors independently screened the studies and extracted data on the factors relating to participation in, or adherence to, falls-prevention strategies. Twenty-four studies were identified, of which 12 were qualitative. Only one study specifically examined interventions that promote participation in falls-prevention programmes; the others explored older people's attitudes and views. The factors that facilitated participation included social support, low intensity exercise, greater education, involvement in decision-making, and a perception of the programmes as relevant and life-enhancing. Barriers to participation included fatalism, denial and under-estimation of the risk of falling, poor self-efficacy, no previous history of exercise, fear of falling, poor health and functional ability, low health expectations and the stigma associated with programmes that targeted older people.

scholarly journals Impact of Pharmacist-led Discharge Counseling on Hospital Readmission and Emergency Department Visits: A Systematic Review and Meta-analysis

2019 ◽  
Vol 15 (01) ◽  
pp. 52-59 ◽  
Author(s):  
Aline Bonetti ◽  
Walleri C Reis ◽  
Antonio M Mendes ◽  
Inajara Rotta ◽  
Fernanda S Tonin ◽  
...  
Keyword(s):  
Systematic Review ◽  
Emergency Department ◽  
Usual Care ◽  
Hospital Readmission ◽  
Data Extraction ◽  
Meta Analysis ◽  
Emergency Department Visits ◽  
Significant Difference ◽  
Meta Analyses ◽  
The Impact

BACKGROUND: Transitions of care can contribute to medication errors and other adverse drug events. PURPOSE: The aim of this study was to evaluate the impact of pharmacist-led discharge counseling on hospital readmission and emergency department visits through a systematic review and meta-analysis. DATA SOURCES: Electronic searches were performed in PubMed, Scopus, and DOAJ (Directory of Open Access Journals), along with a manual search (July 2017). PROSPERO registration no. CRD42017068444. STUDY SELECTION: Two independent reviewers performed all the steps of the systematic review process (screening of titles and abstracts, full-text appraisal, data extraction, and quality assessment), with contributions from a third researcher. We included randomized controlled trials (RCTs) reporting data on pharmacist-led discharge counseling. DATA EXTRACTION: Primary extracted outcomes were emergency department visits and hospital readmission rates. DATA SYNTHESIS: Meta-analyses of intervention versus usual care for hospital readmission and emergency department visit rates were performed using the inverse variance method. Results are reported as risk ratios (RRs) with 95% confidence intervals (CIs). Prediction intervals (PIs) were also calculated. Sensitivity and subgroup analyses were performed. A total of 21 RCTs were included in the qualitative synthesis and 18 in the meta-analyses (n = 7,244 patients). The original meta-analysis revealed a significant difference in the impact between pharmacist-led discharge counseling and usual care on overall hospital readmission (RR = 0.864 [95% CI 0.763-0.997], P = .020) and emergency department (RR = 0.697 [95% CI 0.535-0.907], P = .007) visits. However, the small number of included studies, the high heterogeneity among trials (I2 between 40% and 60%), and the wide PIs (hospital readmission: PI 0.542-1.186; emergency department visits: PI 0.027-1.367) prevented drawing further conclusions. CONCLUSIONS: Insufficient evidence exists regarding the effect of pharmacist-led discharge counseling on hospital readmission and emergency department visits. Further well-designed clinical trials with defined core outcome sets are needed.

scholarly journals What Works to Prevent Falls in Community-Dwelling Older Adults? Umbrella Review of Meta-analyses of Randomized Controlled Trials

2015 ◽  
Vol 95 (8) ◽  
pp. 1095-1110 ◽  
Author(s):  
Brendon Stubbs ◽  
Simone Brefka ◽  
Michael D. Denkinger
Keyword(s):  
Older Adults ◽  
Methodological Quality ◽  
Community Dwelling ◽  
Falls Prevention ◽  
Controlled Trials ◽  
Umbrella Review ◽  
Randomized Controlled ◽  
Meta Analyses ◽  
Community Dwelling Older Adults

Background Preventing falls is an international priority. There is a need to synthesize the highest-quality falls prevention evidence in one place for clinicians. Purpose The aim of this study was to conduct an umbrella review of meta-analyses of randomized controlled trials (RCTs) of falls prevention interventions in community-dwelling older adults. Data Sources The MEDLINE, EMBASE, CINAHL, AMED, BNI, PsycINFO, Cochrane Library, PubMed, and PEDro databases were searched. Study Selection Meta-analyses with one pooled analysis containing ≥3 RCTs that investigated any intervention to prevent falls in community-dwelling older adults aged ≥60 years were eligible. Sixteen meta-analyses, representing 47 pooled analyses, were included. Data Extraction Two authors independently extracted data. Data Synthesis Data were narratively synthesized. The methodological quality of the meta-analyses was moderate. Three meta-analyses defined a fall, and 3 reported adverse events (although minor). There is consistent evidence that exercise reduces falls (including the rate, risk, and odds of falling), with 13/14 pooled analyses (93%) from 7 meta-analyses demonstrating a significant reduction. The methodological quality of meta-analyses investigating exercise were medium/high, and effect sizes ranged from 0.87 (relative risk 95% confidence interval=0.81, 0.94; number of studies=18; number of participants=3,568) to 0.39 (rate ratio 95% confidence interval=0.23, 0.66; number of meta-analyses=6). There is consistent evidence that multifactorial interventions reduce falls (5/6, 83% reported significant reduction). There is conflicting evidence regarding the influence of vitamin D supplementation (7/12, 58.3% reported significant reduction). Limitations Meta-analyses often used different methods of analysis, and reporting of key characteristics (eg, participants, heterogeneity, publication bias) was often lacking. There may be some overlap among included meta-analyses. Conclusions There is consistent evidence that exercise and individually tailored multifactorial interventions are effective in reducing falls in community-dwelling older adults.

scholarly journals Influence of Resistance Training on Gait & Balance Parameters in Older Adults: A Systematic Review

2021 ◽  
Vol 18 (4) ◽  
pp. 1759
Author(s):  
Christopher J. Keating ◽  
José Carlos Cabrera-Linares ◽  
Juan A. Párraga-Montilla ◽  
Pedro A. Latorre-Román ◽  
Rafael Moreno del Castillo ◽  
...  
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Resistance Training ◽  
Randomized Controlled Trials ◽  
Aging Population ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Straight Line ◽  
Evidence Database ◽  
Meta Analyses

In this work we aimed to perform a systematic review of randomized controlled trials within an aging population that investigated the general impacts of a resistance training (RT) protocol on key outcome measures relating to gait and/or balance. Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement guidelines, two electronic databases (PubMed, and Scopus) were searched for randomized controlled trials that measured at least one key outcome measure focusing on gait and/or balance in older adults. 3794 studies were identified, and after duplicates were removed, 1913 studies remained. 1886 records were removed due to the abstract not meeting the inclusion criteria. 28 full-text articles were assessed further, and 20 of the articles were identified as meeting the criteria for inclusion. The remaining 20 studies were assessed for quality using the Physiotherapy Evidence Database (PEDro) scale; 12 studies remained and were included in this systematic review. Our review suggests that RT has a positive effect on both gait and balance in an elderly population. RT improves gait, specifically straight-line walking speed in older adults. RT is an adequate training method to improve balance in an aging population. Improvements in strength, attributed to RT, may allow for greater autonomy and independence to carry out activities of daily living as we age.

scholarly journals Reducing falls in older adults recently discharged from hospital: a systematic review and meta-analysis

2018 ◽  
Vol 47 (4) ◽  
pp. 512-519 ◽  
Author(s):  
Chiara Naseri ◽  
Terry P Haines ◽  
Christopher Etherton-Beer ◽  
Steven McPhail ◽  
Meg E Morris ◽  
...  
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Injury Rate ◽  
Community Dwelling ◽  
Nutritional Supplementation ◽  
Falls Prevention ◽  
Home Exercise ◽  
Low Grade ◽  
Exercise Interventions ◽  
Prevention Interventions

Abstract Background older adults are known to have increased falls rates and functional decline following hospital discharge, with substantial economic healthcare costs. This systematic review aimed to synthesise the evidence for effective falls prevention interventions in older adults recently discharged from hospital. Methods literature searches of six databases of quantitative studies conducted from 1990 to June 2017, reporting falls outcomes of falls prevention interventions for community-dwelling older adults discharged from hospital were included. Study quality was assessed using a standardised JBI critical appraisal tool (MAStARI) and data pooled using Rev-Man Review Manager® Results sixteen studies (total sample size N = 3,290, from eight countries, mean age 77) comprising 12 interventions met inclusion criteria. We found home hazard modification interventions delivered to those with a previous falls history (1 study), was effective in reducing the number of falls (RR 0.63, 95%CI 0.43, 0.93, Low GRADE evidence). Home exercise interventions (3 studies) significantly increased the proportion of fallers (OR 1.74, 95%CI 1.17, 2.60, Moderate GRADE evidence), and did not significantly reduce falls rate (RR 1.27, 95%CI 0.99, 1.62, Very Low GRADE evidence) or falls injury rate (RR 1.16, 95%CI, 0.83,1.63, Low GRADE evidence). Nutritional supplementation for malnourished older adults (1 study) significantly reduced the proportion of fallers (HR 0.41, 95% CI 0.19, 0.86, Low GRADE evidence). Conclusion the recommended falls prevention interventions for older adults recently discharged from hospital are to provide home hazard minimisation particularly if they have a recent previous falls history and consider nutritional supplementation if they are malnourished.

scholarly journals Effective SLOPE: EffectS of Lifestyle interventions in Older PEople with obesity: a systematic review and network meta-analysis protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e038330
Author(s):  
Gabriel Torbahn ◽  
Daniel Schoene ◽  
Lukas Schwingshackl ◽  
Gerta Rücker ◽  
Helge Knüttel ◽  
...  
Keyword(s):  
Older Adults ◽  
Data Extraction ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Lifestyle Interventions ◽  
Assessment Development ◽  
Registration Number ◽  
Randomised Controlled ◽  
Meta Analyses

IntroductionObesity is highly prevalent in older adults aged 65 years or older. Different lifestyle interventions (diet, exercise, self-management) are available but benefits and harms have not been fully quantified comparing all available health promotion interventions. Special consideration must be given to functional outcomes and possible adverse effects (loss of muscle and bone mass, hypoglycaemia) of weight loss interventions in this age group. The objective of this study is to synthesise the evidence regarding the effects of different types and modalities of lifestyle interventions, or their combinations, on physical function and obesity-related outcomes such as body composition in older adults with obesity.Methods and analysesSix databases (Medline, Embase, Cochrane Central Register of Controlled Trials, Cumulated Index to Nursing and Allied Health Literature (CINAHL), Psychinfo and Web of Science) and two trial registries (Clinicaltrials.gov and the WHO International Clinical Trials Registry Platform) will be searched for randomised controlled trials of lifestyle interventions in older adults with obesity. Screening (title/abstract and full-text) and data extraction of references as well as assessment of risk of bias and rating of the certainty of evidence (Grading of Recommendations, Assessment, Development and Evaluation for network meta-analyses) will be performed by two reviewers independently. Frequentist random-effects network meta-analyses will be conducted to determine the pooled effects from each intervention.Ethics and disseminationWe will submit our findings to peer-reviewed journals and present at national and international conferences as well as in scientific medical societies. Patient-targeted dissemination will involve local and national advocate groups.PROSPERO registration numberCRD42019147286.

scholarly journals Effectiveness of digital primary prevention interventions targeting physical activity, motor skills and nutrition in children aged 3–10 years in the setting of day care and primary school: protocol for a systematic review

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e053628
Author(s):  
Patrick Timpel ◽  
Sandra Herrmann ◽  
Philipp Flößel ◽  
Heidrun Beck ◽  
Peter EH Schwarz
Keyword(s):  
Physical Activity ◽  
Systematic Review ◽  
Primary Prevention ◽  
Motor Skills ◽  
Day Care ◽  
Public Discourse ◽  
Data Extraction ◽  
Evidence Synthesis ◽  
Controlled Trials ◽  
Prevention Interventions

IntroductionAvailable evidence points to an association of increased screen time and the availability of digital tools during childhood with negative health outcomes in later life. For many years, public discourse focused on restricting access and use of digital technologies below certain ages. However, little is known about the specific benefit of a responsible use of digital primary prevention in the setting of (early) childhood education. The objective of this evidence synthesis is to investigate the effectiveness of digital primary prevention interventions targeting physical activity, motor skills and/or nutrition in children aged 3–10 years in day-care facilities and (pre-) schools.Methods and analysisWe present the rationale and methodological steps of a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses procedures. Automated searches will be conducted by applying a pretested search strategy to the databases MEDLINE/PubMed, EMBASE and PsycInfo to identify relevant interventional (randomised controlled trials, controlled trials, crossover trials and pilot and feasibility) and observational (case–control, cohort) studies in English or German, with no date restrictions. The overall search will be complemented by backward, forward and additional hand searches. Two researchers will independently screen titles/abstracts and assess full texts by applying predefined eligibility criteria. Data extraction will be conducted by using a pretested data extraction sheet. The assessment of methodological quality will be performed independently by two review authors using the Critical Appraisals Skills Programme relevant to the study design applied in the given study. Additionally, qualitative content analysis will be conducted to analyse priorities for future research extracted from the discussion sections and conclusions of included studies.PROSPERO registration numberCRD42020207682.

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