Falls prevention interventions in older adults with cognitive impairment: A systematic review of reviews

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.

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

Injury Prevention ◽

10.1136/injuryprev-2019-043214 ◽

2019 ◽

Vol 25 (6) ◽

pp. 557-564 ◽

Cited By ~ 4

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.

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Falls prevention interventions for community-dwelling older persons with cognitive impairment: a systematic review

International Psychogeriatrics ◽

10.1017/s1041610212001573 ◽

2012 ◽

Vol 25 (2) ◽

pp. 215-227 ◽

Cited By ~ 34

Author(s):

Heidi Winter ◽

Kerrianne Watt ◽

Nancye May Peel

Keyword(s):

Systematic Review ◽

Cognitive Impairment ◽

Older People ◽

Large Body ◽

Community Dwelling ◽

Falls Prevention ◽

Original Research ◽

Cognitively Impaired ◽

Falls Risk ◽

Prevention Interventions

ABSTRACTBackground:Globally, falls in older people are a leading cause of injury-related mortality and morbidity. Cognitive impairment is a well-known risk factor for falls in this population group. While there is now a large body of evidence to support effective interventions for falls reduction across care settings, very little is known about interventions in the vulnerable, but increasing population of cognitively impaired community-dwelling older people. Therefore, the purpose of this systematic review is to investigate interventions designed to reduce falls in community-dwelling, cognitively impaired older adults.Methods:A literature search of databases was conducted to identify original research published in English, which met predefined inclusion and exclusion criteria for effective (non-pharmacological) falls prevention interventions in cognitively impaired community-dwelling people over 65 years of age. Data from the selected papers were extracted into data extraction tables and analyzed according to study characteristics, measures, results, and quality.Results:The review identified 11 studies providing data from 1,928 participants. Interventions included exercise, health assessment and management of risk, multi-component and cognitive behavioral programs, and hip protectors as falls risk reduction strategies. Seven of the selected studies showed an intervention effect in decreasing falls risk; however, only two of these showed a significant improvement in physical performance measures specifically in a cognitively impaired group.Conclusions:The diversity of interventions, study designs, populations, and quality of the studies, which met inclusion criteria, resulted in conflicting evidence and inconclusive results for falls prevention interventions in this highly complex population.

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Effectiveness of Falls Prevention Education on its Prevention Behavior among Older Adults: A Systematic Review

Indian Journal of Public Health Research & Development ◽

10.37506/v11/i1/2020/ijphrd/193989 ◽

2020 ◽

Vol 11 (1) ◽

pp. 1119

Author(s):

Goh Jing Wen ◽

Devinder Kaur Ajit Singh ◽

Suzana Shahar

Keyword(s):

Systematic Review ◽

Older Adults ◽

Falls Prevention ◽

Prevention Education ◽

Prevention Behavior

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Repetition Priming in Individuals with Amnestic Mild Cognitive Impairment and Alzheimer’s Dementia: a Systematic Review and Meta-Analysis

Neuropsychology Review ◽

10.1007/s11065-021-09504-5 ◽

2021 ◽

Author(s):

Liselotte De Wit ◽

Vitoria Piai ◽

Pilar Thangwaritorn ◽

Brynn Johnson ◽

Deirdre O’Shea ◽

...

Keyword(s):

Systematic Review ◽

Older Adults ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Repetition Priming ◽

Meta Analysis ◽

Healthy Older Adults ◽

Amnestic Mci ◽

Standard Mean Difference ◽

Priming Paradigm

AbstractThe literature on repetition priming in Alzheimer’s disease (AD) is inconsistent, with some findings supporting spared priming while others do not. Several factors may explain these inconsistencies, including AD severity (e.g., dementia vs. Mild Cognitive Impairment; MCI) and priming paradigm-related characteristics. This systematic review and meta-analysis provides a quantitative summary of repetition priming in AD. We examined the between-group standard mean difference comparing repetition priming in AD dementia or amnestic MCI (aMCI; presumably due to AD) to controls. Thirty-two studies were selected, including 590 individuals with AD dementia, 267 individuals with amnestic MCI, and 703 controls. Our results indicated that both individuals with aMCI and AD dementia perform worse on repetition priming tasks than cognitively older adults. Paradigm-related moderators suggested that the effect size between studies comparing the combined aMCI or AD dementia group to cognitively healthy older adults was the highest for paradigms that required participants to produce, rather than identify, primes during the test phase. Our results further suggested that priming in AD is impaired for both conceptual and perceptual priming tasks. Lastly, while our results suggested that priming in AD is impaired for priming tasks that require deep processing, we were unable to draw firm conclusions about whether priming is less impaired in aMCI or AD dementia for paradigms that require shallow processing.

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Hearing Loss Treatment in Older Adults With Cognitive Impairment: A Systematic Review

Journal of Speech Language and Hearing Research ◽

10.1044/2018_jslhr-h-18-0077 ◽

2018 ◽

Vol 61 (10) ◽

pp. 2589-2603 ◽

Cited By ~ 9

Author(s):

Sara K. Mamo ◽

Nicholas S. Reed ◽

Carrie Price ◽

Dona Occhipinti ◽

Alexandra Pletnikova ◽

...

Keyword(s):

Systematic Review ◽

Older Adults ◽

Hearing Loss ◽

Cognitive Impairment ◽

Hearing Aids ◽

Controlled Trial ◽

Controlled Vocabulary ◽

Assessment Tools ◽

Cochrane Library ◽

Full Text Review

Purpose The purpose of this systematic review was to assess studies of treating hearing loss in older adults with cognitive impairment. Of interest to this review is identifying clinical adaptations that may be used to tailor hearing loss treatment to older adults with cognitive impairment in order to better serve this vulnerable population. Method A systematic search with controlled vocabulary and key word terms was applied to PubMed, the Cochrane Library, Embase, CINAHL, and PsycINFO. Search concepts included terms related to hearing loss and cognitive impairment. The overall search resulted in 4,945 unique references, 50 of which were eligible for full-text review and 13 of which were included in the final review. Included manuscripts were categorized according to the American Speech-Language-Hearing Association's levels of evidence and the National Institutes of Health Quality Assessment Tools. Results Only 1 study implemented a randomized controlled trial design to assess cognitive function and behavioral symptoms after treatment with hearing aids. Other quasiexperimental studies evaluated dementia-related symptoms and/or auditory function after treating hearing loss in pre/post research designs. Finally, evidence from case studies suggested that hearing loss treatment is feasible, reduces stressful communication for caregivers, and improves dementia-related behavior problems. Conclusion Based on the systematic review, evidence suggests that treating hearing loss in persons with cognitive impairment can have benefits to communication and quality of life. Because of the quasi- and nonexperimental nature of most of the evidence found in this review, further studies are necessary to understand the effect of treatment in the context of a variable and progressive disease.

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Community-Based Rehabilitation Post Hospital Discharge Interventions for Older Adults With Cognitive Impairment Following a Hip Fracture: A Systematic Review Protocol

JMIR Research Protocols ◽

10.2196/resprot.3485 ◽

2014 ◽

Vol 3 (3) ◽

pp. e47 ◽

Cited By ~ 4

Author(s):

Paula M van Wyk ◽

Charlene H Chu ◽

Jessica Babineau ◽

Martine Puts ◽

Dina Brooks ◽

...

Keyword(s):

Systematic Review ◽

Older Adults ◽

Cognitive Impairment ◽

Hip Fracture ◽

Hospital Discharge ◽

Systematic Review Protocol ◽

Community Based ◽

Community Based Rehabilitation ◽

Review Protocol

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A Systematic Review on Detraining Effects after Balance and Fall Prevention Interventions

Journal of Clinical Medicine ◽

10.3390/jcm10204656 ◽

2021 ◽

Vol 10 (20) ◽

pp. 4656

Author(s):

Shaghayegh Modaberi ◽

Esmaeel Saemi ◽

Peter A. Federolf ◽

Steven van Andel

Keyword(s):

Systematic Review ◽

Older Adults ◽

Fall Prevention ◽

Intervention Programs ◽

Positive Effects ◽

Specific Focus ◽

The World ◽

Prevention Interventions ◽

Review Study

Since the COVID-19 pandemic hit, lockdowns have been implemented to fight off infections in countries around the world. Whilst this measure is without a doubt effective against spreading infection, it might also decrease participation in exercise. For older adults, exercise is particularly important in the prevention of falls, and sudden detraining because of a lockdown or due to other causes might have detrimental consequences. This systematic review study aims to assess what is currently known on detraining effects for balance outcomes. Nine studies were included within this review. Results suggest that detraining effects could already be significant as early as 4 weeks after stopping the intervention. Programs that specifically focus on improving balance were more robust against detraining, with most positive effects still being present after 8 weeks. However, even with a specific focus on balance, studies started to show some signs of detraining. The current study is limited by the low number of included studies in the review, indicating a need to further confirm these results.

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