scholarly journals Economic Models of Community-Based Falls Prevention: A Systematic Review With Subsequent Commissioning And Methodological Recommendations

2021 ◽  
Author(s):  
Joseph Kwon ◽  
Hazel Squires ◽  
Matthew Franklin ◽  
Ms Yujin Lee ◽  
Tracey Young
Keyword(s):  
Systematic Review ◽  
Community Dwelling ◽  
Falls Prevention ◽  
Economic Evaluations ◽  
Community Based ◽  
Prevention Intervention ◽  
Use Of Resources ◽  
Social Inequities ◽  
Activity Promotion ◽  
Modelling Methods

Abstract Background: Falls impose significant health and economic burdens among older populations, making their prevention a priority. Health economic decision models can inform whether the falls prevention intervention represents a cost-effective use of resources and/or meet additional decisional objectives such as reducing social inequities of health. This study aims to conduct a systematic review (SR) of community-based falls prevention models to: (i) systematically identify such models; (ii) synthesise and critically appraise the modelling methods/results; and (iii) formulate methodological and commissioning recommendations.Methods: The SR followed the PRISMA guideline, covering the period 2003-2020, 12 academic databases and grey literature. A study was included if it: targeted community-dwelling persons aged 60 and over and/or aged 50-59 at high falls risk; evaluated intervention(s) designed to reduce falls or fall-related injuries; against any comparator(s); reported outcomes of economic evaluation; used decision modelling; and had English full text. Extracted data fields were grouped under higher categories: (A) model and evaluation overview; (B) falls epidemiology features; (C) falls prevention intervention features; and (D) evaluation methods and outcomes. A checklist for falls prevention economic evaluations assessed reporting/methodological quality. Extracted fields were narratively synthesised and critically appraised to inform methodological and commissioning recommendations. The SR protocol is registered in the Prospective Register of Systematic Reviews (CRD42021232147).Results: 46 models were identified. The most prevalent issue according to the checklist was non-incorporation of all-cause care costs. Based on general population, lifetime models conducting cost-utility analyses, seven interventions produced favourable ICERs relative to no intervention under the cost-effectiveness threshold of £30,000 per QALY gained; of these, results for (1) combined multifactorial and environmental intervention, (2) physical activity promotion for women, and (3) targeted vitamin D supplementation were from validated models. Decision-makers should explore the transferability and feasible reaches of these interventions in their local settings. There was some evidence that exercise and home modification exacerbate existing social inequities of health. Sixteen methodological recommendations were formulated from critical appraisal.Conclusion: There is significant methodological heterogeneity across falls prevention models. This SR’s appraisals of modelling methods should facilitate the conceptualisation of future falls prevention models. Its synthesis of evaluation outcomes could inform commissioning.

scholarly journals Dosage for cost-effective exercise-based falls prevention programs for older people: A systematic review of economic evaluations

2020 ◽  
Vol 63 (1) ◽  
pp. 69-80 ◽  
Author(s):  
Stanley John Winser ◽  
Hei Tung Fion Chan ◽  
Lam Ho ◽  
Lau Sze Chung ◽  
Lau Tsz Ching ◽  
...  
Keyword(s):  
Systematic Review ◽  
Older People ◽  
Cost Effective ◽  
Prevention Programs ◽  
Falls Prevention ◽  
Economic Evaluations

scholarly journals Medications & Polypharmacy Influence on Recurrent Fallers in Community: a Systematic Review

2018 ◽  
Vol 21 (1) ◽  
pp. 14-25 ◽  
Author(s):  
Yu Ming ◽  
Aleksandra Zecevic
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
High Risk Group ◽  
Community Dwelling ◽  
Falls Prevention ◽  
Depression Symptoms ◽  
Prescription Medications ◽  
Recurrent Falls ◽  
Falls In Older Adults ◽  
The Impact

The purpose of this systematic review is to summarize information about the impact different classes of medications and polypharmacy have on recurrent falls, defined as two or more falls in a 12-month period, in community-dwelling older adults. After adjustment for confounders such as age, gender, weight or depression symptoms, the reviewed studies suggested that older adults who use antidepressants, sedatives or hypnotics and anti-epileptics were more likely to experience recurrent falls than non-users. Polypharmacy (use of four or more prescription medications daily) caused 1.5–2 times higher possibility of recurrent falls in older adults. As a high-risk group, recurrent fallers require meaningful intervention. Medications are believed to be a modifiable risk factor in falls prevention; hence, special consideration should be taken to balance the benefit and harm in initiating, continuing or increasing certain classes of medications in elderly recurrent fallers.

Economic Evaluations of Falls Prevention Programs for Older Adults: A Systematic Review

2018 ◽  
Vol 66 (11) ◽  
pp. 2197-2204 ◽  
Author(s):  
Branko F. Olij ◽  
Robbin H. Ophuis ◽  
Suzanne Polinder ◽  
Ed F. van Beeck ◽  
Alex Burdorf ◽  
...  
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Prevention Programs ◽  
Falls Prevention ◽  
Economic Evaluations

scholarly journals Translating Falls Prevention Knowledge to Community-Dwelling Older PLWD: A Mixed-Method Systematic Review

2013 ◽  
Vol 55 (4) ◽  
pp. 560-574 ◽  
Author(s):  
Claudia Meyer ◽  
Sophie Hill ◽  
Briony Dow ◽  
Anneliese Synnot ◽  
Keith Hill
Keyword(s):  
Systematic Review ◽  
Mixed Method ◽  
Community Dwelling ◽  
Falls Prevention

scholarly journals Economic Evaluation of Community-Based Falls Prevention Interventions: A Systematic Methodological Overview of Systematic Reviews

2021 ◽  
Author(s):  
Joseph Kwon ◽  
Hazel Squires ◽  
Matt Franklin ◽  
Yujin Lee ◽  
Tracey Young
Keyword(s):  
Economic Evaluation ◽  
Systematic Reviews ◽  
Health Economic Evaluation ◽  
Reporting Quality ◽  
Falls Prevention ◽  
Decision Models ◽  
Economic Evaluations ◽  
Community Based ◽  
Dynamic Complexity ◽  
Environmental Interventions

Abstract Background: Falls impose significant health and economic burdens on older people, making their prevention a priority for care decision-makers. The volume of falls prevention economic evaluations has increased, the findings from which have been synthesised by systematic reviews (SRs) with pre-specified criteria (e.g., objectives, eligibility, data extraction). Such SRs can inform commissioning and design of future evaluations, particularly decision models; however, their findings can be biased and partial dependent on their pre-specified criteria. This study aims to conduct a systematic overview (SO) to: (1) systematically identify SRs of community-based falls prevention economic evaluations; (2) describe the methodology and findings of SRs; (3) critically appraise the methodology of SRs; and (4) suggest commissioning recommendations based on SO findings. Methods: The SO followed the PRISMA guideline and the Cochrane guideline on SO, covering the period 2003-2020. Identified SRs’ aims, search strategies and results, extracted data fields, quality assessment methods and results, and commissioning and research recommendations were synthesised. The comprehensiveness of previous SRs’ data synthesis was judged against criteria drawn from expert guideline and academic literature on falls prevention/public health economic evaluation. Outcomes of general population, lifetime decision models were re-analysed to inform commissioning recommendations. The SO protocol is registered in the Prospective Register of Systematic Reviews (CRD42021234379).Results: Seven SRs were identified, which extracted 8 to 33 data fields from 44 relevant economic evaluations. Four economic evaluation methodological/reporting quality checklists were used; three SRs narratively synthesised methodological features to varying extent and focus. SRs generally did not appraise decision modelling features, including methods for characterising dynamic complexity of falls risk and intervention need. Their commissioning recommendations were based mainly on cost-per-unit ratios (e.g., incremental cost-effectiveness ratios) and neglected aggregate impact. There is model-based evidence of multifactorial and environmental interventions, home assessment and modification and Tai Chi being cost-effective but also the risk that they exacerbate social inequities of health. Conclusions: Current SRs of falls prevention economic evaluations do not holistically inform commissioning and evaluation design. Accounting for broader decisional factors including intervention reach and capacity constraints and a broader grasp of methodological nuances of economic evaluations, particularly decision models, are needed.

scholarly journals Racial and Ethnic Differences in Falls Among Older Adults: a Systematic Review and Meta-analysis

2021 ◽  
Author(s):  
Natasha Wehner-Hewson ◽  
Paul Watts ◽  
Richard Buscombe ◽  
Nicholas Bourne ◽  
David Hewson
Keyword(s):  
Systematic Review ◽  
Ethnic Groups ◽  
English Language ◽  
Meta Analysis ◽  
Community Dwelling ◽  
Racial And Ethnic Differences ◽  
Use Of Resources ◽  
Language Studies ◽  
Risk Of Falls ◽  
Meta Analyses

Abstract The aim of this systematic review and meta-analysis was to determine whether differences in reported fall rates exist between different ethnic groups. Searches were carried out on four databases: Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, and Web of Science. Only English language studies with community-dwelling participants aged 60 + years were included. Studies also needed to compare fall prevalence for at least two or more ethnic groups. Two reviewers independently screened all articles and evaluated study quality. Twenty-three articles were included for systematic review, and meta-analyses were carried out on the 16 retrospective studies that reported falls in the previous 12 months. The Asian group demonstrated significantly lower fall prevalence than all other ethnic groups at 13.89% (10.87, 16.91). The Hispanic group had a fall prevalence of 18.54% (12.95, 24.13), closely followed by the Black group at 18.60% (13.27, 23.93). The White group had the highest prevalence at 23.77% (18.66, 28.88). Some studies provided adjusted estimates of effect statistics for the odds/risk of falls, which showed that differences still existed between some ethnic groups even after adjusting for other risk factors. Overall, differences in fall prevalence do appear to exist between different ethnic groups, although the reasons for these differences currently remain undetermined and require further investigation. These findings highlight the need to provide more ethnically tailored responses to public health challenges, which could potentially increase the adherence to prevention interventions, and allow for a more targeted use of resources.

scholarly journals Global Cognitive Impairment Prevalence and Incidence in Community Dwelling Older Adults—A Systematic Review

Geriatrics ◽  
2020 ◽  
Vol 5 (4) ◽  
pp. 84
Author(s):  
Ricardo Pais ◽  
Luís Ruano ◽  
Ofélia P. Carvalho ◽  
Henrique Barros
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Cognitive Impairment ◽  
Community Dwelling ◽  
Cognitive Tests ◽  
Community Based ◽  
Definition Of ◽  
Community Dwelling Older Adults

(1) Background: We proposed to review worldwide estimates of cognitive impairment prevalence and incidence in adults older than 50 years of age living in the community. (2) Methods: Systematic searches were performed in January 2019 using MEDLINE/PubMed. Articles were selected if they referred to cognitive impairment, prevalence, incidence, elders, and population or community-based studies. Analysis, aggregated by different methodologic features, was performed. (3) Results: Prevalence (80 studies) ranged between 5.1% and 41% with a median of 19.0% (25th percentile = 12.0%; 75th percentile = 24.90%). Incidence (11 studies) ranged from 22 to 76.8 per 1000 person-years with a median of 53.97 per 1000 person-years (25th percentile = 39.0; 75th percentile = 68.19). No statistically significant effects were found except for inclusion age. (4) Conclusion: We propose that the homogenization and clarification of the definition of what constitutes cognitive impairment are essential to refine the epidemiological understanding of this entity. The results of this review reinforce the importance of adherence to standardized cut-off scores for cognitive tests to promote study comparability.

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