Multifactorial intervention compared with usual care or usual care plus advice for preventing falls in older people living in the community
| Patient or population: Preventing falls in older people living in the community Setting: Older people living in the community Intervention: Multifactorial intervention Comparison: Usual care or usual care plus minimal control | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | Number of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with comparator intervention | Risk with multifactorial intervention | |||||
| Rate of falls (falls per person-years) Follow-up: range 12–24 months | 1416 per 1000 |
1119 per 1000
(991 to 1246) |
Rate ratio 0.79
(0.70 to 0.88) | 10 116 (20 RCTs) | ⨁⨁◯◯ Low†‡ | |
| Number of people sustaining one or more falls Follow-up: range 12–48 months | 467 per 1000 |
444 per 1000
(421 to 467) |
RR 0.95
(0.90 to 1.00) | 13 817 (30 RCTs) | ⨁⨁⨁◯ Moderate† | |
| Number of people sustaining recurrent falls (defined as two or more falls in a specified time period) Follow-up: range 12–24 months | 247 per 1000 |
217 per 1000
(192 to 247) |
RR 0.88
(0.78 to 1.00) | 7277 (15 RCTs) | ⨁⨁⨁◯ Moderate† | |
| Number of people sustaining one or more fall-related fractures Follow-up: range 12–48 months | 53 per 1000 |
39 per 1000
(28 to 54) |
RR 0.73
(0.53 to 1.01) | 3160 (10 RCTs) | ⨁⨁⨁◯ Moderate† | |
| Number of people who experience a fall that required hospital admission Follow-up: range 12–36 months | 265 per 1000 |
265 per 1000
(244 to 286) |
RR 1.00
(0.92 to 1.08) | 5077 (14 RCTs) | ⨁⨁◯◯ Low†§ | |
| Number of people who experience a fall that required medical attention Follow-up: range 12–36 months | 151 per 1000 |
148 per 1000
(127 to 172) |
RR 0.98
(0.84 to 1.14) | 3669 (9 RCTs) | ⨁⨁⨁◯ Moderate† | |
| Health-related quality of life: endpoint score ollow-up: range 12–36 months | – | SMD 0.13 higher (0.01 lower to 0.26 higher) | – | 2000 (7 RCTs) | ⨁⨁◯◯ Low†¶ | Converted to SF-36 scale (0 worst to 100 best) MD 11.84 (95% CI −0.12 to 30.8) |
GRADE Working Group grades of evidence. High certainty: We are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: We are moderately confident in the effect estimate. The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: Our confidence in the effect estimate is limited. The true effect may be substantially different from the estimate of the effect. Very low certainty: We have very little confidence in the effect estimate. The true effect is likely to be substantially different from the estimate of effect.
*The risk in the intervention group (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
†Downgraded one level for risk of bias (more than one trial at high or unclear risk of bias).
‡Downgraded one level for inconsistency (there was considerable statistical heterogeneity in these outcomes that could not be explained by prespecified sensitivity and subgroup analyses).
§Downgraded one level for indirectness (poor reporting meant that it was sometimes unclear how many hospital admissions were falls related; therefore, we included outcome data on hospital admissions in general).
¶Downgraded one level for imprecision (relatively broad overall CI).
GRADE, Grading of Recommendations, Assessment, Development and Evaluation; MD, mean difference; RCT, randomised controlled trial; RR, risk ratio; SMD, standardised mean difference.