Evaluation of Clinical Practice Guidelines on Fall Prevention and Management for Older Adults: A Systematic Review
journal contributionposted on 2022-05-04, 23:54 authored by Nieuwboer Alice, Ellen Vlaeyen, Koen Milisen, Robert Bourke, Sirpa Hartikainen, Tischa Van der Cammen, Chris Todd, Finbarr C Martin, David R Marsh, James Frith, Pip Logan, Dawn Skelton, Hubert Blain, Cedric Anweiller, Ellen Freiberger, Clemens and Becker, Matteo Cesari, Alvaro Casas-Herrero, Christina Alonzo Bouzòn, Ana-Karim Welmer, Stephanie Birnghebuam, Reto Kressig, Manuel Montero-Odasso, Bill McIlroy, Richard Camicioli, Mireille Norris, Jennifer Watt, Louise Mallet, David B Hogan, Sejdic Ervin, Luigi Ferruci, David A Ganz, Neil B Alexander, Fabiana Giber, Marcelo Schapira, Ricardo Jauregui, Felipe Melgar-Cuellar, Daniela Cristina Carvalho de Abreu, Roberto Alves Lourenço, Monica Pierrucini, Alejandro Ceriani, Pedro Marín-Larraín, José Fernando Gómez-Montes, Carlos Alberto Cano-Gutierrez, Xinia Ramirez Ulate, José Ernesto Picado Ovares, Patricio Gabriel Buendia, Susana Lucia Tito, Diego Martínez Padilla, Sara G Aguilar-Navarro, Alberto Mimenza, Rogelio Moctezum, Alberto Avila-Funes, Luis Miguel Gutiérrez-Robledo, Luis Manuel Cornejo Alemán, Edgar Aguilera Caona, Juan Carlos Carbajal, José F Parodi, Aldo Sgaravatti, Cathie Sherrington, Cathy Said, Ian Cameron, Meg MorrisMeg Morris, Gustavo Duque, Ngaire Kerse, Leilei Duan, Ryota Sakurai, Chek Hooi Wong, Hossein Negahban, Chang Won Won, Jeffrey Hausdorff, Sebastiana Kalula, Olive Kobusingye
Importance: With the global population aging, falls and fall-related injuries are ubiquitous, and several clinical practice guidelines for falls prevention and management for individuals 60 years or older have been developed. A systematic evaluation of the recommendations and agreement level is lacking. Objectives: To perform a systematic review of clinical practice guidelines for falls prevention and management for adults 60 years or older in all settings (eg, community, acute care, and nursing homes), evaluate agreement in recommendations, and identify potential gaps. Evidence Review: A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-analyses statement methods for clinical practice guidelines on fall prevention and management for older adults was conducted (updated July 1, 2021) using MEDLINE, PubMed, PsycINFO, Embase, CINAHL, the Cochrane Library, PEDro, and Epistemonikos databases. Medical Subject Headings search terms were related to falls, clinical practice guidelines, management and prevention, and older adults, with no restrictions on date, language, or setting for inclusion. Three independent reviewers selected records for full-text examination if they followed evidence- and consensus-based processes and assessed the quality of the guidelines using Appraisal of Guidelines for Research & Evaluation II (AGREE-II) criteria. The strength of the recommendations was evaluated using Grades of Recommendation, Assessment, Development, and Evaluation scores, and agreement across topic areas was assessed using the Fleiss κ statistic. Findings: Of 11 414 records identified, 159 were fully reviewed and assessed for eligibility, and 15 were included. All 15 selected guidelines had high-quality AGREE-II total scores (mean [SD], 80.1% [5.6%]), although individual quality domain scores for clinical applicability (mean [SD], 63.4% [11.4%]) and stakeholder (clinicians, patients, or caregivers) involvement (mean [SD], 76.3% [9.0%]) were lower. A total of 198 recommendations covering 16 topic areas in 15 guidelines were identified after screening 4767 abstracts that proceeded to 159 full texts. Most (≥11) guidelines strongly recommended performing risk stratification, assessment tests for gait and balance, fracture and osteoporosis management, multifactorial interventions, medication review, exercise promotion, environment modification, vision and footwear correction, referral to physiotherapy, and cardiovascular interventions. The strengths of the recommendations were inconsistent for vitamin D supplementation, addressing cognitive factors, and falls prevention education. Recommendations on use of hip protectors and digital technology or wearables were often missing. None of the examined guidelines included a patient or caregiver panel in their deliberations. Conclusions and Relevance: This systematic review found that current clinical practice guidelines on fall prevention and management for older adults showed a high degree of agreement in several areas in which strong recommendations were made, whereas other topic areas did not achieve this level of consensus or coverage. Future guidelines should address clinical applicability of their recommendations and include perspectives of patients and other stakeholders.
This work was supported by project grant PTJ 153100 from the Canadian Institute of Health Research.
JournalJAMA network open
PublisherAmerican Medical Association
Rights Statement© 2021 Montero-Odasso MM et al. JAMA Network Open. This is an open access article distributed under the terms of the CC-BY License.
Science & TechnologyLife Sciences & BiomedicineMedicine, General & InternalGeneral & Internal MedicineRISK-FACTORSVITAMIN-DCOGNITIVE IMPAIRMENTLONG-TERMCOMMUNITYPEOPLEHEALTHRECOMMENDATIONSDEPRESSIONBALANCEAccidental FallsAgedAged, 80 and overCombined Modality TherapyConsensusEnvironment DesignHealth PromotionHealth Services for the AgedHumansMedication ReviewMiddle AgedOsteoporosisPhysical Therapy ModalitiesPractice Guidelines as TopicWounds and InjuriesTask Force on Global Guidelines for Falls in Older Adults