Prevention of falls and fall-related fractures in community-dwelling older adults: a meta-analysis of estimates of effectiveness based on recent guidelines.

BACKGROUND: Two recent falls prevention guidelines have been published but did not include quantitative estimates of effectiveness based on the published reports that were reviewed to support their recommendations. AIM: To produce quantitative estimates of effectiveness of falls prevention programs from the randomised controlled trials cited in the guidelines together with an updated search of the available published reports to August 2002.
METHODS: A meta-analysis of randomised controlled trials cited in falls guidelines and studies identified by an updated search of the available published reports was carried out. Randomised controlled trials were identified from the falls guidelines and a search, which met the following criteria: trials in community-dwelling older people; 1-year follow up; and outcome measures reported as the number of subjects with at least one fall or the number of subjects with a fracture.
RESULTS: The guidelines identified four studies of 'exercise as a sole intervention', which when combined with one further study identified in a search of the published reports, gave a fixed effects odds ratio (OR) favouring this strategy of 0.81 (95% confidence interval (CI) 0.58-1.14); the number of patients needed to be treated to prevent one person having a fall was 19.5. The guidelines identified seven studies of a 'multiple intervention' strategy that gave a random effects OR favouring this strategy of 0.64 (95% CI 0.47-0.88). Four further studies were identified by the search of the published reports. The updated OR favouring this intervention strategy was 0.65 (95% CI 0.52-0.81); the number of patients needed to be treated to prevent one person having a fall was 9.8. Only two studies had data for fracture and a fixed effects OR favouring falls interventions for fracture prevention was 0.50 (95% CI 0.18-1.40); the number of patients needed to be treated to prevent one person having a fracture was 45.5.
CONCLUSION: Semiquantitative statements of evidence can both understate and overstate the effectiveness of falls prevention strategies. There is moderate evidence of efficacy for falls prevention particularly for multiple intervention strategies.