Evidence review on older people's views and experiences of falls prevention strategies.

BACKGROUND: A systematic review was undertaken of qualitative and quantitative studies and reviews that focus on older people's views and experiences of falls prevention. The review was undertaken to provide an additional dimension to the clinical effectiveness evidence provided by a Cochrane review on falls prevention (Gillespie et al. 2003) to inform the development of a national guideline on falls prevention in older people. As guideline recommendations or policies relating to preventive strategies have the potential to increase health care costs, it is important that all sources of evidence are reviewed by guideline development groups so that an understanding is achieved of the acceptability and sustainability of interventions in relation to different groups and settings.
METHOD: Accordingly, this review examined the literature on the views, preferences, and experiences of older people in relation to falls prevention strategies. Twenty-four studies meeting the inclusion criteria were critically reviewed and were then summarized into evidence tables. The key facilitators and barriers to participation in falls prevention programs were derived from the commonly occurring and consistent themes arising from the reviewed studies. The implications of these findings for the clinical effectiveness review conclusions were then taken into account.
FINDINGS: Several important findings emerged. These included preferences for falls prevention strategies not involving behaviour change among some groups, the need to promote the social value of falls prevention programs, and the importance of identifying and addressing factors associated with activity avoidance. CONCLUSIONS AND IMPLICATIONS: In terms of the impact of these findings on the Cochrane review, the most important implication is that although trials of multifactorial falls prevention packages have reported beneficial results, in clinical practice it is important to consult with individual potential participants and find out what characteristics they are willing to modify, and what changes they are prepared to make to reduce their risk of falling. Otherwise, there is the risk that expensive programs are not properly targeted or fail to achieve maximum participation rates. Further work on the most robust and pragmatic methods of synthesizing disparate studies on patients' views and preferences to inform evidence-based guideline recommendations is needed.