Standing Strong: A Systematic Review of Multifaceted Fall Prevention in Older Adults

Abstract

Background: Falls among older adults are a major public health concern, leading to significant morbidity, mortality, and healthcare costs. This systematic review and meta-analysis aimed to evaluate the effectiveness of falls prevention interventions for community-dwelling older adults aged 65 and above. Methods: We searched PubMed, Cochrane Library, CINAHL, Embase, and Web of Science databases for randomized controlled trials published between January 1, 2000, and December 31, 2023. Studies evaluating interventions designed to reduce fall incidence or fall-related injuries in community-dwelling older adults were included. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the RoB 2 tool. Meta-analyses were conducted using random-effects models. Results: Forty-seven studies met the inclusion criteria, involving 23,584 participants across 15 countries. The mean age of participants was 76.3 years (SD 4.7), and 68% were female. Overall, interventions significantly reduced fall rates (Rate Ratio 0.80, 95% CI 0.75-0.86, I=67%). Multifaceted interventions showed the greatest reduction in fall rates (RR 0.75, 95% CI 0.68-0.82), followed by exercise interventions alone (RR 0.85, 95% CI 0.78-0.92). Interventions also reduced the risk of becoming a faller (Risk Ratio 0.85, 95% CI 0.80-0.90) and the risk of fall-related injuries (Risk Ratio 0.83, 95% CI 0.76-0.91). Subgroup analyses revealed greater effectiveness in high-risk populations (RR 0.72, 95% CI 0.65-0.80). Longer interventions (12 months or more) showed greater reductions in fall rates. The mean adherence rate was 76%, with no serious adverse events reported. Conclusions: This review provides strong evidence supporting the implementation of multifaceted falls prevention programs for community-dwelling older adults, with a particular emphasis on exercise interventions. Future research should focus on long-term adherence, cost-effectiveness, and innovative approaches to fall prevention in diverse populations and settings.