Fall prevention interventions in community-dwelling older people with cognitive impairment: a systematic review.

Abstract

Introduction: Falls are a major health concern for older adults, particularly those with cognitive impairment. Many factors contribute to the risk of falls, making it a complex issue to manage.

Aim: This systematic review aimed to identify and describe the implementation strategies used for fall prevention in community-dwelling older people with cognitive impairment.

Eligibility criteria: The review included studies on fall prevention interventions for community-dwelling adults aged > 50 years with cognitive impairment. Eligible studies were primary research, including experimental, quasi-experimental, qualitative, and mixed methods designs, with detailed implementation strategies. Systematic reviews, protocols, editorials, opinions, commentaries, and conference papers were excluded.

Methods: This review followed the JBI methodology for systematic reviews of effectiveness and was reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Five databases were searched for studies published in English after 2000: MEDLINE (EBSCOhost), CINAHL Ultimate (EBSCOhost), PsycINFO (EBSCOhost), Scopus, and Web of Science Core Collection. Data on implementation strategies and outcomes were extracted and synthesized using the ERIC framework and Proctor's implementation taxonomy.

Results: Twenty-one studies met the eligibility criteria. Twenty-four implementation strategies were identified, with 15 directly fitting the ERIC list and 9 additional strategies emerging. The most common strategies were engaging consumers (i.e., patients and family members or caregivers) (n = 13), adapting and tailoring to context (n = 9), and training and educating stakeholders (n = 8). Implementation outcomes were reported inconsistently across studies. Several implementation strategies were often used, but their combined effects on fall prevention outcomes were not clearly reported.

Conclusions: This review indicates that engaging consumers, particularly family members, was the most common implementation strategy to prevent falls. The review also highlights new strategies, such as providing culturally appropriate interventions and using dementia-trained instructors. Lastly, the review identifies the need for clearer reporting of implementation strategies and outcomes in future studies.

Review registration: PROSPERO CRD4202454689.

Spanish abstract: http://links.lww.com/IJEBH/A380.