Multi-Factorial and Multi-Component Fall Prevention Interventions Initiated From the Emergency Department: A Systemic Review and Meta-Analysis.

Abstract

Background: Fall risk screening and prevention interventions initiated from the Emergency Department (ED) are endorsed by current national guidelines. We aimed to evaluate the effectiveness of ED-based multi-factorial and multi-component interventions to prevent falls.

Methods: We conducted a systematic review and meta-analysis of interventions for fall prevention initiated in the ED for older patients (age ≥ 60 years). Multi-component and multi-factorial interventions were included. We excluded studies without a control or comparison group. The published literature was searched from 2019 to May 2024. Risk of bias was assessed with the Newcastle Ottawa tool for observation studies and the Cochrane Risk of Bias v2 for randomized trials. A meta-analysis was completed for the outcomes with multiple studies.

Results: The search resulted in 6312 abstracts with 2571 duplicates, for 3741 unique citations. A total of 18 studies were included in the systematic review; 5 were rated as high risk of bias/low quality. The articles were heterogenous in the intervention type (8 multi-factorial and 8 multi-component), setting (ED focused vs. outpatient), intervention components (i.e., nurses, physicians, therapists), and size (103-1435 participants). The interventions did not decrease risk of falls at 3 months (risk difference 0.05 95% CI [0.00; 0.09]), 6 months (0.07 [-0.04; 0.18]) or 12 months (-0.02 [-0.11; 0.07]). ED revisits at 1 month (-0.01 [-0.03; 0.00]), 3 months (-0.04 [-0.14; 0.06]), and 12 months (0.02 [-0.05; 0.25]) were also unchanged. Mortality and hospitalization rates were also unaffected. Improvement in functional status was noted in 4 of 5 studies reporting this outcome.

Conclusions: Multi-factorial and multi-component fall prevention interventions initiated from the ED did not decrease falls or recurrent healthcare use. These interventions may improve functional status in older adults at fall risk. Comparisons are limited by the heterogeneity in types of interventions, intervention compliance, and timing of outcomes.