Rethinking individual and community fall prevention strategies: a meta-regression comparing single and multifactorial interventions
|
|
- Marcus Todd
- 6 years ago
- Views:
Transcription
1 Age and Ageing 2007; 36: doi: /ageing/afm122 The Author Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please Rethinking individual and community fall prevention strategies: a meta-regression comparing single and multifactorial interventions A. JOHN CAMPBELL, M.CLARE ROBERTSON Department of Medical and Surgical Sciences, University of Otago Medical School, Dunedin, New Zealand Address correspondence to: A. John Campbell. john.campbell@stonebow.otago.ac.nz Abstract Background guidelines recommend that fall prevention programmes for older people include multifactorial interventions. Objective we aimed to determine if randomised controlled trial evidence supports interventions with multiple components over single strategies in community based fall prevention. Methods we searched the literature for trials of interventions aimed at preventing falls. We included trials if they met the following criteria: (i) participants were randomly allocated to intervention and control groups, (ii) all participants were aged 65 years or older, (iii) the majority lived independently in the community, (iv) fall events were recorded prospectively using a diary or calendar during the entire trial and monitored at least monthly, (v) follow up was for 12 months or longer, (vi) at least 70% of participants completed the trial, (vii) all falls during the trial for at least 50 participants were included in the analysis, and (viii) a relative rate ratio with 95% CI comparing the number of falls in the intervention and control groups was reported. We calculated a pooled rate ratio separately for trials testing multifactorial and single interventions and compared their overall efficacy using meta-regression. Results meta-regression showed that single interventions were as effective in reducing falls as interventions with multiple components (pooled rate ratios 0.77, 95% CI and 0.78, respectively). Conclusion multifactorial fall prevention interventions are effective for individual patients. However, for community programmes for populations at risk, targeted single interventions are as effective as multifactorial interventions, may be more acceptable and cost effective. Keywords: accidental falls, elderly, meta-analysis, randomised controlled trials, public health Introduction Half of those 80 years and over, will fall sometime in any 1 year [1, 2] and 27% of all hospital costs for this population will result from these falls [3]. The falls put older people at risk of injury, loss of independence, rest home admission and death. Over the last 10 years a number of successful fall prevention trials using a variety of interventions have been published and, as a consequence, there has been international interest and investment in fall prevention programmes. To have any noticeable effect on such a common problem as falls, community programmes need to be proven to be effective, acceptable to participants and affordable within limited public health budgets. Most importantly, they need to be available to a high proportion of the population at risk. Current guidelines support multi-component fall prevention programmes [4, 5]. On the surface, such an approach seems entirely logical. Most falls result from multiple risk factors and the early multifactorial intervention trials were successful [6]. However, it has not yet been demonstrated that multiple or multifactorial interventions prevent more falls than single, targeted interventions. The assumption that 656
2 Rethinking individual and community fall prevention strategies more components are necessarily better may have arisen from a failure to distinguish between fall prevention for an individual patient and community fall prevention for populations at risk. Fall prevention requires two approaches: (i) services for individual patients referred for specialist management, and (ii) community programmes directed at populations of elderly people living in the community and at risk of falling. The services for individual patients are based on comprehensive patient assessment and diagnosis and are staff and resource intensive. A multi-disciplinary team provides treatment. On the other hand, community or public health programmes need to be less individually expensive and staff intensive in order to reach more people at risk. They are commonly based on a simple assessment, delivered by a single health professional working according to a protocol and suitable for widespread dissemination. Although there is trial evidence to support a full assessment, and multifactorial interventions for individual patients [7] there is no direct trial evidence that multiple or multifactorial interventions are more effective than targeted single interventions for community populations at risk. However, there is trial evidence that two interventions used concurrently are less effective in reducing falls than the interventions used singly. In a recently completed trial of two interventions we showed that the effective intervention prevented more falls when delivered singly than in combination [8]. Multifactorial intervention community programmes, especially if delivered by a multi-disciplinary team, are likely to be more costly than single interventions [9, 10]. The additional cost of multifactorial interventions could only be justified if they prevented more falls than single intervention programmes. To determine if multi-component interventions are more effective than single interventions we have reviewed all community based fall prevention randomised controlled trials and conducted a meta-regression of those trials where the analysis and reporting of data made the comparison of all falls possible [11]. Methods This study was part of an ongoing research programme, so that literature searches were made at multiple time points until December We searched the Cochrane Bone, Joint and Muscle Trauma Group register, Cochrane Controlled Trials Register, MEDLINE, EMBASE, CINAHL, and reference lists of identified articles (including systematic reviews and meta-analyses) for trials of interventions aimed at preventing falls. The search strategy was developed and used during a systematic review of interventions to prevent falls in elderly people for the Cochrane Library [12]. Resources allowed review of articles in English only. Trials were included in our meta-analyses if they met the following criteria: (i) participants were randomly allocated to intervention and control groups, (ii) all participants were aged 65 years or older, (iii) the majority lived independently in the community, (iv) fall events were recorded prospectively using a diary or calendar during the entire trial and monitored at least monthly, (v) follow up was for 12 months or longer, (vi) at least 70% of participants completed the trial, (vii) all falls during the trial for at least 50 participants were included in the analysis, and (viii) a relative rate ratio with 95% CI comparing the number of falls in the intervention and control groups was reported [13 16]. The quality of the methodology used in each trial was assessed by two reviewers independently using a predetermined scoring system [12]. Reviewers were not blinded to author and source institutions and authors did not review their own studies. Disagreement was resolved by consensus or third party adjudication. We grouped the studies into two categories according to the intervention being tested (i) multi-component interventions and (ii) interventions addressing one category of fall risk factor only (for example, exercise programme, home safety programme). We used Stata 8.0 to calculate a pooled rate ratio separately for the multi-component and single factor interventions. We tested for heterogeneity between the studies using the chi-squared test and the I 2 statistic (which was greater than 50% in all cases for fixed effect models). Consequently, we used random effect models. We compared the two pooled rate ratios by introducing a variable indicating whether the intervention was single factor or had multiple components into a meta-regression model of all the trials [17]. We carried out a sensitivity analysis by widening the three following selection criteria items and repeating the analyses: (i) all participants were aged 60 years or older or mean age 70 years, (ii) fall events were recorded prospectively using a diary or calendar during the entire trial (frequency of monitoring not restricted), and (iii) follow up was for 6 months or longer. Results We identified 90 trials in community living older people and 32 in institutions and hospitals. From the community trials, 14 trials (5,968 participants, with 3,991 (67%) being women) met our initial criteria (Appendix Table 1 on the journal website In five trials, each participant in the intervention groups received an individual combination of interventions addressing more than one major risk factor [6, 18 21], and in nine trials, each intervention addressed only one particular category of risk [8, 10, 22 28]. In one trial with a two-by-two factorial design, two single interventions were tested [8], and in one trial, two multifactorial interventions were each compared with the control [21]. The quality assessment scores are available in Appendix Table 2 on the journal website ( Meta-analyses showed that the six interventions with multiple components reduced falls by 22% (pooled rate ratio 0.78, 95% CI ) and the 10 single interventions 657
3 reduced falls by 23% (pooled rate ratio 0.77, 95% CI ) (Figure 1). The indicator variable for single and multifactorial intervention trials was not significant in a metaregression model containing all 16 comparisons (P = 0.902), confirming no difference in the two pooled rate ratios. The sensitivity analyses included nine more trials (one multifactorial comparison and 10 single intervention comparisons [29 37], see Appendix Table 1 on the journal website ( but showed similar results (total 8,380 participants, 5,903 (70%) women). The seven multifactorial interventions reduced falls by 23% (pooled rate ratio 0.77, 95% CI ) and the 20 single interventions reduced falls by 29% (pooled rate ratio 0.71, 95% CI ) (Figure 2). There was no difference in these two pooled rate ratios (P = 0.273). For both the initial and sensitivity meta-analyses there was evidence for heterogeneity in the single intervention models (Q = 19.56, P = 0.021, I 2 = 54%; Q = 42.54, P = 0.001, I 2 = 55% respectively) but none for the multifactorial models (Q = 8.06, P = 0.153, I 2 = 38%; Q = 8.52, P = 0.203, I 2 = 30%). Discussion The meta-analyses demonstrate that the delivery of single factor interventions to selected populations is as effective in reducing falls as delivering multifactorial interventions to atrisk community populations. This runs contrary to currently accepted guidelines, and both the validity of and explanation for this finding require close examination. There may be, as yet, insufficient good quality trials to demonstrate significant additional benefits from multifactorial interventions. Using very rigorous inclusion criteria, we were able to include 16 interventions involving 5,968 individuals in the first analysis. We performed a sensitivity analysis using broader criteria and included 27 interventions involving 8,380 individuals. In neither analysis was there any trend towards multifactorial interventions being more effective. Effective fall prevention interventions, single or multicomponent, decreased the number of falls by almost a third. The interventions used in the trials were based on the increased fall rate associated with known falls risk factors. The contribution of known, remediable risk factors for falls [38], and the extent to which these risk factors are improved on intervention [39], suggest that fall reduction in the order of 30 40% is likely to be the maximum effect to be expected in multifactorial fall prevention trials. It is, therefore, unlikely that future interventions, based on decreasing known fall risk factors, will increase the trial success rate sufficiently to alter the meta-regression null result. There was significant heterogeneity in the single intervention meta-analyses, which is consistent with the hypothesis that single interventions need to be carefully directed to the appropriate population. Such interventions are highly successful when used in populations where the risk factor addressed accounts for a large proportion of the falls risk. Such a specific intervention is ineffective if it does 658 not alter the risk factor, or the risk factor accounts for a small proportion of the risk. If there is a single risk factor, such as dementia, which accounts for a high proportion of the falls risk, then even multifactorial interventions which do not address the root cause of the falling, will be ineffective [40]. In multifactorial intervention studies there may be an interaction amongst the interventions, which means that each is less effective when used in combination. In a factorial design of fall prevention trial in elderly people with severe visual impairment, we found that a successful home modification intervention used alone prevented more falls than when used in conjunction with a previously successful strength and balance re-training programme [8]. The interaction was significant and there are plausible explanations for such an interaction, which may explain the lack of additional benefit seen in the multifactorial intervention trials. Two or more interventions may cause confusion, or lead to more change than the older person is willing to accept. She may then opt for the intervention which is most acceptable. This is particularly so if the advice appears conflicting. For example, a home and behaviour modification programme emphasises safety and possible decrease of some activities, whereas a strength and balance programme requires increased and new activity. Too many changes may lead to rejection of all interventions, decreased adherence or limited programme uptake. Not all interventions in multi-component intervention studies result in change. In the multifactorial intervention study of Tinetti et al., the reduction in psychotropic drug use was no different in the intervention and control groups at reassessment [6]. In multifactorial intervention studies there may be insufficient time and resource to implement effectively the more demanding interventions. Single interventions were effective when they were directed at the major remedial risk factor for the particular trial population. Strength and balance re-training, home based, as a group programme or as tai chi, was the most widely investigated intervention. Impairment of strength and balance may be the final common pathway to a fall for a number of risk factors, such as knee arthritis, inactivity, medications (for example, psychotropic medications) and vitamin D deficiency. The population chosen for strength and balance as a single intervention needs not to be too fit or too frail. Our studies have shown benefit in those of 80 years and over, but not in those younger [41]. In the VIP study, in which the population was severely visually impaired and frailer than in our earlier studies, there was a lower adherence to the Otago Exercise Programme, and no fall reduction in those who did not exercise regularly [8]. We suggest that strength and balance re-training is most effective when the participants are just at that critical threshold where daily home tasks are at the limits of the person s stability. Small gains have a disproportionate benefit by enabling the person to cope more safely with the activities of daily living.
4 Rethinking individual and community fall prevention strategies Tinetti 1994 Hogan 2001 Clemson 2004 Davison 2005 Lord 2005 (a) Lord 2005 (b) (a) (b) Buchner 1997 Campbell 1997 Cumming 1999 Robertson 2001 Stevens 2001 Barnett 2003 Lord 2003 Wolf 2003 Campbell 2005 (a) Campbell 2005 (b) Figure 1. (a) Meta-analysis for multifactorial interventions (initial pooling) ; (b) Meta-analysis for single interventions (initial pooling). Pooled rate ratio 0.78 (95% CI ). Tests for homogeneity: Q = 8.06, P = 0.153; I 2 = 38%. Pooled rate ratio 0.77 (95% CI ). Tests for homogeneity: Q = 19.56, P = 0.021; I 2 = 54%. Selection need not be complex and can be made on the basis of age, previous falls, or determination by the general practitioner. Community programmes based on more sophisticated analysis of risk have not been more effective [21]. Those with dementia have been shown not to benefit from a fall prevention programme [40]. Inability to participate in a programme because of cognitive impairment is currently a justifiable reason for exclusion. A home safety programme delivered by an occupational therapist was successful in those with a previous fall, discharged from hospital [24] and in a population with severe visual impairment [8]. A safe environment may be particularly important for those with severe sensory impairments. Other than in these groups, success has been limited. Environmental hazards may be too ubiquitous for total removal and elderly people too resistant to interference in their homes for this intervention to be more universally successful. In two successful home modification trials, falls have been reduced as much away from home as at home [8, 24]. The advice of the occupational therapist may be the critical element in the intervention rather than the home modifications. Programmes that have included a detailed assessment for syncope showed a subsequent reduction in falls [32]. The number needed to assess in order to identify those likely to benefit from subsequent interventions means that this is not an intervention suitable for primary community prevention. Instead, such patients need to be identified by their general practitioners or emergency department staff and referred for specialist assessment. The blinded withdrawal of psychotropic drugs was successful in preventing falls in a community based study [31]. However, recruitment and adherence were so difficult that this intervention was likely to be successful in individualised programmes and not in community primary prevention. Concluding comment Those who have fallen and are at increased risk of further falls may benefit from individualised assessment and treatment. 659
5 Tinetti 1994 Hogan 2001 Nikolaus 2003 Clemson 2004 Davison 2005 Lord 2005 (a) Lord 2005 (b) (a) (b) Wolf 1996 (a) Wolf 1996 (b) Buchner 1997 Campbell 1997 Campbell 1999 (a) Campbell 1999 (b) Cumming 1999 Kenny 2001 Robertson 2001 Stevens 2001 Barnett 2003 Lord 2003 Wolf 2003 Campbell 2005 (a) Campbell 2005 (b) Harwood 2005 Li 2005 Skelton 2005 Foss 2006 Voukelatos Figure 2. (a) Meta-analysis for multifactorial interventions (sensitivity analysis) ; (b) Meta-analysis for single interventions (sensitivity analysis). Pooled rate ratio 0.77 (95% CI ). Tests for homogeneity: Q = 8.52, P = 0.203; I 2 = 30%. Pooled rate ratio 0.71 (95% CI ). Tests for homogeneity: Q = 42.54, P = 0.001; I 2 = 55%. Such intensive assessment will not be available for the large number of elderly people at risk of falling. We suggest that lean and targeted single interventions are the most acceptable and easily instituted method of achieving fall reduction in the community. For a community based approach, targeted single interventions are as effective as multifactorial interventions, may be more acceptable and cost effective Acknowledgements Key points Most falls result from multiple risk factors. Therefore, it is assumed that multifactorial fall prevention strategies will be most effective Meta-regression showed that interventions addressing a single risk factor are as effective in reducing falls as interventions with multiple components Multifactorial fall prevention interventions are effective for individual patients We are grateful to Lesley Gillespie from the Cochrane Bone, Joint and Muscle Trauma Group for the literature searches, and fellow Cochrane systematic review authors Lesley Gillespie, Bill Gillespie, Sally Lamb, Bob Cumming and Brian Rowe for the quality assessments. We thank Peter Herbison, biostatistician, for advice on statistical methodology. Conflict of interest statement There are no conflicts of interest. 660
6 Rethinking individual and community fall prevention strategies Funding Associate Professor Robertson was funded by the Health Research Council of New Zealand. Supplementary data Supplementary data for this article is available online at References 1. Campbell AJ, Borrie MJ, Spears GF. Risk factors for falls in a community-based prospective study of people 70 years and older. J Gerontol Med Sci 1989; 44: M Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med 1988; 319: Robertson MC, Devlin N, Scuffham P et al. Economic evaluation of a community based exercise programme to prevent falls. J Epidemiol Community Health 2001; 55: American Geriatrics Society, British Geriatrics Society, American Academy of Orthopaedic Surgeons Panel on Falls Prevention. Guideline for the prevention of falls in older persons. J Am Geriatr Soc 2001; 49: NHS National Institute for Clinical Excellence. Falls: the assessment and prevention of falls in older people, November 2004; Clinical Guideline Tinetti ME, Baker DI, McAvay G et al. A multifactorial intervention to reduce the risk of falling among elderly people living in the community. N Engl J Med 1994; 331: Close JCT, Patel A, Hooper R et al. PROFET improved clinical outcomes at no additional cost. Age Ageing 2000; 29: Campbell AJ, Robertson MC, La Grow SJ et al. Randomised controlled trial of prevention of falls in people aged 75 with severe visual impairment: the VIP trial. BMJ 2005; 331: Rizzo JA, Baker DI, McAvay G et al. The cost-effectiveness of a multifactorial targeted prevention program for falls among community elderly persons. Med Care 1996; 34: Robertson MC, Devlin N, Gardner MM et al. Effectiveness and economic evaluation of a nurse delivered home exercise programme to prevent falls. 1: Randomised controlled trial. BMJ 2001; 322: Herbert RD, Bo K. Analysis of quality of interventions in systematic reviews. BMJ 2005; 331: Gillespie LD, Gillespie WJ, Robertson MC et al. Interventions for preventing falls in elderly people. Cochrane Database Syst Rev 2003; 4: CD Ganz DA. Monitoring falls in cohort studies of communitydwelling older people: effect of the recall interval. J Am Geriatr Soc 2005; 53: Lamb SE, Jorstad-Stein EC, Hauer K et al. Prevention of Falls Network Europe, Outcomes Consensus Group. Development of a common outcome data set for fall injury prevention trials: the Prevention of Falls Network Europe consensus. J Am Geriatr Soc 2005; 53: Kjaergard LL, Villumsen J, Gluud C. Reported methodologic quality and discrepancies between large and small randomized trials in meta-analyses. Ann Intern Med 2001; 135: Robertson MC, Campbell AJ, Herbison P. Statistical analysis of efficacy in falls prevention trials. J Gerontol Med Sci 2005; 60: Sharp SJ. Meta-analysis regression. Stata Tech Bull 1998; 42: Hogan DB, MacDonald FA, Betts J et al. A randomized controlled trial of a community-based consultation service to prevent falls. Can Med Assoc J 2001; 165: Clemson L, Cumming RG, Kendig H et al. The effectiveness of a community-based program for reducing the incidence of falls in the elderly: a randomized trial. J Am Geriatr Soc 2004; 52: Davison J, Bond J, Dawson P et al. Patients with recurrent falls attending accident and emergency benefit from multifactorial intervention a randomised controlled trial. Age Ageing 2005; 34: Lord SR, Tiedemann A, Chapman K et al. The effect of an individualized fall prevention program on fall risk and falls in older people: a randomized, controlled trial. J Am Geriatr Soc 2005; 53: Buchner DM, Cress ME, de Lateur BJ et al. The effect of strength and endurance training on gait, balance, fall risk, and health services use in community-living older adults. J Gerontol Med Sci 1997; 52A: M Campbell AJ, Robertson MC, Gardner MM et al. Randomised controlled trial of a general practice programme of home based exercise to prevent falls in elderly women. BMJ 1997; 315: Cumming RG, Thomas M, Szonyi G et al. Home visits by an occupational therapist for assessment and modification of environmental hazards: a randomized trial of falls prevention. J Am Geriatr Soc 1999; 47: Stevens M, Holman CD, Bennett N et al. Preventing falls in older people: outcome evaluation of a randomized controlled trial. J Am Geriatr Soc 2001; 49: Barnett A, Smith B, Lord SR et al. Community-based group exercise improves balance and reduces falls in at-risk older people: a randomised controlled trial. Age Ageing 2003; 32: Lord SR, CastellS, CorcoranJ et al. The effect of group exercise on physical functioning and falls in frail older people living in retirement villages: a randomized, controlled trial. J Am Geriatr Soc 2003; 51: Wolf SL, Sattin RW, Kutner M et al. Intense tai chi exercise training and fall occurrences in older, transitionally frail adults: a randomized, controlled trial. J Am Geriatr Soc 2003; 51: Nikolaus T, Bach M. Preventing falls in community-dwelling frail older people using a home intervention team (HIT): results from the randomized Falls-HIT trial. J Am Geriatr Soc 2003; 51: Wolf SL, Barnhart HX, Kutner NG et al. Reducing frailty and falls in older persons: an investigation of Tai Chi and computerized balance training. J Am Geriatr Soc 1996; 44: Campbell AJ, Robertson MC, Gardner MM et al. Psychotropic medication withdrawal and a home-based exercise program to prevent falls: a randomized, controlled trial. J Am Geriatr Soc 1999; 47: Kenny RA, Richardson DA, Steen N et al. Carotid sinus syndrome: a modifiable risk factor for nonaccidental falls 661
7 in older adults (SAFE PACE). J Am Coll Cardiol 2001; 38: Harwood RH, Foss AJ, Osborn F et al. Falls and health status in elderly women following first eye cataract surgery: a randomised controlled trial. Br J Ophthalmol 2005; 89: Li F, Harmer P, Fisher KJ et al. Tai Chi and fall reductions in older adults: a randomized controlled trial. J Gerontol Med Sci 2005; 60A: Skelton D, Dinan S, Campbell M et al. Tailored group exercise (Falls Management Exercise FaME) reduces falls in community-dwelling older frequent fallers (an RCT) [letter]. Age Ageing 2005; 34: Foss AJ, Harwood RH, Osborn F et al. Falls and health status in elderly women following second eye cataract surgery: a randomised controlled trial. Age Ageing 2006; 35: Voukelatos A, Rissel C, Cumming R et al. The Central Sydney Tai Chi Trial: A randomised Controlled Trial of the Effectiveness of tai chi in Reducing the Risk of Falls in Older People. Sydney: NSW Department of Health, Tromp AM, Pluijm SM, Smit JH et al. Fall-risk screening test: a prospective study on predictors for falls in community-dwelling elderly. J Clin Epidemiol 2001; 54: Tinetti ME, McAvay G, Claus E. Does multiple risk factor reduction explain the reduction in fall rate in the Yale FICSIT Trial? Frailty and Injuries Cooperative Studies of Intervention Techniques. Am J Epidemiol 1996; 144: Shaw FE, Bond J, Richardson DA et al. Multifactorial intervention after a fall in older people with cognitive impairment and dementia presenting to the accident and emergency department: randomised controlled trial. BMJ 2003; 326: Robertson MC, Campbell AJ, Gardner MM et al. Preventing injuries in older people by preventing falls: a meta-analysis of individual-level data. J Am Geriatr Soc 2002; 50: Received 24 January 2007; accepted in revised form 25 May
Falls prevention strategies for people with visual impairment
Falls prevention strategies for people with visual impairment Clare Robertson University of Otago Medical School Dunedin, New Zealand Vision loss in Australia 480,000 visually impaired in both eyes (visual
More informationT he prevention of falls in the older population is a
421 ORIGINAL ARTICLE Predictors of falls in a high risk population: results from the prevention of falls in the elderly trial (PROFET) J C T Close, R Hooper, E Glucksman, SHDJackson, C G Swift... See end
More informationGuidelines for the Physiotherapy management of older people at risk of falling
Guidelines for the Physiotherapy management of older people at risk of falling AGILE: Chartered Physiotherapists working with Older People Produced by the AGILE Falls guidelines working group: Victoria
More informationKupu Taurangi Hauora o Aotearoa
Kupu Taurangi Hauora o Aotearoa What it means to fall leading cause of injury in 65+ year olds loss of confidence, fear of further falls for frail elderly with osteoporotic fractures almost 50% will require
More informationEconomic evaluation of a community based exercise programme to prevent falls
600 Department of Medical and Surgical Sciences, University of Otago Medical School, Dunedin, New Zealand M C Robertson M M Gardner A J Campbell Department of Preventive and Social Medicine,University
More informationExercise prescription for falls prevention A/Prof Cathie Sherrington
Exercise prescription for falls prevention A/Prof Cathie Sherrington Affiliated with the University of Sydney 1 ProFaNE taxonomy for exercise Gait, balance, and functional training Strength/resistance
More informationThe effect of water based exercises on fall risk factors: a mini-review. Dr Esther Vance, Professor Stephen Lord
The effect of water based exercises on fall risk factors: a mini-review Dr Esther Vance, Professor Stephen Lord Falls and Balance Research Group, NeuRA. There is considerable evidence from systematic reviews
More informationFalls in the Elderly. Causes and solutions.
Falls in the Elderly. Causes and solutions. Brent Tipping Sub-specialist Geriatrician and Specialist Physician Division of Geriatric Medicine University of the Witwatersrand 6 th Annual congress of the
More informationUpdate on Falls Prevention Research
Update on Falls Prevention Research Professor Stephen Lord Coffs Harbour Falls Prevention Network Rural Forum 28 th February 2014 Acknowledgments: Dr Jasmine Menant, Mr. Daniel Schoene Recent falls risk
More informationOccupational participation postdischarge. adults: A mixed methods study. Elizabeth Pritchard PhD Candidate NZAOT Conference 2012
Occupational participation postdischarge in older adults: A mixed methods study Elizabeth Pritchard PhD Candidate NZAOT Conference 2012 Overview Study context Definition of occupational participation Incidence
More informationArchives of Gerontology and Geriatrics
Archives of Gerontology and Geriatrics 48 (2009) 325 331 Contents lists available at ScienceDirect Archives of Gerontology and Geriatrics journal homepage: www.elsevier.com/locate/archger A systematic
More informationEvery year, a third of Americans over age 65
Falls and mobility problems are not just part of getting old! Every year, a third of Americans over age 65 living in the community suffer a fall, and 50% over the age of 80 fall at least once per year.
More informationMental health and falls in older people. Stephen Lord
Mental health and falls in older people Stephen Lord Depression Common Risk Factors Biderman et al (2002) Identified 5 common risk factors for depression and falls Poor self-rated health Poor cognitive
More informationUpdate on Falls Prevention Research
Update on Falls Prevention Research Jasmine Menant NSW Falls Prevention Network Rural Forum 26 th March 2015 Acknowledgments: Prof Stephen Lord Recent falls risk factor studies Vascular disease 38.6% of
More informationA John Campbell MD, FRACP M Clare Robertson PhD
Foreword Falls are such common events for older people that it is easy to overlook their often very serious consequences for the person and their considerable cost to the country. Falls seem such simple
More informationEffectiveness and economic evaluation of a nurse delivered home exercise programme to prevent falls. 1: Randomised controlled trial
Effectiveness and economic evaluation of a nurse delivered home exercise programme to prevent falls. 1: Randomised controlled trial M Clare Robertson, Nancy Devlin, Melinda M Gardner, A John Campbell Abstract
More informationReducing Falls: Merging Research and Community Resources
University of Vermont ScholarWorks @ UVM Family Medicine Block Clerkship, Student Projects College of Medicine 2016 Reducing Falls: Merging Research and Community Resources Alison Mercier Follow this and
More informationIt s NOT about Bingo Jennifer Ellis, PT, DPT, PhD, MS, GCS What s in a hand
It s NOT about Bingo Jennifer Ellis, PT, DPT, PhD, MS, GCS What s in a hand 1 2 3 4 Optimal Optimal Aging Aging Successful aging theory. Adapted from Flood (2005). 13 Optimal Optimal Aging? Aging 14 Adults
More informationMultifactorial and multiple component interventions for preventing falls in older people living in the community(review)
Cochrane Database of Systematic Reviews Multifactorial and multiple component interventions for preventing falls in older people living in the community (Review) Hopewell S, Adedire O, Copsey BJ, Boniface
More informationInterventions for preventing falls in older people in care facilities and hospitals (Review)
Interventions for preventing falls in older people in care facilities and hospitals (Review) Cameron ID, Gillespie LD, Robertson MC, Murray GR, Hill KD, Cumming RG, Kerse N This is a reprint of a Cochrane
More informationUpdate on Falls Prevention Research
Update on Falls Prevention Research Dr Jasmine Menant NSW Falls Prevention Network Rural Forum 17 th October 2014 Acknowledgement: Prof Stephen Lord Recent falls risk factor studies Vascular disease 38.6%
More informationT he economic impact of falls in older persons is a matter of
740 RESEARCH REPORT Incidence and costs of unintentional falls in older people in the United Kingdom P Scuffham, S Chaplin, R Legood... See end of article for authors affiliations... Correspondence to:
More informationRelationship between Dental Occlusion and Falls among the Elderly with Dementia
Prosthodont Res Pract 5 : 52-56, 26 ORIGINAL ARTICLE Relationship between Dental Occlusion and Falls among the Elderly with Dementia Mitsuyoshi Yoshida, DDS, PhD, Hidehiko Morikawa, DDS, Yayoi Kanehisa,
More informationUpdate on Falls Prevention Research
Update on Falls Prevention Research Jasmine Menant NSW Falls Prevention Network Rural Forum 8 th March 2018 Acknowledgments: Prof Stephen Lord Recent falls risk factor studies Brain activation in older
More informationResources and References Handout. Preventing Falls Among Community-Dwelling Older Adults
Resources and References Handout Preventing Falls Among Community-Dwelling Older Adults Hyperlinks http://www.aoa.gov/aoa_programs/oaa/how_to_find/agencies/find_agenci es.aspx http://www.aota.org/consumers/aging
More informationPrevention of falls in older age: The role of physical activity. Dr Anne Tiedemann Senior Research Fellow
Prevention of falls in older age: The role of physical activity Dr Anne Tiedemann Senior Research Fellow Fall definition Prevention of Falls Network Europe (ProFaNE) definition 1 : an unexpected event
More informationUpdate on Falls Prevention Research
Update on Falls Prevention Research Jasmine Menant NSW Falls Prevention Network Rural Forum 24 th August 2018 Acknowledgements: Prof Stephen Lord, Dr Daina Sturnieks Recent falls risk factor studies Lubaszy
More informationEvidence-based clinical practice in falls prevention: a randomised controlled trial of a falls prevention service
Australian Health Review [Vol 26 No 3] 2003 Evidence-based clinical practice in falls prevention: a randomised controlled trial of a falls prevention service CRAIG WHITEHEAD, RACHEL WUNDKE, MARIA CROTTY
More informationPrevalence and correlates of fear of falling, and associated avoidance of activity in the general population of community-living older people
Age and Ageing Advance Access published March 22, 2007 Age and Ageing doi:10.1093/ageing/afm021 The Author 2007. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights
More informationFall Prevention and hip protectors
Presenter Disclosure Information Edgar Pierluissi Division of Geriatrics Edgar Pierluissi, MD Medical Director, Acute Care for Elders Unit, San Francisco General Hospital and Trauma Center Fall Prevention
More informationSupplementary Online Content. Tinetti ME, Kumar C. The patient who falls: It s always a trade-off. JAMA.
Supplementary Online Content Tinetti ME, Kumar C. The patient who falls: It s always a trade-off. JAMA. 2010;303(3):258-266. efigure. Clock Draw eappendix. Search Strategy and Resulting References for
More informationLinda Furness, Occupational Therapy Clinical Education Support Officer, Darling Downs Hospital and Health Service Contact:
Linda Furness, Occupational Therapy Clinical Education Support Officer, Darling Downs Hospital and Health Service Contact: linda.furness@health.qld.gov.au Why? 1 older person dies every 5 hours following
More informationFalls. Key Points. The highest proportions of community-dwelling older adults who fall are in the 80+ age cohort (de Negreiros Carbral et al., 2013).
Falls Key Points Reducing falls and fall-associated deaths and serious injuries is one of the major goals of Healthy People 2020 (U.S. Department of Health and Human Services, 2010). Twenty-eight to thirty-five
More informationInterventions for preventing falls in older people in nursing care facilities and hospitals (Review)
Interventions for preventing falls in older people in nursing care facilities and hospitals (Review) Cameron ID, Murray GR, Gillespie LD, Robertson MC, Hill KD, Cumming RG, Kerse N This is a reprint of
More informationInterventions that work to prevent falls
Interventions that work to prevent falls Dr Frances Batchelor Research Fellow/Physiotherapist Director, Health Promotion National Ageing Research Institute How big a problem What causes a fall? What is
More informationFALL PREVENTION AND OLDER ADULTS BURDEN. February 2, 2016
February 2, 2016 FALL PREVENTION AND OLDER ADULTS Each year in Winnipeg, one in three adults over 65 years of age will experience a fall. 1 Approximately one third of people 65 years of age and older and
More informationPreven&on of Falls in Older Adults
David Ganz, MD, PhD Staff Physician, VA Greater Los Angeles Assistant Professor of Medicine, UCLA Preven&on of Falls in Older Adults No conflicts of interest to disclose Objectives Detail the evidence-based
More informationElderly Fallers: What Do We Need To Do?
Elderly Fallers: What Do We Need To Do? Si Ching Lim, MB. ChB, MRCP (UK) Department of Geriatric Medicine, Singapore General Hospital, Singapore Abstract Falls are very common among the elderly. Furthermore,
More informationS Gates, S E Lamb, J D Fisher, M W Cooke and Y H Carter. BMJ published online 18 Dec 2007; doi: /bmj be
Multifactorial assessment and targeted intervention for preventing falls and injuries among older people in community and care settings: systematic review and meta-analysis S Gates, S E Lamb, J D Fisher,
More informationUpper Extremity Fractures and Secondary Fall Prevention: Opportunities to Improve Management and Outcomes Across Disciplines
Upper Extremity Fractures and Secondary Fall Prevention: Opportunities to Improve Management and Outcomes Across Disciplines Christine McDonough, PhD, PT, CEEAA Health Outcomes Unit Department of Health
More informationThe Winchester falls project: a randomised controlled trial of secondary prevention of falls in older people
Age and Ageing 2008; 1 8 doi: 10.1093/ageing/afn192 Age and Ageing Advance Access published October 1, 2008 C The Author 2008. Published by Oxford University Press on behalf of the British Geriatrics Society.
More informationCritical Appraisal on Randomized Factorial Trial of Falls Prevention Among Older People Living in Their Own Homes
Rehabilitation Science 2018; 3(1): 17-22 http://www.sciencepublishinggroup.com/j/rs doi: 10.11648/j.rs.20180301.14 Review Article Critical Appraisal on Randomized Factorial Trial of Falls Prevention Among
More informationDavid Chircop ( address: 4 th year undergraduate occupational therapy student, University of Western Sydney
There is strong evidence (level 1a) that a home hazard assessment and modifications can reduce the number of falls at home in older people with a history of falling but not in those without a history of
More informationThe prognosis of falls in elderly people living at home
Age and Ageing 1999; 28: 121 125 The prognosis of falls in elderly people living at home IAN P. D ONALD, CHRISTOPHER J. BULPITT 1 Elderly Care Unit, Gloucestershire Royal Hospital, Great Western Road,
More informationItem No: 10. Meeting Date: Wednesday 20 th September Glasgow City Integration Joint Board. Alex MacKenzie, Chief Officer, Operations
Item No: 10 Meeting Date: Wednesday 20 th September 2017 Glasgow City Integration Joint Board Report By: Contact: Alex MacKenzie, Chief Officer, Operations Anne Mitchell, Head of Older People & Primary
More informationAn economic evaluation of community and residential aged care falls prevention strategies in NSW.
An economic evaluation of community and residential aged care falls prevention strategies in NSW. Jody Church AB, Stephen Goodall A, Richard Norman A, Marion Haas A A Centre for Health Economics Research
More informationGamification technology and falls prevention. Mr Bibhas Roy CMFT Dr Emma Stanmore UoM
Gamification technology and falls prevention Mr Bibhas Roy CMFT Dr Emma Stanmore UoM Gamification in healthcare is the application of design principles of computer games to healthcare solutions that work
More informationProblem solving therapy
Introduction People with severe mental illnesses such as schizophrenia may show impairments in problem-solving ability. Remediation interventions such as problem solving skills training can help people
More informationPreventing Falls in People with Cognitive Impairment Is there any Evidence?
Preventing Falls in People with Cognitive Impairment Is there any Evidence? A/Prof Jacqueline CT Close Prince of Wales Hospital & Clinical School Neuroscience Research Australia University of New South
More informationExercise for the prevention of falls in residential aged care. Results of the SUNBEAM trial
Exercise for the prevention of falls in residential aged care Results of the SUNBEAM trial jenniehewitt@feroscare.com.au Acknowledgements Professor Kathryn Refshauge Professor Stephen Goodall Professor
More informationImproving activity levels in older adults improves clinical outcomes Part 1. Professor Dawn Skelton
Improving activity levels in older adults improves clinical outcomes Part 1 Professor Dawn Skelton Presentation Aims Benefits of physical activity irrespective or age or medical condition Benefits of rehabilitation
More informationA sustainable programme to prevent falls and near falls in community dwelling older people: results of a randomised trial
J Epidemiol Community Health 2;54:227 232 227 University of Queensland, Queensland, Australia Correspondence to: Dr M Steinberg, Healthy Ageing Unit, Department of Social and Preventive Medicine, University
More informationFall prevention research update. Professor Stephen Lord Neuroscience Research Australia University of NSW Sydney, Australia
Fall prevention research update Professor Stephen Lord Neuroscience Research Australia University of NSW Sydney, Australia Simple Predictors of Falls in Residential Care Dwellers Whitney J et al, Arch
More informationGwent Integrated Falls Service. Dr S Vasishta ABHB Clinical Lead for Falls Service
Gwent Integrated Falls Service Dr S Vasishta ABHB Clinical Lead for Falls Service Fall An unwanted event whereby an individual comes to rest inadvertently either on the ground or another level from standing
More informationScoping Exercise on Fallers Clinics
Scoping Exercise on Fallers Clinics Report to the National Co-ordinating Centre for NHS Service Delivery and Organisation R & D (NCCSDO) March 2007 prepared by Sarah Lamb* Simon Gates* Joanne Fisher* Matthew
More informationFall-predictive factors and calculation of probability of falls based on Assessment Score Sheet of Falls
ORIGINAL ARTICLE Fall-predictive factors and calculation of probability of falls based on Assessment Score Sheet of Falls Takashi Ishikura ) Miho Takahashi 2) ) Department of Rehabilitation Science, Osaka
More informationFalls and mobility problems are common and serious
Quality Indicators for Falls and Mobility Problems in Vulnerable Elders John T. Chang, MD, PhD, MPH, w and David A. Ganz, MD, PhD, MPH wz Key words: quality indicators; quality of care; falls; mobility
More information7/12/2016. Presenter Disclosure Information. The Other Half of the Fracture Equation: Fall Prevention and Management. Presentation Outline
Presenter Disclosure Information Edgar Pierluissi Division of Geriatrics Edgar Pierluissi, MD Acute Care for Elders Unit Zuckerberg San Francisco General Hospital July 21, 2016 OSTEOPOROSIS NEW INSIGHTS
More informationAssessment and management of dementia in relation to falls risk: Tools and tips for community, hospital and residential care
Assessment and management of dementia in relation to falls risk: Tools and tips for community, hospital and residential care Professor Jacqueline CT Close Neuroscience Research Australia Prince of Wales
More informationStaying on Your Feet. Taking Steps to Prevent Falls
Staying on Your Feet Taking Steps to Prevent Falls 1 Why falls prevention? 1 out of 3 Canadians over the age of 65 and 1 out of 2 Canadians over the age of 80 will fall at least once a year older adults
More informationRecently Reviewed and Updated CAT: March 2018
Short Question: Specific Question: In patients with Benign Joint Hypermobility Syndrome (BJHS) is targeted physiotherapy more effective than generalised Physiotherapy? Clinical bottom line This update
More informationFor More Information
THE ARTS CHILD POLICY CIVIL JUSTICE EDUCATION ENERGY AND ENVIRONMENT This PDF document was made available from www.rand.org as a public service of the RAND Corporation. Jump down to document6 HEALTH AND
More informationInterventions for the prevention of falls in older adults: systematic review and meta-analysis of randomised clinical trials
Editorial by Gillespie and p 676 Interventions for the prevention of falls in older adults: systematic review and meta-analysis of randomised clinical trials John T Chang, Sally C Morton, Laurence Z Rubenstein,
More informationPrevention (Home Care)
Prevention (Home Care) Improvements in Balance in Older Adults Engaged in a Specialized Home Care Falls Prevention Program. Whitney SL, Marchetti GF, Ellis JL, Otis L. J. Geriatr. Phys. Ther. 2012; epub(epub):
More informationCharacteristics of Optimum Falls Prevention Exercise Programmes for Community-Dwelling Older Adults using the FITT principle
Characteristics of Optimum Falls Prevention Exercise Programmes for Community-Dwelling Older Adults using the FITT principle Valerie Power and Amanda M. Clifford Department of Clinical Therapies, Faculty
More informationOlder people can stay on their feet: final results of a community-based falls prevention programme
HEALTH PROMOTION INTERNATIONAL Vol. 15, No. 1 Oxford University Press 2000 Printed in Great Britain Older people can stay on their feet: final results of a community-based falls prevention programme ANNE
More informationStop Delirium! A complex intervention for delirium in care homes for older people
Stop Delirium! A complex intervention for delirium in care homes for older people Final report Summary September 2009 1 Contents Abstract...3 Lay Summary...4 1. Background...6 2. Objectives...6 3. Methods...7
More informationSummary of session. Prevention and Management of Falls Professor Dawn Skelton. How common are falls? Falls in the UK. Cost to the Individual
Summary of session Prevention and Management of Falls Professor Dawn Skelton The size of the problem The risk factors The Interventions (New CMO Physical Activity Guidelines) Adherence to interventions
More informationCommunity-based group exercise improves balance and reduces falls in at-risk older people: a randomised controlled trial
Age and Ageing 2003; 32: 407 414 Age and Ageing Vol. 32 No. 4 # 2003, British Geriatrics Society. All rights reserved. Community-based group exercise improves balance and reduces falls in at-risk older
More informationUnderstanding and managing fear of falling in older adults
Understanding and managing fear of falling in older adults Presented by Jasmine Menant on behalf of Kim Delbaere NSW Falls Prevention Network Rural Forum Cessnock 26th March 2015 1. Understanding fear
More informationSteady As You Go Peer-led, community-based fall prevention Exercise classes for older adults: Falls, Injuries, and Costs
Steady As You Go Peer-led, community-based fall prevention Exercise classes for older adults: Falls, Injuries, and Costs Birgit Maria Wurzer A thesis submitted for the degree of Master of Physiotherapy
More informationPMH HKU PWH HKPU QMH. Tong HK, A&E Dept. Chu MLM, OT Dept. Fung KKH, OT Dept. Chan MTE, OT Dept. Wong CM, Com Med Dept.
HKU Wong CM, Com Med Dept. PMH Lit CHA, A&E Dept. Cheng WCS, OT Dept. Wong D, OT Dept. Fong NKK, Rehab Sc Dept. HKPU A Community OT Falls Reduction Program Reducing Falls in Six Months for Elderly Attending
More informationModeling the population level impact, costs and benefits of falls prevention measures
Modeling the population level impact, costs and benefits of falls prevention measures A collaborative project between researchers and policy officers at Monash, Ballarat and Flinders and New South Wales
More informationPatients with recurrent falls attending Accident & Emergency benefit from multifactorial intervention a randomised controlled trial
14. Knaus WA, Wagner DP, Zimmerman JE, Draper EA. Variations in mortality and length of stay in intensive care units. Ann Intern Med 1993; 118: 753 61. 15. Le Gall JR, Lemeshow S, Saulnier F. A new simplified
More informationThe effect of a 10-week postural stability exercise intervention on measures of balance in elderly female care home residents
The effect of a 10-week postural stability exercise intervention on measures of balance in elderly female care home residents By Sophie Thomas (supervisor: Dr Louisa Beale) Background Ageing population
More informationData extraction. Specific interventions included in the review Dressings and topical agents in relation to wound healing.
Systematic reviews of wound care management: (2) dressings and topical agents used in the healing of chronic wounds Bradley M, Cullum N, Nelson E A, Petticrew M, Sheldon T, Torgerson D Authors' objectives
More informationThis systematic review was part of a larger project that reviewed research studies
Systematic Review of the Effect of Home Modification and Fall Prevention Programs on Falls and the Performance of Community-Dwelling Older Adults Carla A. Chase, Kathryn Mann, Sarah Wasek, Marian Arbesman
More informationRisk factors for falls
Part I Risk factors for falls 1 Epidemiology of falls and fall-related injuries In this chapter, we examine the epidemiology of falls in older people. We review the major studies that have described the
More informationFalls & Injury Prevention Reflections and Projections Jacqueline CT Close
Falls & Injury Prevention Reflections and Projections Jacqueline CT Close Orthogeriatrician Prince of Wales Hospital Director - Falls and Injury Prevention Group, NeuRA Conjoint Professor - Prince of Wales
More informationAgeing baby boomers: will falls prevention need to change as the ageing population changes?
Ageing baby boomers: will falls prevention need to change as the ageing population changes? Professor Keith Hill, Head, School of Physiotherapy and Exercise Science Keith.Hill@Curtin.edu.au Curtin University
More informationRisk Factors for Falls in Cognitive Impairment
Risk Factors for Falls in Cognitive Impairment A/Prof Jacqueline Close Falls and Injury Prevention Group NeuRA Prince of Wales Clinical School University of New South Wales Background Epidemiology of falls
More informationEVALUATING MODELS OF SERVICE DELIVERY MAY Scoping exercise on fallers clinics
EVALUATING MODELS OF SERVICE DELIVERY MAY 2008 ResearchSummary Scoping exercise on fallers clinics Older people living in the community are at increased risk of falling and fallrelated injuries. Fallers
More informationFALLS PREVENTION. S H I R L E Y H U A N G, M S c, M D, F R C P C
FALLS PREVENTION S H I R L E Y H U A N G, M S c, M D, F R C P C S T A F F G E R I A T R I C I A N T H E O T T A W A H O S P I T A L B R U Y E R E C O N T I N U I N G C A R E W I N C H E S T E R D I S T
More informationThe Effect of Tai Chi Chuan in Reducing Falls in Elderly People at Risk
Professional Assignment Project 2008 The Effect of Tai Chi Chuan in Reducing Falls in Elderly People at Risk Systematic review Carla Boehm Linda Gunnarsdóttir European School of Physiotherapy, Hogeschool
More informationThe U.S. Preventive Services Task Force (USPSTF) makes
Annals of Internal Medicine Clinical Guideline Prevention of Falls in Community-Dwelling Older Adults: U.S. Preventive Services Task Force Recommendation Statement Virginia A. Moyer, MD, MPH, on behalf
More informationINTEGRATED SOLUTIONS FOR SUSTAINABLE FALL PREVENTION
INTEGRATED SOLUTIONS FOR SUSTAINABLE FALL PREVENTION THE isolve PROJECT Establishing pathways and processes to implement and sustain evidence-based fall prevention in primary care Trans Tasman Symposium,
More informationStrategies and Actions for Independent Living (SAIL)
Falls Prevention Training for Strategies and Actions for Independent Living (SAIL) Abstract This article describes a quasiexperimental study on falls prevention for clients of home support services in
More informationDistraction techniques
Introduction are a form of coping skills enhancement, taught during cognitive behavioural therapy. These techniques are used to distract and draw attention away from the auditory symptoms of schizophrenia,
More informationExercise for Falls Prevention in Older People: Evidence & Questions. Professor Pam Dawson
Exercise for Falls Prevention in Older People: Evidence & Questions Professor Pam Dawson Associate Pro Vice Chancellor Strategic Workforce Planning and Development Northumbria University 13 March 2017
More informationTammy Filby ( address: 4 th year undergraduate occupational therapy student, University of Western Sydney
There is evidence from one RCT that an energy conservation course run by an occupational therapist decreased the impact of fatigue by 7% in persons with multiple sclerosis Prepared by; Tammy Filby (email
More informationFear of falling: measurement strategy, prevalence, risk factors and consequences among older persons
Age and Ageing 2008; 37: 19 24 The Author 2008. Published by Oxford University Press on behalf of the British Geriatrics Society. doi:10.1093/ageing/afm169 The online version of this article has been published
More informationPROSPERO International prospective register of systematic reviews
PROSPERO International prospective register of systematic reviews Closed reduction methods for acute anterior shoulder dislocation [Cochrane Protocol] Kanthan Theivendran, Raj Thakrar, Subodh Deshmukh,
More informationSummary of session. Preventing and Managing Falls some thoughts. When do we become fallers instead of trippers? Falls in the UK 02/02/2013
Summary of session Preventing and Managing Falls some thoughts Professor Dawn Skelton The size of the problem The risk factors The Interventions (New CMO Physical Activity Guidelines) Adherence to interventions
More informationDraft. Case Study. Otago Exercise Program. Tiffany E. Shubert, PhD, PT
Case Study for Otago Exercise Program Tiffany E. Shubert, PhD, PT tshubert@med.unc.edu Funding A portion of this work was supported by the Bureau of Health Professions (BHPr), Health Resources and Services
More informationFalls are a serious threat to the lives, health, and independence. Clinical Guideline
Annals of Internal Medicine Clinical Guideline Primary Care Relevant Interventions to Prevent Falling in Older Adults: A Systematic Evidence Review for the U.S. Preventive Services Task Force Yvonne L.
More informationComprehensive geriatric assessment and home-based rehabilitation for elderly people with a history of recurrent non-elective hospital admissions
Geriatric assessment and home-based rehabilitation Age and Ageing 2006; 35: 487 491 doi:10.1093/ageing/afl049 Published electronically 13 June 2006 The Author 2006. Published by Oxford University Press
More informationPatients with joint hypermobility syndrome
Short Question: Specific Question: In patients with Benign Joint Hypermobility Syndrome (BJHS) is targeted physiotherapy more effective than generalised Physiotherapy. Clinical bottom line There is insufficient
More informationStrengths and Weaknesses of Falls Prevention Strategies
Strengths and Weaknesses of Falls Prevention Strategies Dr Dawn Skelton, Reader in Ageing & Health, Glasgow Caledonian University My presentation will. Very briefly explore the prevalence and consequences
More informationAccuracy of validated falls risk assessment tools and clinical judgement
Accuracy of validated falls risk assessment tools and clinical judgement Rapid Review Citation Yap G. and Melder A. Accuracy of validated falls risk assessment tools and clinical judgement: Rapid Review.
More information