PROSPERO International prospective register of systematic reviews Preventing falls and associated mortality in older people: an umbrella review of systematic reviews Mukesh Dherani, Stefanie Buckner, Daniel Pope, Louise Lafortune, Nigel Bruce Citation Mukesh Dherani, Stefanie Buckner, Daniel Pope, Louise Lafortune, Nigel Bruce. Preventing falls and associated mortality in older people: an umbrella review of systematic reviews. PROSPERO 2015:CRD42015010571 Available from http://www.crd.york.ac.uk/prospero_rebranding/display_record.asp?id=crd42015010571 Review question(s) 1) What interventions/strategies have been shown to be effective in preventing falls in older people? 2) What interventions/strategies have been shown to be effective in reducing mortality due to falls in older people? Searches A structured search strategy will be developed using exhaustive search terms related to falls such as fall(s) using MeSH terms or thesaurus of the relevant databases with a wide range of free-text terms. The falls related terms will be combined with other search terms relevant to research questions such as incidence, injury and mortality, prevention, and interventions. Searches will be limited to systematic reviews published/conducted over the 2000-2014 period. The searches will be limited to reviews focusing on older people of either sex living in (i) the community or (ii) institutions. Searches will be limited to publications in English language. Databases to be searched include: MEDLINE EMBASE Scopus PsycINFO CINAHL Web of science core collection: Citation Indexes (Social Science Index, Social science citation index) Cochrane Central Register of Controlled Trials (CENTRAL) The Cochrane Collaboration and Database of Systematic Reviews Database of Abstracts of Reviews of Effectiveness (DARE) HTA York CRD databases Relevant websites will be searched for grey literature (e.g. NHS Evidence, WHO, Open Grey.) Ongoing clinical trials registers - to identify trials in progress Experts in the field will be consulted to identify any further potentially relevant papers Page: 1 / 5
Link to search strategy http://www.crd.york.ac.uk/prosperofiles/10571_strategy_20150202.pdf Types of study to be included Systematic reviews of (i) randomised controlled trials, (ii) quasi-experimental studies (before-and-after with control group), (iii) before-and-after studies and (iv) observational studies assessing relevant interventions will be included. Condition or domain being studied Interventions for the prevention of falls and/or associated mortality in older people Participants/ population All systematic reviews which provide outcome information about people of either sex of older people will be included. We will also include those reviews which involve people of younger age groups but disaggregate data to provide information on older people Intervention(s), exposure(s) Intrinsic: any intervention that is related to strengthening body parts such as muscles or bones or improvement in vision. Such interventions include exercise, Vitamin D supplementation, vision checks, medication reviews. Narrow/immediate extrinsic: any intervention carried in the closer personal vicinity where an individual lives such as home. Any intervention such as assessment of home risk including lighting, flooring, carpets, grab rails. Wider extrinsic: An environment outside one s dwellings such as pavements and kerbs, seating areas, accessibility of public transport. Educational : educational programmes targeting older people informing risk factors of falls and about steps to mitigate them. Any review including studies assessing the impact of participation in falls prevention programme on accidental falls will also be included. Comparator(s)/ control Comparison groups will include older people without the intervention of interest (no intervention or unrelated action). For reviews that do not use a comparison group (e.g. of observational/ cross-sectional studies), descriptive information will be provided in the final report (data will not be used in any meta-analysis that is conducted) Context Any systematic review published in English language that assesses the impact of interventions designed to address the incidence of, and/or mortality from, falls in the home, wider environment, and institutionalised settings in older people will be eligible for this study Outcome(s) Primary outcomes There are two main outcomes of the review: 1) Prevention of falls in older people defined as a reduction in the (i) total number of falls per year, (ii) number of falls per person per year and (iii) proportion of falls among older people. The incidence of falls will be analysed by gender, age group and location (home vs outside home); 2) Prevention of mortality from falls defined as a reduction in the mortality rate from injuries sustained due to falls in older people. Secondary outcomes Additional/ secondary outcomes will include adverse effects from falls including disability (physical and psychological/ affecting daily living) and costs (to individuals and institutions). Data extraction, (selection and coding) Page: 2 / 5
Initial results of database search: Using the pre-defined search terms, databases will be searched for relevant published articles by one reviewer (results from each database will be logged in a flow chart). All records will be imported into Endnote software with deletion of duplicates. Title and Abstract screening: Two reviewers will independently screen titles and abstracts for inclusion in the review. Relevant articles will be flagged in Endnote and compared with discrepancies being resolved by a third reviewer. Full text article screening: All short-listed articles from the title and abstract screening will have an independent full text review by two reviewers for eligibility into the systematic review. Again, after comparison, any discrepancies will be resolved through discussion with a third, more experienced, reviewer Risk of bias (quality) assessment The methodological quality of each systematic review will be assessed using a previously validated tool - the AMSTAR tool (www.amstar.ca). Each full review will be assessed for quality by one reviewer and checked for accuracy by another. A minimum of 10% of the studies will be fully double assessed. Any discrepancy between reviewers will be resolved through discussion with resolution, as required, through consultation with a third reviewer. Strategy for data synthesis Findings will initially be tabulated descriptively to map the evidence in terms of study design, participants, interventions, setting and delivery, comparators, outcome measures and effectiveness. Findings will then undergo narrative synthesis. Data will be presented separately for contextual settings settings. Key themes based on analysis of the evidence across each topic area will be identified and described. Finally quantitative results on intervention effectiveness will be summarized in a tabular format (with appropriate contextual stratification) Analysis of subgroups or subsets Interventions carried out at community levels and at institutional levels will be analysed separately Dissemination plans Academics and researchers: peer review publications are planned summarising findings from the review. In addition initial findings will be presented at appropriate conferences. Policy makers, service providers and other stakeholders: a workshop will be planned and inviting relevant stakeholders (involved in provision of services for older people/ healthcare providers/ older persons groups etc) will to discuss the study findings. A detailed report will be available to these stakeholders. Contact details for further information Dr Dherani Waterhouse building B dheranim@liv.ac.uk Organisational affiliation of the review University of Liverpool / University of Cambridge www.liv.ac.uk Review team Dr Mukesh Dherani, University of Liverpool Dr Stefanie Buckner, University of Cambridge Dr Daniel Pope, University of Liverpool Dr Louise Lafortune, University of Cambridge Professor Nigel Bruce, University of Liverpool Page: 3 / 5
Collaborators Dr Cherie McCracken, University of Liverpool Dr Rory McGill, University of Liverpool Details of any existing review of the same topic by the same authors None Anticipated or actual start date 16 March 2015 Anticipated completion date 15 December 2015 Funding sources/sponsors NIHR- School of Public Health Research Conflicts of interest None known Other registration details None Language English Country England Subject index terms status Subject indexing assigned by CRD Subject index terms Accidental Falls; Aged; Humans Any other information The review is being carried out as part of a research project on developing age-friendly towns and cities within the Ageing Well Programme of the NIHR School for Public Health Research Stage of review Ongoing Date of registration in PROSPERO 02 March 2015 Date of publication of this revision 02 March 2015 DOI 10.15124/CRD42015010571 Stage of review at time of this submission Started Completed Preliminary searches Yes No Piloting of the study selection process No No Formal screening of search results against eligibility criteria No No Page: 4 / 5
Powered by TCPDF (www.tcpdf.org) Data extraction No No Risk of bias (quality) assessment No No Data analysis No No PROSPERO International prospective register of systematic reviews The information in this record has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. CRD bears no responsibility or liability for the content of this registration record, any associated files or external websites. Page: 5 / 5