Featured Review: Multifactorial and multiple component interventions for preventing falls in older people living in the community

"It is crucial that people have an understanding of what interventions work in what populations so as to make correct clinical and policy practice related decisions.”

An international team, supported by  Cochrane Bone, Joint & Muscle Trauma, assessed whether fall-prevention strategies that target two or more risk factors for falls are effective in preventing falls in older people living in the community.

As people age they are more likely to fall. Although most fall-related injuries are minor, they can cause significant pain and discomfort, affect a person's confidence and lead to a loss of independence. Some falls can cause serious long-term health problems. A combination of factors increases the risk of falls with ageing, such as weak muscles, stiff joints, hearing problems, changes in sight, side effects of medications, tiredness or confusion. Poor lighting, slippery or uneven surfaces, and issues with poor footwear can also increase the risk of falling.

Different interventions have been developed to help prevent falls in older people. They may involve a single type of intervention, such as exercise to increase muscle strength, or combinations of interventions, such as exercise and adjustment of a person's medication. A combination of two or more components can be delivered as either a multifactorial intervention based on an assessment of a person's risk factors for falling or as a multiple component intervention where the same combination of interventions is provided to all participants.

The lead author of the review, Dr Sally Hopewell, explains, "This review is an important update for anyone with an interest in falls in older people. It provides useful information on the benefits and risks associated with both multifactorial and multiple component interventions. The growing use of these more complex types of intervention for preventing falls reflect the theory that multiple risk factors are at play, and that these risk factor profiles vary between people.  It is crucial that people have an understanding of what interventions work in what populations so as to make correct clinical and policy practice related decisions.”

The team identified 43 trials that compared multifactorial interventions with an inactive control group.  They concluded that multifactorial interventions led to some reduction in the rate at which people fall but not the number of people who experienced one or more falls (fallers); however, the quality of the evidence was low.  They identified 17 trials that looked at multiple component interventions and concluded they probably reduce the rate at which people fall and the number of fallers compared with the inactive control group.

The review includes 62 randomised trials involving 19,935 older participants living in the community.