Personalised programmes to prevent falls may make no difference: Cochrane review

Personalised programmes designed to reduce falls in older people may make no difference to how often people fall, according to the most comprehensive research review to date. 

A new Cochrane review led by the University of Exeter has found that programmes tailored to individual risk, known as multifactorial programmes, probably make no difference to how often people fall or the risk of falling, compared with offering falls advice or education.   

With support from the Exeter NIHR Biomedical Research Centre, the Dennis and Mireille Gillings Foundation, and the Bateman Family Charitable Trust, the researchers conducted a Cochrane Review – a high-quality, systematic analysis to help guide clinical care.   

They found that multifactorial programmes are less effective than cheaper options such as delivering good education to prevent falls. The review showed they only slightly reduced the rate of falls or risk of falling again when compared to usual medical care. When compared with exercise, it is unclear whether they reduce the rate of falls or the risk of falling again.  

Falls are one of the most common causes of injury and death in older people around the world. Around one in three people aged over 65 experience at least one fall each year, with 684,000 falls reported annually.  

A range of treatments have been developed to help prevent falls. Some involve a single type of treatment, such as exercise to build muscle strength. Others combine two or more treatments, such as exercise alongside changes to medication, while others tailor treatments to an individual’s levels of risk, such as home hazard removals.  

The review also looked at  different programmes which include a range of factors but are not personalised, called multi-component treatments. It found that they have little or no benefit in how often people fall when compared to usual medical care, exercise or falls prevention education. The review  concluded that there may be  a small benefit in the number of falls and risk of falling again when the tailored programmes were compared  with usual care, but the effects were  much smaller when compared to exercise or falls prevention education.  

Co-lead author Dr Lianne Wood, Bateman Family Chair in Peripheral Neuropathy at  the  University of Exeter Medical School , said: “In an ageing society, effectively preventing falls can save lives and help people live healthier lives for longer. Our health services operate on limited funding, and we need to ensure we’re being guided by the best evidence to prevent falls. There’s a lot of research out there – we designed this review to find answers on what really works.”  

Co-lead author Dr Cynthia Swarnalatha, of the University of Exeter Medical School, said: “We’ve conducted the most comprehensive review of the best evidence across the world, and we were surprised to find that many of the more complex programmes did not measure up. Providing effective education and focussing on encouraging the uptake of exercise are more simple approaches, and we also found them to have  potentially the most benefit in falls prevention.” 

Co author Professor Sarah (Sallie) Lamb, Mireille Gillings Professor of Health Innovation at the University of Exeter, said: “Our results show how much we still need to learn about how and why falls happen in the first place. We’re now conducting a major study to understand why people have unstable walking and are at higher risk of falls. Combined with this review, it will help us design the best prevention programmes in future, to reduce frailty and help people live well for as long as possible.”  

The Cochrane review is titled ‘Multifactorial and multiple component interventions for preventing falls in older people living in the community’.