Home fall-hazard reduction for preventing falls in older people

Summary

A Cochrane review «Environmental interventions for preventing falls in older people living in the community»1 «Clemson L, Stark S, Pighills AC et al. Environmental interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 2023;3(3):CD013258. »1 included 22 studies from 10 countries involving a total of 8463 subjects, of which 14 studies with a total of 5830 subjects studied home fall-hazard interventions. Participants were community-residing people from several countries, on average 78 years old, and 65 % were women. These interventions aimed to reduce falls by assessing fall hazards and making environmental safety adaptations (e.g. non-slip strips on steps) or behavioural strategies (e.g. avoiding clutter). Home fall-hazard interventions appear to reduce the overall rate of falls by 26 % (rate ratio (RaR) 0.74, 95 % confidence interval (CI) 0.61 to 0.91; 12 studies, n=5293); based on a control group risk of 1319 falls per 1000 people a year, this was 343 (95 % CI 118 to 514) fewer falls. These interventions were more effective in people who were selected for higher risk of falling, with a reduction of 38 % (RaR 0.62, 95 % CI 0.56 to 0.70; 9 studies, n=1513; 702 (95 % CI 554 to 812) fewer falls based on a control risk of 1847 falls per 1000 people). There was no evidence of a reduction in rate of falls when people were not selected for fall risk (RaR 1.05, 95 % CI 0.96 to 1.16; 6 studies, n=3780).

Home fall-hazard interventions probably make little or no difference to health-related quality of life (HRQoL) (standardised mean difference 0.09, 95 % CI −0.10 to 0.27; 5 studies, n=1848). They may make little or no difference to the risk of fall-related fractures (RR 1.00, 95 % 0.98 to 1.02; 2 studies, n=1668), fall-related hospitalisations (RR 0.96, 95 % CI 0.87 to 1.06; 3 studies, n=325), or in the rate of falls requiring medical attention (RaR 0.91, 95 % CI 0.58 to 1.43; 3 studies, n=946).