To optimize assessment and interventions for reducing the number of falls in older people.
Vision statement of the Guideline Working Group
The panel anticipates that these guidelines will provide a stimulus for widespread use of effective, evidence-based fall prevention services for older adults. Public awareness of the benefits of such prevention will also increase leading to more demand for fall prevention services by older adults and their advocates. Health care providers across diverse disciplines and settings and at multiple points of access will be able to use the generic criteria provided in these guidelines to appropriately screen individuals for risk of falls. All people identified as being at risk will be offered a multifactorial assessment and tailored interventions, with the understanding that these interventions need to be integrated and balanced with other health care priorities. Preventive services will result in a reduction in the incidence of falls and will maximize functional and quality-of-life outcomes.
Fall: For the purposes of this update, a fall is defined as “an event whereby an individual unexpectedly comes to rest on the ground or another lower level without known loss of consciousness.”
Multifactorial fall risk assessment: Assessment of known predisposing factors within the person and in the environment that increase the risk of falling.
Intervention domains (categories): Medication, exercise, vision, postural hypotension, heart rate and rhythm, vitamin D, foot and footwear, home environment, education.
Single intervention: An intervention in one of the preceding categories, such as a balance and strength exercise program, medication adjustment, vision improvement, home/environmental modification, footwear adjustment, educational programs.
Multifactorial intervention: An intervention made up of a subset of interventions that are selected and offered to an individual to address the specific risk factors identified through a multifactorial fall risk assessment.
Multicomponent intervention: A set of interventions addressing more than one intervention domain or category offered to all participants in a program (population approach).
Most papers reporting epidemiological data or clinical interventions related to falls in older individuals have not defined a fall. Since this Update is intended for use in the context of health care assessment at a level of detail appropriate to the context, a simpler definition was considered preferable to that of the 2001 Guidelines.
The panel reviewed the RCTs published between April 2008 and July 2009 and concluded that the additional evidence did not change the ranking of the evidence or the guideline recommendations. Of note, the negative RCTs of multifactorial interventions all involved risk factor assessment with referral without direct intervention or ensuring that the interventions were instituted.