Research Round-Up (March 2024)
Posted March 27, 2024
Following-up January’s Research Round-Up, here are some more recent publications and their potential relevance to Loop members working on implementing and sustaining fall prevention programs. These Research Round-Ups are meant to help share the latest evidence on fall prevention, assessment, management and tools with Loop members. Please note, these Round-Ups will be on hold until programming funding can be secured (see Discussion Post by Pam Fuselli).
We hope you find this helpful!
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Recent publications
Let’s look at recent research into three issues for fall prevention: effectiveness of community-based fall prevention, implementing and sustaining prevention programs, and how frailty and fall risk are linked.
1. Is there evidence that community‐based multiple component interventions are effective in preventing falls?
As this question has come from many community health organizations each year, we were keen to see the comprehensive review and synthesis of evidence by the Cochrane Public Health Group published in January. They analysed cluster randomized control trials (RCTs) and non-random trials involving thousands of older adults in multicomponent community‐wide initiatives to change the underlying societal, cultural, or environmental conditions increasing the risk of falling. The key message in the results was:
As a public health rater of the review said: “This study can be useful; however, we are still "uncertain" about the answer to a very important question.”
The study authors did try to find different ways to measure outcomes and recognized the lack of research and evaluation funding support for population-based fall prevention interventions. Long-term support for well-designed, comprehensive prevention programs in multiple communities, and ongoing evaluation is difficult to achieve and sustain.
In a smaller scale trial, a look at how an evidence-based home hazard removal program (HARP) delivery in low-income senior apartments worked in the "real world", found that HARP did not significantly reduce the rate of falls. A rater commented that "underpowered research designs with small effect sizes can blur our understanding of risks and how our interventions mitigate them". We need to know more about how interventions of all sizes do change fall risks.
2. What implementation strategies work for fall prevention programs, and how can they be sustained in communities?
Recent research contributes to our understanding of what works:
a. A study with six practical recommendations for implementing community fall prevention programs including motivating participants, peer training, and long-term continuation
b. A study examining community-based referral networks in the uptake of falls prevention programs that stresses the importance of ongoing funds to support the efforts of organizational networks
c. A commentary on early fall prevention interventions for long-term effects suggests that involving ‘the golden resource’ of older adults in design and implementation is the primary measure for sustainable and effective fall-prevention programs
3. Can frailty be measured and prevented, and does it connect to falls risk?
Increasingly, research into aging, and risk and effects of falls, has focused on assessing frailty as a deficit, and not as preventable as falls. Some new publications offer different views:
a. A summary of best evidence for prevention and management of frailty used multiple sources to evaluate methods to prevent frailty. Like fall prevention, a comment was that the best evidence be localised in frailty intervention programs, considering the people and available health facilities.
b. A global review compares the currently used frailty screenings tools, to enable quick selection of the appropriate scale for different populations.
c. Electronic frailty indexes (eFIs) have emerged as a rapid approach to screening. A paper describes the early experience of 3 diverse groups in different countries in developing, implementing and adopting eFIs.
d. On a more conceptual level, a multivariate frailty index in a decision model is proposed to improve on community fall prevention models for geriatric economic evaluation.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Don’t forget!
The Loop Knowledge Centre has Evidence Summaries based on members’ information requests, ‘hot topics’ on the Loop discussion board and emerging areas of evidence. Evidence Summaries are available here: https://www.fallsloop.com/knowledge-products. You can also view Loop webinar recordings here: https://www.fallsloop.com/services/loop-webinars .
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Links:
Implementing community-based fall prevention programs
Population-based interventions for preventing falls and fall-related injuries in older people.
Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10767771/ Plain Language Summary: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10767771/#abstract-a.bb.b.aatitle
Removing home hazards for older adults living in affordable housing: A stepped-wedge cluster-randomized trial. https://doi.org/10.1111/jgs.18706 or https://pubmed.ncbi.nlm.nih.gov/38103187/
Optimizing and implementing a community-based group fall prevention program.
Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10887802/
Developing community-level implementation networks to connect older adults to evidence-based falls prevention programs. Abstract: https://pubmed.ncbi.nlm.nih.gov/38509756/
Involvement of older adults, the golden resources, as a primary measure for fall prevention.
Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10751217/
Frailty Screening and Falls Risk
Summary of best evidence for prevention and management of frailty. https://doi.org/10.1093/ageing/afae011 or https://pubmed.ncbi.nlm.nih.gov/38300725/
Global frailty screening tools: Review and application of frailty screening tools from 2001 to 2023.
Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10883846/
New horizons in frailty identification via electronic frailty indices: early implementation lessons from experiences in England and the United States. https://doi.org/10.1093/ageing/afae025 or https://pubmed.ncbi.nlm.nih.gov/38421151/
Incorporating frailty to address the key challenges to geriatric economic evaluation
Full text: http://www.ncbi.nlm.nih.gov/pmc/articles/pmc10868084/ .