Non-pharmacological interventions to prevent falls in older patients: Clinical practice recommendations – the SENATOR ONTOP Series

Abstract

Objectives: To develop explicit evidence-based recommendations for non-pharmacological interventions to prevent falls in older subjects using the GRADE approach to rate the quality of evidence and the strength of recommendations. Methods: A multidisciplinary panel was constituted composed of geriatricians, a research nurse and a clinical epidemiologist. The GRADE approach was used to rate the evidence and to formulate recommendations. Results: The critical outcomes were fall rate and number of fallers. Forty-five clinical questions and the associated recommendations were formulated for single, multiple and multifactorial non-pharmacological interventions in three different settings (home, care facilities and hospitals). Seven strong recommendations in favour, and one strong recommendation against, were formulated, all of which were supported by moderate-quality evidence. The remaining 37 clinical questions had weak recommendations. A strong recommendation was formulated in favour of exercise, as a single component, in groups and individually, for community-dwelling older people. Tai Chi was strongly recommended for older adults at risk of falling, living at home. Home safety assessment and modification was strongly recommended for older adults living at home and at high risk of falling. Multifactorial interventions were strongly recommended for older adults, at high risk of falling, living at home and, in older adults in care facilities and hospitals, while knowledge/education alone was strongly recommended against for older people at home. Conclusions: Based on a systematic review of the evidence, 45 recommendations were formulated regarding non-pharmacological interventions to prevent falls in older adults living at home, in care facilities and in hospitals. (C) 2017 Published by Elsevier Masson SAS.