Montero-Odasso, Manuel M. and Kamkar, Nellie and Pieruccini-Faria, Frederico and Osman, Abdelhady and Sarquis-Adamson, Yanina and Close, Jacqueline and Hogan, David B. and Hunter, Susan Winifred and Kenny, Rose Anne and Lipsitz, Lewis A. and Lord, Stephen R. and Madden, Kenneth M. and Petrovic, Mirko and Ryg, Jesper and Speechley, Mark and Sultana, Munira and Tan, Maw Pin and van der Velde, N. and Verghese, Joe and Masud, Tahir and Falls, Task Force Global Guidelines (2021) Evaluation of clinical practice guidelines on fall prevention and management for older adults a systematic review. JAMA Network Open, 4 (12). ISSN 2574-3805, DOI https://doi.org/10.1001/jamanetworkopen.2021.38911.
Full text not available from this repository.Abstract
IMPORTANCE With the global population aging, falls and fall-related injuries are ubiquitous, and several clinical practice guidelines for falls prevention and management for individuals 60 years or older have been developed. A systematic evaluation of the recommendations and agreement level is lacking. OBJECTIVES To perform a systematic review of clinical practice guidelines for falls prevention and management for adults 60 years or older in all settings (eg, community, acute care, and nursing homes), evaluate agreement in recommendations, and identify potential gaps. EVIDENCE REVIEW A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-analyses statement methods for clinical practice guidelines on fall prevention and management for older adults was conducted (updated July 1, 2021) using MEDLINE, PubMed, PsycINFO, Embase, CINAHL, the Cochrane Library, PEDro, and Epistemonikos databases. Medical Subject Headings search terms were related to falls, clinical practice guidelines, management and prevention, and older adults, with no restrictions on date, language, or setting for inclusion. Three independent reviewers selected records for full-text examination if they followed evidence- and consensus-based processes and assessed the quality of the guidelines using Appraisal of Guidelines for Research & Evaluation II (AGREE-II) criteria. The strength of the recommendations was evaluated using Grades of Recommendation, Assessment, Development, and Evaluation scores, and agreement across topic areas was assessed using the Fleiss kappa statistic. FINDINGS Of 11 414 records identified, 159 were fully reviewed and assessed for eligibility, and 15 were included. All 15 selected guidelines had high-quality AGREE-II total scores (mean SD], 80.1% 5.6%]), although individual quality domain scores for clinical applicability (mean SD], 63.4% 11.4%]) and stakeholder (clinicians, patients, or caregivers) involvement (mean SD], 76.3%9.0%]) were lower. A total of 198 recommendations covering 16 topic areas in 15 guidelines were identified after screening 4767 abstracts that proceeded to 159 full texts. Most (>= 11) guidelines strongly recommended performing risk stratification, assessment tests for gait and balance, fracture and osteoporosis management, multifactorial interventions, medication review, exercise promotion, environment modification, vision and footwear correction, referral to physiotherapy, and cardiovascular interventions. The strengths of the recommendations were inconsistent for vitamin D supplementation, addressing cognitive factors, and falls prevention education. Recommendations on use of hip protectors and digital technology or wearables were often missing. None of the examined guidelines included a patient or caregiver panel in their deliberations. CONCLUSIONS AND RELEVANCE This systematic review found that current clinical practice guidelines on fall prevention and management for older adults showed a high degree of agreement in several areas in which strong recommendations were made, whereas other topic areas did not achieve this level of consensus or coverage. Future guidelines should address clinical applicability of their recommendations and include perspectives of patients and other stakeholders.
| Item Type: | Article |
|---|---|
| Funders: | Canadian Institutes of Health Research (CIHR) [PTJ 153100] |
| Uncontrolled Keywords: | Risk-Factors; Vitamin-D; Cognitive Impairment; Long Term; Community; People; Health; Recommendations; Depression; Balance |
| Subjects: | R Medicine > R Medicine (General) |
| Divisions: | Faculty of Medicine > Medicine Department |
| Depositing User: | Ms Zaharah Ramly |
| Date Deposited: | 31 May 2022 07:43 |
| Last Modified: | 31 May 2022 07:43 |
| URI: | http://eprints.um.edu.my/id/eprint/34641 |
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