Older people's participation in and engagement with falls prevention interventions in community settings: an augment to the Cochrane systematic review.

BACKGROUND Randomised controlled trials (RCTs) of fall prevention conducted in community settings have recently been systematically reviewed. OBJECTIVE To augment this review by analysing older people's participation in the trials and engagement with the interventions. DESIGN Review of the 99 single and multifactorial RCTs included in the Cochrane systematic review of falls prevention interventions. SETTING Community. PARTICIPANTS Adults aged 60+/mean age minus one standard deviation of 60+. METHODS Calculated aggregate data on recruitment (proportion who accepted the invitation to participate), attrition at 12 month follow-up (loss of participants), adherence (to intervention protocol) and whether adherence moderated the effect of interventions on trial outcomes. RESULTS The median recruitment rate was 70.7% (64.2-81.7%, n = 78). At 12 months the median attrition rate including mortality was 10.9% (9.1-16.0%, n = 44). Adherence rates (n = 69) were ≥80% for vitamin D/calcium supplementation; ≥70% for walking and class-based exercise; 52% for individually targeted exercise; approximately 60-70% for fluid/nutrition therapy and interventions to increase knowledge; 58-59% for home modifications; but there was no improvement for medication review/withdrawal of certain drugs. Adherence to multifactorial interventions was generally ≥75% but ranged 28-95% for individual components. The 13 studies that tested for whether adherence moderated treatment effectiveness produced mixed results. CONCLUSIONS Using median rates for recruitment (70%), attrition (10%) and adherence (80%), we estimate that, at 12 months, on average half of community-dwelling older people are likely to be adhering to falls prevention interventions in clinical trials.