Rethinking individual and community fall prevention strategies: a meta-regression comparing single and multifactorial interventions.

BACKGROUND Guidelines recommend that fall prevention programmes for older people include multifactorial interventions. OBJECTIVE We aimed to determine if randomised controlled trial evidence supports interventions with multiple components over single strategies in community based fall prevention. METHODS We searched the literature for trials of interventions aimed at preventing falls. We included trials if they met the following criteria: (i) participants were randomly allocated to intervention and control groups, (ii) all participants were aged 65 years or older, (iii) the majority lived independently in the community, (iv) fall events were recorded prospectively using a diary or calendar during the entire trial and monitored at least monthly, (v) follow up was for 12 months or longer, (vi) at least 70% of participants completed the trial, (vii) all falls during the trial for at least 50 participants were included in the analysis, and (viii) a relative rate ratio with 95% CI comparing the number of falls in the intervention and control groups was reported. We calculated a pooled rate ratio separately for trials testing multifactorial and single interventions and compared their overall efficacy using meta-regression. RESULTS Meta-regression showed that single interventions were as effective in reducing falls as interventions with multiple components (pooled rate ratios 0.77, 95% CI 0.67-0.89 and 0.78, 0.68-0.89 respectively). CONCLUSION Multifactorial fall prevention interventions are effective for individual patients. However, for community programmes for populations at risk, targeted single interventions are as effective as multifactorial interventions, may be more acceptable and cost effective.