Final Research Plan

Falls Prevention in Community-Dwelling Older Adults: Interventions

July 21, 2022

Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.

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Figure 1 is the analytic framework that depicts the two Key Questions to be addressed in the systematic review. The figure illustrates how interventions to prevent falls for community-dwelling older adults (age 65 years or older) who are unselected or at increased risk may have an impact on falls, fall-related morbidity, or mortality (key question 1) and adverse effects (key question 2).

  1. Do interventions to prevent falls in unselected or increased-risk community-dwelling older adults reduce falls, fall-related morbidity, or mortality?
    1. How is “increased risk” defined in the included trials?
  2. Do interventions to prevent falls in unselected or increased-risk community-dwelling older adults result in any adverse effects?

Contextual questions will not be systematically reviewed and are not shown in the Analytic Framework.

  1. What is the prognostic accuracy of falls risk assessment tools that are feasible for administration in primary care?

The Research Approach identifies the study characteristics and criteria that the Evidence-based Practice Center will use to search for publications and to determine whether identified studies should be included or excluded from the Evidence Review. Criteria are overarching as well as specific to each of the key questions (KQs).

Category Included Excluded
Aim Trials with the primary or secondary aim of reducing falls or fall-related injuries Comparative effectiveness trials of fall interventions
Population

Community-dwelling, ambulatory adults age 65 years or older who are unselected for risk or at increased risk for falls
  • Trials conducted exclusively in populations living in special settings outside of the community (e.g., hospitals, nursing or care homes, rehabilitation centers, or other long-term care facilities)
  • Trials conducted exclusively in special populations (e.g., adults with neurocognitive disorders such as moderate to severe dementia or Parkinson’s disease) for whom interventions may be considered disease management
  • Trials conducted exclusively in a population with pre-existing social ties
Interventions

Interventions that are primary care feasible or referable

Categories of included interventions:

  • Exercise (supervised or unsupervised, individual or group)
  • Multifactorial assessment and intervention
  • Medication modification/review
  • Psychological (individual or group)
  • Environmental assessment and modification
  • Knowledge/education

Interventions may be delivered alone or in combination

Categories of excluded interventions:

  • Social marketing
  • Policy
  • Surgery
  • Fluid or nutrition therapy
  • Management of urinary incontinence
  • Assistive technology
  • Vitamin D or supplements
Comparators Placebo, minimal control (i.e., provision of education via written materials, video, or lecture), or usual care Active comparators
Outcomes KQ 1:
  • Falls
  • Mortality (all-cause and fall-related)
  • Fall-related morbidity, defined as:
    • Fall-related injuries and fractures
    • Disability (as measured by instrumental activities of daily life instruments)
    • Quality of life (validated instruments)
    • Hospitalizations for fall-related injuries
    • Emergency department visits for fall-related injuries
    • Institutionalizations (e.g., transition from community dwelling to nursing or care homes, or other long-term care facilities)

KQ 2: Harms outcomes as reported in studies

 KQ 1:
  • Basic activities of daily living
  • Falls Efficacy Scale
  • Function measures (e.g., Performance-Oriented Mobility Assessment, Timed Get Up & Go Test, 6-meter timed walk, Functional Reach Test, and Berg Balance Scale)

KQ 2: Minor adverse events that are reported using nonvalidated and nongeneralizable measures
Followup Minimum of 6 months followup  
Study Designs Randomized, controlled trials

Editorials, letters, systematic and nonsystematic reviews, opinions, nonrandomized studies of interventions, convenience surveys, and qualitative studies
Setting Interventions conducted in primary care or that are referable from primary care  
Country Countries categorized as “Very High” on the 2019 Human Development Index (as defined by the United Nations Development Programme) Countries that are not categorized as “Very High” on the 2019 Human Development Index
Language English only Non-English-language publications
Quality Fair or good, according to design-specific criteria Poor, according to design-specific criteria

The draft Research Plan was posted for public comment on the U.S. Preventive Services Task Force (USPSTF) website from April 21 to May 18, 2022. In response to public comment, the USPSTF will include fall prevention studies recruiting older adults with osteoporosis, osteoarthritis, and sarcopenia. The population designation “average-risk” was also replaced with “unselected” in the analytic framework and key questions and “unselected for risk” in the research approach. The intervention name “medication management” was also changed to “medication modification/review” to better reflect the intended inclusion criteria.