TY - JOUR
T1 - Efficacy of exercise-based interventions in preventing falls among community-dwelling older persons with cognitive impairment
T2 - Is there enough evidence? An updated systematic review and meta-analysis
AU - Li, Fuzhong
AU - Harmer, Peter
AU - Eckstrom, Elizabeth
AU - Ainsworth, Barbara E.
AU - Fitzgerald, Kathleen
AU - Voit, Jan
AU - Chou, Li Shan
AU - Welker, Fei Li
AU - Needham, Shana
N1 - Publisher Copyright:
© 2021 The Author(s) 2021. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.
PY - 2021/9/1
Y1 - 2021/9/1
N2 - Objective: Exercise prevents falls in the general older population, but evidence is inconclusive for older adults living with cognitive impairment. We performed an updated systematic review and meta-analysis to assess the potential effectiveness of interventions for reducing falls in older persons with cognitive impairment. Methods: PubMed, EMBASE, CINAHL, Scopus, CENTRAL and PEDro were searched from inception to 10 November 2020. We included randomised controlled trials (RCTs) that evaluated the effects of physical training compared to a control condition (usual care, waitlist, education, placebo control) on reducing falls among community-dwelling older adults with cognitive impairment (i.e. any stage of Alzheimer's disease and related dementias, mild cognitive impairment). Results: We identified and meta-analysed nine studies, published between 2013 and 2020, that included 12 comparisons (N = 1,411; mean age = 78 years; 56% women). Overall, in comparison to control, interventions produced a statistically significant reduction of approximately 30% in the rate of falls (incidence rate ratio = 0.70; 95% CI, 0.52-0.95). There was significant between-trial heterogeneity (I2 = 74%), with most trials (n = 6 studies [eight comparisons]) showing no reductions on fall rates. Subgroup analyses showed no differences in the fall rates by trial-level characteristics. Exercise-based interventions had no impact on reducing the number of fallers (relative risk = 1.01; 95% CI, 0.90-1.14). Concerns about risk of bias in these RCTs were noted, and the quality of evidence was rated as low. Conclusions: The positive statistical findings on reducing fall rate in this meta-analysis were driven by a few studies. Therefore, current evidence is insufficient to inform evidence-based recommendations or treatment decisions for clinical practice. PROSPERO Registration number: CRD42020202094.
AB - Objective: Exercise prevents falls in the general older population, but evidence is inconclusive for older adults living with cognitive impairment. We performed an updated systematic review and meta-analysis to assess the potential effectiveness of interventions for reducing falls in older persons with cognitive impairment. Methods: PubMed, EMBASE, CINAHL, Scopus, CENTRAL and PEDro were searched from inception to 10 November 2020. We included randomised controlled trials (RCTs) that evaluated the effects of physical training compared to a control condition (usual care, waitlist, education, placebo control) on reducing falls among community-dwelling older adults with cognitive impairment (i.e. any stage of Alzheimer's disease and related dementias, mild cognitive impairment). Results: We identified and meta-analysed nine studies, published between 2013 and 2020, that included 12 comparisons (N = 1,411; mean age = 78 years; 56% women). Overall, in comparison to control, interventions produced a statistically significant reduction of approximately 30% in the rate of falls (incidence rate ratio = 0.70; 95% CI, 0.52-0.95). There was significant between-trial heterogeneity (I2 = 74%), with most trials (n = 6 studies [eight comparisons]) showing no reductions on fall rates. Subgroup analyses showed no differences in the fall rates by trial-level characteristics. Exercise-based interventions had no impact on reducing the number of fallers (relative risk = 1.01; 95% CI, 0.90-1.14). Concerns about risk of bias in these RCTs were noted, and the quality of evidence was rated as low. Conclusions: The positive statistical findings on reducing fall rate in this meta-analysis were driven by a few studies. Therefore, current evidence is insufficient to inform evidence-based recommendations or treatment decisions for clinical practice. PROSPERO Registration number: CRD42020202094.
KW - cognitive function
KW - exercise training
KW - fall prevention
KW - incidental falls
KW - older people
KW - systematic review
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U2 - 10.1093/ageing/afab110
DO - 10.1093/ageing/afab110
M3 - Review article
C2 - 34120175
AN - SCOPUS:85107538583
SN - 0002-0729
VL - 50
SP - 1557
EP - 1568
JO - Age and Ageing
JF - Age and Ageing
IS - 5
ER -