Evaluation of Clinical Practice Guidelines on Fall Prevention and Management for Older Adults
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- Manuel M. Montero-Odasso
- Schulich School of Medicine and Dentistry, Division of Geriatric Medicine, Department of Medicine, The University of Western Ontario, London, Ontario, Canada
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- Nellie Kamkar
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, Ontario, Canada
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- Frederico Pieruccini-Faria
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, Ontario, Canada
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- Abdelhady Osman
- Department of Epidemiology and Biostatistics, The University of Western Ontario, London, Ontario, Canada
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- Yanina Sarquis-Adamson
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, Ontario, Canada
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- Jacqueline Close
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, Australia
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- David B. Hogan
- Division of Geriatric Medicine, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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- Susan Winifred Hunter
- Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
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- Rose Anne Kenny
- Department of Medical Gerontology, Mercers Institute for Ageing, St James Hospital, Dublin, Ireland
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- Lewis A. Lipsitz
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, Massachusetts
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- Stephen R. Lord
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia
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- Kenneth M. Madden
- Division of Geriatric Medicine, Department of Medicine, Department of Internal Medicine, Section of Geriatric Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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- Mirko Petrovic
- Section of Geriatrics, Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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- Jesper Ryg
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
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- Mark Speechley
- Department of Epidemiology and Biostatistics, The University of Western Ontario, London, Ontario, Canada
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- Munira Sultana
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, Ontario, Canada
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- Maw Pin Tan
- Centre for Innovation in Medical Engineering, Faculty of Engineering, University of Malaysia, Kuala Lumpur, Malaysia
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- N. van der Velde
- Section of Geriatric Medicine, Department of Internal Medicine, Amsterdam Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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- Joe Verghese
- Institute for Aging Research, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
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- Tahir Masud
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
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- Alice Nieuwboer
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Ellen Vlaeyen
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Koen Milisen
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Robert Bourke
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Sirpa Hartikainen
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Tischa Van der Cammen
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Nathalie Van der Velde
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Chris Todd
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Finbarr C. Martin
- for the Task Force on Global Guidelines for Falls in Older Adults
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- David R. Marsh
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Sallie Lamb
- for the Task Force on Global Guidelines for Falls in Older Adults
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- James Frith
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Pip Logan
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Dawn Skelton
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Hubert Blain
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Cedric Anweiller
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Ellen Freiberger
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Clemens Becker
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Matteo Cesari
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Alvaro Casas-Herrero
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Javier Perez Jara
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Christina Alonzo Bouzòn
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Ana-Karim Welmer
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Stephanie Birnghebuam
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Reto Kressig
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Manuel Montero-Odasso
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Bill McIlroy
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Susan Hunter
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Richard Camicioli
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Kenneth Madden
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Mireille Norris
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Jennifer Watt
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Louise Mallet
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Ervin Sejdic
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Luigi Ferrucci
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Lewis Lipsitz
- for the Task Force on Global Guidelines for Falls in Older Adults
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- David A. Ganz
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Neil B. Alexander
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Fabiana Giber
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Marcelo Schapira
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Ricardo Jauregui
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Felipe Melgar-Cuellar
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Daniela Cristina Carvalho de Abreu
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Roberto Alves Lourenço
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Monica Pierrucini
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Alejandro Ceriani
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Pedro Marín-Larraín
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Homero Gac Espinola
- for the Task Force on Global Guidelines for Falls in Older Adults
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- José Fernando Gómez-Montes
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Carlos Alberto Cano-Gutierrez
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Xinia Ramirez Ulate
- for the Task Force on Global Guidelines for Falls in Older Adults
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- José Ernesto Picado Ovares
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Patricio Gabriel Buendia
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Susana Lucia Tito
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Diego Martínez Padilla
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Sara G. Aguilar-Navarro
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Alberto Mimenza
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Rogelio Moctezum
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Alberto Avila-Funes
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Luis Miguel Gutiérrez-Robledo
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Luis Manuel Cornejo Alemán
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Edgar Aguilera Caona
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Juan Carlos Carbajal
- for the Task Force on Global Guidelines for Falls in Older Adults
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- José F. Parodi
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Aldo Sgaravatti
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Stephen Lord
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Cathie Sherrington
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Cathy Said
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Ian Cameron
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Meg Morris
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Gustavo Duque
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Ngaire Kerse
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Leilei Duan
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Ryota Sakurai
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Chek Hooi Wong
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Hossein Negahban
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Chang Won Won
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Jeffrey Hausdorff
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Sebastiana Kalula
- for the Task Force on Global Guidelines for Falls in Older Adults
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- Olive Kobusingye
- for the Task Force on Global Guidelines for Falls in Older Adults
書誌事項
- タイトル別名
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- A Systematic Review
抄録
<jats:sec id="ab-zoi211099-4"><jats:title>Importance</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec id="ab-zoi211099-5"><jats:title>Objectives</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec id="ab-zoi211099-6"><jats:title>Evidence Review</jats:title><jats:p>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 &amp; 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 κ statistic.</jats:p></jats:sec><jats:sec id="ab-zoi211099-7"><jats:title>Findings</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec id="ab-zoi211099-8"><jats:title>Conclusions and Relevance</jats:title><jats:p>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.</jats:p></jats:sec>
収録刊行物
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- JAMA Network Open
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JAMA Network Open 4 (12), e2138911-, 2021-12-15
American Medical Association (AMA)