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Evaluation of clinical practice guidelines on fall prevention and management for older adults : a systematic review

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Abstract
IMPORTANCE 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. OBJECTIVES 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. EVIDENCE REVIEW 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 & 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. FINDINGS 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. CONCLUSIONS AND RELEVANCE 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.
Keywords
clinical practice guidelines, falls, prevention, management, older adults, systematic review, RISK-FACTORS, VITAMIN-D, COGNITIVE IMPAIRMENT, LONG-TERM, COMMUNITY, PEOPLE, HEALTH, RECOMMENDATIONS, DEPRESSION, BALANCE

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MLA
Montero-Odasso, Manuel M., et al. “Evaluation of Clinical Practice Guidelines on Fall Prevention and Management for Older Adults : A Systematic Review.” JAMA NETWORK OPEN, vol. 4, no. 12, 2021, doi:10.1001/jamanetworkopen.2021.38911.
APA
Montero-Odasso, M. M., Kamkar, N., Pieruccini-Faria, F., Osman, A., Sarquis-Adamson, Y., Close, J., … Task Force on Global Guidelines for Falls in Older Adults, [missing]. (2021). Evaluation of clinical practice guidelines on fall prevention and management for older adults : a systematic review. JAMA NETWORK OPEN, 4(12). https://doi.org/10.1001/jamanetworkopen.2021.38911
Chicago author-date
Montero-Odasso, Manuel M., Nellie Kamkar, Frederico Pieruccini-Faria, Abdelhady Osman, Yanina Sarquis-Adamson, Jacqueline Close, David B. Hogan, et al. 2021. “Evaluation of Clinical Practice Guidelines on Fall Prevention and Management for Older Adults : A Systematic Review.” JAMA NETWORK OPEN 4 (12). https://doi.org/10.1001/jamanetworkopen.2021.38911.
Chicago author-date (all authors)
Montero-Odasso, Manuel M., Nellie Kamkar, Frederico Pieruccini-Faria, Abdelhady Osman, Yanina Sarquis-Adamson, Jacqueline Close, David B. Hogan, Susan Winifred Hunter, Rose Anne Kenny, Lewis A. Lipsitz, Stephen R. Lord, Kenneth M. Madden, Mirko Petrovic, Jesper Ryg, Mark Speechley, Munira Sultana, Maw Pin Tan, N. van der Velde, Joe Verghese, Tahir Masud, Alice Nieuwboer, Ellen Vlaeyen, Koen Milisen, Jesper Ryg, Rose Anne Kenny, Robert Bourke, Sirpa Hartikainen, Tischa Van der Cammen, Nathalie Van der Velde, Tahir Masud, Chris Todd, Finbarr C. Martin, David R. Marsh, Sallie Lamb, James Frith, Pip Logan, Dawn Skelton, Hubert Blain, Cedric Anweiller, Ellen Freiberger, Clemens Becker, Matteo Cesari, Alvaro Casas-Herrero, Javier Perez Jara, Christina Alonzo Bouzòn, Ana-Karim Welmer, Stephanie Birnghebuam, Reto Kressig, Manuel Montero-Odasso, Mark Speechley, Bill McIlroy, Susan Hunter, Richard Camicioli, Kenneth Madden, Mireille Norris, Jennifer Watt, Louise Mallet, David B. Hogan, Joe Verghese, Ervin Sejdic, Luigi Ferruci, Lewis Lipsitz, David A. Ganz, Neil B. Alexander, Fabiana Giber, Marcelo Schapira, Ricardo Jauregui, Felipe Melgar-Cuellar, Daniela Cristina Carvalho de Abreu, Roberto Alves Lourenço, Monica Pierrucini, Alejandro Ceriani, Pedro Marín-Larraín, Homero Gac Espinola, José Fernando Gómez-Montes, Carlos Alberto Cano-Gutierrez, Xinia Ramirez Ulate, José Ernesto Picado Ovares, Patricio Gabriel Buendia, Susana Lucia Tito, Diego Martínez Padilla, Sara G. Aguilar-Navarro, Alberto Mimenza, Rogelio Moctezum, Alberto Avila-Funes, Luis Miguel Gutiérrez-Robledo, Luis Manuel Cornejo Alemán, Edgar Aguilera Caona, Juan Carlos Carbajal, José F. Parodi, Aldo Sgaravatti, Stephen Lord, Cathie Sherrington, Cathy Said, Ian Cameron, Meg Morris, Gustavo Duque, Jacqueline Close, Ngaire Kerse, Maw Pin Tan, Leilei Duan, Ryota Sakurai, Chek Hooi Wong, Hossein Negahban, Chang Won Won, Jeffrey Hausdorff, Sebastiana Kalula, Olive Kobusingye, and [missing] Task Force on Global Guidelines for Falls in Older Adults. 2021. “Evaluation of Clinical Practice Guidelines on Fall Prevention and Management for Older Adults : A Systematic Review.” JAMA NETWORK OPEN 4 (12). doi:10.1001/jamanetworkopen.2021.38911.
Vancouver
1.
Montero-Odasso MM, Kamkar N, Pieruccini-Faria F, Osman A, Sarquis-Adamson Y, Close J, et al. Evaluation of clinical practice guidelines on fall prevention and management for older adults : a systematic review. JAMA NETWORK OPEN. 2021;4(12).
IEEE
[1]
M. M. Montero-Odasso et al., “Evaluation of clinical practice guidelines on fall prevention and management for older adults : a systematic review,” JAMA NETWORK OPEN, vol. 4, no. 12, 2021.
@article{8730891,
  abstract     = {{IMPORTANCE 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.
OBJECTIVES 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.
EVIDENCE REVIEW 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 & 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.
FINDINGS 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.
CONCLUSIONS AND RELEVANCE 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.}},
  articleno    = {{e2138911}},
  author       = {{Montero-Odasso, Manuel M. and Kamkar, Nellie and Pieruccini-Faria, Frederico and Osman, Abdelhady and Sarquis-Adamson, Yanina and Close, Jacqueline and Hogan, David B. and Hunter, Susan Winifred and Kenny, Rose Anne and Lipsitz, Lewis A. and Lord, Stephen R. and Madden, Kenneth M. and Petrovic, Mirko and Ryg, Jesper and Speechley, Mark and Sultana, Munira and Tan, Maw Pin and van der Velde, N. and Verghese, Joe and Masud, Tahir and Nieuwboer, Alice and Vlaeyen, Ellen and Milisen, Koen and Ryg, Jesper and Kenny, Rose Anne and Bourke, Robert and Hartikainen, Sirpa and Van der Cammen, Tischa and Van der Velde, Nathalie and Masud, Tahir and Todd, Chris and Martin, Finbarr C. and Marsh, David R. and Lamb, Sallie and Frith, James and Logan, Pip and Skelton, Dawn and Blain, Hubert and Anweiller, Cedric and Freiberger, Ellen and Becker, Clemens and Cesari, Matteo and Casas-Herrero, Alvaro and Jara, Javier Perez and Bouzòn, Christina Alonzo and Welmer, Ana-Karim and Birnghebuam, Stephanie and Kressig, Reto and Montero-Odasso, Manuel and Speechley, Mark and McIlroy, Bill and Hunter, Susan and Camicioli, Richard and Madden, Kenneth and Norris, Mireille and Watt, Jennifer and Mallet, Louise and Hogan, David B. and Verghese, Joe and Sejdic, Ervin and Ferruci, Luigi and Lipsitz, Lewis and Ganz, David A. and Alexander, Neil B. and Giber, Fabiana and Schapira, Marcelo and Jauregui, Ricardo and Melgar-Cuellar, Felipe and Carvalho de Abreu, Daniela Cristina and Lourenço, Roberto Alves and Pierrucini, Monica and Ceriani, Alejandro and Marín-Larraín, Pedro and Gac Espinola, Homero and Gómez-Montes, José Fernando and Cano-Gutierrez, Carlos Alberto and Ramirez Ulate, Xinia and Picado Ovares, José Ernesto and Buendia, Patricio Gabriel and Tito, Susana Lucia and Martínez Padilla, Diego and Aguilar-Navarro, Sara G. and Mimenza, Alberto and Moctezum, Rogelio and Avila-Funes, Alberto and Gutiérrez-Robledo, Luis Miguel and Cornejo Alemán, Luis Manuel and Aguilera Caona, Edgar and Carbajal, Juan Carlos and Parodi, José F. and Sgaravatti, Aldo and Lord, Stephen and Sherrington, Cathie and Said, Cathy and Cameron, Ian and Morris, Meg and Duque, Gustavo and Close, Jacqueline and Kerse, Ngaire and Tan, Maw Pin and Duan, Leilei and Sakurai, Ryota and Hooi Wong, Chek and Negahban, Hossein and Won Won, Chang and Hausdorff, Jeffrey and Kalula, Sebastiana and Kobusingye, Olive and Task Force on Global Guidelines for Falls in Older Adults, [missing]}},
  issn         = {{2574-3805}},
  journal      = {{JAMA NETWORK OPEN}},
  keywords     = {{clinical practice guidelines,falls,prevention,management,older adults,systematic review,RISK-FACTORS,VITAMIN-D,COGNITIVE IMPAIRMENT,LONG-TERM,COMMUNITY,PEOPLE,HEALTH,RECOMMENDATIONS,DEPRESSION,BALANCE}},
  language     = {{eng}},
  number       = {{12}},
  pages        = {{15}},
  title        = {{Evaluation of clinical practice guidelines on fall prevention and management for older adults : a systematic review}},
  url          = {{http://doi.org/10.1001/jamanetworkopen.2021.38911}},
  volume       = {{4}},
  year         = {{2021}},
}

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