Multifactorial interventions and exercise programs showed mixed effects on falls and fractures in older adults.
This systematic review and network meta-analysis included 69 randomized controlled studies involving older adults. The interventions assessed included multifactorial approaches such as traditional health education, medication management, exercise, environment modification, risk assessment, and advice, alongside specific exercise programs like gait and balance training or strength and resistance exercises. Outcomes measured included risks for falls, recurrent falls, injurious falls, and fractures.
Analysis of specific components revealed concerning associations. Traditional health education was associated with an increased incidence rate ratio (iRR) of 1.10 for fall risk (95% CI [1.03; 1.67]) and 1.25 for recurrent fall risk (95% CI [1.06; 1.48]). Medication management showed an iRR of 1.35 for recurrent fall risk (95% CI [1.09; 1.67]) and an iRR of 2.11 for fracture risk (95% CI [1.48; 3.00]). Additionally, exercise programs were linked to an increased fracture risk with an iRR of 1.24 (95% CI [1.01; 1.53]).
Conversely, certain components demonstrated protective effects. Environment modification reduced fracture risk with an iRR of 0.56 (95% CI [0.61; 0.79]). Gait and balance training reduced recurrent fall risk with an iRR of 0.58 (95% CI [0.36; 0.93]). An intervention combining gait and balance with strength and resistance also reduced the risk of falls and fall-related injuries. The additive effect of risk assessment, advice, exercise, and environment modification was noted to reduce fall risk, though specific effect sizes were not reported.
The study did not report safety tolerability beyond the risk outcomes, nor did it specify the follow-up duration or clinical settings. Limitations include the potential for heterogeneity across the 69 included studies and the lack of reported absolute numbers. Clinicians should interpret these results with caution, recognizing that specific intervention components may have divergent effects on fall and fracture outcomes in older adults.
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