Prevention of Fall: Effective Interventions for Older Adults in a Health Care Setting

This rapid review identifies effective interventions for preventing falls among older adults in a health care setting. It includes a summary of the background, objective, criteria for review, types of studies, type of participants, type of interventions, type of outcome measures, search strategy, method of review, data extraction, and review results.

Running head: PREVENTION OF FALL
Name of the student
Name of the university
Author note

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Table of Contents
Background:.....................................................................................................................................2
Background:.....................................................................................................................................5
Objective:.........................................................................................................................................8
Criteria for considering review:.......................................................................................................8
Types of studies:..........................................................................................................................8
Type of participants:....................................................................................................................8
Type of intervention:...................................................................................................................9
Type of outcome measures:.........................................................................................................9
Search strategy:................................................................................................................................9
Method of review:..........................................................................................................................10
Data extraction:..........................................................................................................................11
Review result:................................................................................................................................11
Description of the studied:.........................................................................................................11

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Result:............................................................................................................................................14
Quality of systematic reviews:...................................................................................................14
Discussion:.....................................................................................................................................15
Quality of evidence:...................................................................................................................16
A potential limitation of the review:..........................................................................................17
Conclusion:....................................................................................................................................18
References:....................................................................................................................................20
Appendix I:....................................................................................................................................25
Appendix II:...................................................................................................................................25
APPENDIX III:.............................................................................................................................26
APPENDIX IV: AMSTAR TOOL................................................................................................29
Appendix V....................................................................................................................................30

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Executive Summary:
Background:
This rapid review has been conducted in order to gain an understanding of effective measures to prevent falls among older
adult in a health care setting. Sudden fall in a hospital setting is identified as one of the major problems in hospital setting amongst
older people over 65 years. The sudden fall is associated with a variety consequences such as fractures, open bound; bruises brain
injury, bone dislocation, and stained muscle. Hence, the hospital is the ideal setting for incorporating these interventions for
preventing fall among older adult.
Objective:
To identify effective interventions for preventing fall amongst older adults in a health care setting.
Inclusion criteria:
The systematic reviews with the interventions for fall in the hospital were included in the review. Older patients of above 65
years have been included as participants in the review. The articles from 2014 to 2019 with the English language have been included.
Type of participants:
The review included population of older adults over 65 years. No coexisting health conditions have been included in the
review

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Types of studies:
For rapid review, systematic review of randomized controlled trail has been included with the preventive measures of fall in
the older adults in the hospital setting.
Interventions:
Hospital-based interventions such as exergame , exercise and step training interventions have been included in the review.
Outcome:
The primary outcome of the review will be reduced incident rate of fall. The secondary outcome will be improved fall
prevention strategy because of the educated nurse and empowered patient, reduced anxiety level and fear of fall in patients and
improved quality of life.
Search strategy:
A detailed search has been conducted using two electronic databases such as CINAHL (Cumulative Index of Nursing and
Allied Health Literature) and Medline. The recent systematic reviews of 964 articles were accessed for finding out the effective
preventive measures for older adults in the hospital. The best piece of the systematic reviews were identified and included in the

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review with the assistance of the PICO question. The inclusion and exclusion were designed according to it and after quality appraisal
total; five reviews were include with all necessary contents.
Methodology:
Methodology quality of six systematic reviews was evaluated using the assessment of multiple systematic reviews
(AMSTAR). It is an effective assessment tool for assessing the quality of methodology that has been undertaken in the systematic
review.
Data extraction and synthesis:
The data extraction of these reviews was done considering each detail of the paper. Narrative approach was taken for
synthesizing the data which will further assist in generating themes. After critical appraisal, best systematic review was identified in
order to make recommendations.
Result:
Among the existing five systematic reviews, while three reviews identified Exergame technology, exercise, and step training
as an effective intervention for reducing the fall, other two journals highlighted fall prevention programs and compared intervention
as effective. These interventions found to have a positive outcome on patients.
Conclusion:

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Hospital-based multifactorial or single factorial approaches such as exergame technology, exercise, step training, and fall
prevention programs would be effective to reduce the incidents of fall in the clinical setting. The exergame along with visual
assessment would be effective intervention to reduce the incidents rate of fall in hospital.
Key words: hospital based intervention, fall of above 65 years older adults,

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Background:
Fall is an incident when a person coming to rest inadvertently on the ground or on the floor or other lower level. Falls among
the ageing population are one of the key reasons behind increased rate of morbidity and mortality globally. As per the data shared by
the Australian and New Zealand Falls Prevention Society, approximately close to 30 % of the older adults population belonging to the
age group of 65 and older have been reported to encounter incidents of fall at least once a year, or even more than that (Franco et al.,
2015). As discussed by Davies, and O’mahony (2015), approximately 30% of the inpatients experienced an injury after fall where 4 %
to 6% older adults experienced serious health injury.
Patients who experienced serious injuries because of fall are reported to have approximately $4200 higher hospital charges
than patients who never experienced fall (Grossman et al., 2018). Hence, the prevention of falls in the hospital setting is crucial for the
safety of patients and resolved public health issues. However, it is unfortunately, there are little evidence has been found on the
effectiveness of the hospital fall prevention program.
This review was conducted because there are a significant number of risk factors of fall which increases the cost of health care
and affects the wellbeing of older population and falls can be prevented by appropriate interventions (Uusi-Rasi et al., 2015). Detailed
research conducted by Liu, L., Stroulia, Nikolaidis, Miguel-Cruz and Rincon (2016), suggested risk factors include impaired

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balanced, altered mobility, history of falling, cognitive impairment, depression, dizziness, vertigo orthostatic hypotension, visual
impairment and side effects of certain medications (Edvinsson et al., 2015). On the other hand, few studies also identified specific
diagnosis as a potential risk factor of fall in the clinical setting. Most of the literature on falls mostly focused on the elderly adults
living in the community or long term care facilities. Very few research focused on the falls and associated preventive measure in the
hospital setting (Verma et al., 2016). Hence, this rapid review has been undertaken in order to identify preventive measures for older
patients in the hospital setting where patients of 65 years or more than 65 years have been included in the review.
Landi et al.( 2016), highlighted interventions of preventing fall such as exercise, dietary intervention, medication review,
multifactorial interventions or behavioral approaches can be effective. The randomized controlled trial also highlighted that there can
be a gap existed in knowledge whether single or multifactorial interventions can reduce incidents of falling and obstacles observed in
the implementation of these interventions in the hospital setting (Kojima, 2016). Hence, the aim of this rapid review is to obtain best
preventive measures for the older adults in the clinical setting with an intention of the reducing the frequent fall in the hospital setting
and recommend strategies to health professionals. The review also was conducted for evaluating whether physical assessment of risk
factor can reduce incidents of fall. In this case, specific fall prevention program is important to reduce fall risk then the fall prevention
can be reduced in the clinical setting.
The review would be crucial for identifying different measures for fall prevention that can be implemented in the hospital
setting which will result in improvement of nursing practice in reducing incidents of fall and improve quality of life. The designed

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PICO question for this review is that is hospital-based multifactorial or single factorial intervention effective to reduce the prevention
of fall in the patients of 65 years or above in the hospital setting?
P: the population is older patients of 65 years old in the hospital setting. The rationale behind conducting this population is that as the
population of this age experience most of the fall because of risk factors discussed above.
I: a hospital-based multifactorial or single factorial interventions for preventing fall. The reason behind these interventions is that it
would help to identify hospital based and implement in the clinical setting.
C: Conventional fall prevention strategy
O: The outcome would be reduced incidence of preventing fall in the hospital setting. The outcome may be associated with a reduced
number of hospital stays, the number of emergency visit and improved practice of health professionals.
Hence, this review summary would be able to close the gap of diverse literature by finding out the effectiveness of hospital-
based multifactorial or single factorial intervention approach such as exergame intervention, stepping training, person-centered
intervention. This paper will discuss effective preventive measures for the older adults of above 65 years in the clinical setting and
comparing in between them with the intention of providing the best possible recommendation for interventions.

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Objective:
The purpose of providing a summative overview of the systematic reviews as well as analyzing the result is to find out best
possible Intervention for reducing the incidents of fall in older adults of 65 years. A research question such as “what is the most
effective intervention to prevent fall among older adult of above 65 years in health care setting” would use as road map for conducting
review.
Criteria for considering review:
Types of studies:
This rapid review considered any systematic review which evaluates the intervention s designed for preventing fall in older
adults, focusing on the health of older individuals of 65 years in the hospital setting. Systematic reviews included in the review
undertaken different studies required for the interventions.
Type of participants:
The review only considered those studies which undertaken the older adults of 65 years with the risk of fall in the hospital
setting. The prime reason behind it is that these target group is highly vulnerable to the risk factors such as impaired balanced, altered

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mobility, history of falling, cognitive impairment, depression, dizziness, vertigo orthostatic hypotension, visual impairment and side
effects of certain medications. In every 11 seconds, older adult is treated in the emergency room for a fall and in every 19 minutes one
older individuals above 65 years die after fall (Duque et al., 2016).
Type of intervention:
The review included those systematic reviews which focused on interventions for minimizing incidents of fall among older
adults. It may be involved multifactorial as well as single factorial approaches such as visual assessment and treatment, multifactorial
assessment, fall prevention through different interventions such as exercise, balance training, exergame.
Type of outcome measures:
The primary outcome:
The most effective intervention was exergame with visual assessment. Based on the result, the primary outcome would be
Incidents of fall, reduced risk of fall prevention and improved muscle flexibility. The outcome measure would be proper fall
assessment; balance, muscle flexibility.
The secondary outcome: reduced incidents of fall because of improved balance reduced level of anxiety in patients because of
educated nurse and empowered nurses. Nurses would be able to engage family members in the practice to empower these patients.
The outcome measures in this case are movement, quality of life and assessment of mental health such as anxiety.

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Search strategy:
In order to obtain the systematic reviews, electronic data bases such as CINAHL and PubMed were used for accessing the
articles. The specific inclusion and exclusion criteria has been designed for obtaining accurate articles since these criteria are a road
map for accessing accurate article. The key search terms that was used in the review include “ fall in older adults”, “ fall in older
adults above 65 years in hospital setting” , “ preventive measures for reducing fall in older adults” , “ hospital based interventions to
prevent fall in older adults above 65 years”. The details were provided in appendix I and II. Inclusion criteria for the review are all
journals within 2014 to 2019 were included. All journals published in English language were included. All journals focusing on falls
of older individuals above 65 years in hospital setting were included. All journals focusing on hospital based interventions were
included. From two electronic data bases such as PubMed and CINAHL, total 964 articles were retrieved where in Medline 705 and
in CINAHL 259 articles were retrieved.
The exclusion criteria of the review are all journals more than 2014 to 2019 were excluded.All journals published other than
English language were excluded. All journals focusing on other than falls of older individuals above 65 years in hospital setting were
excluded. All journals focusing on other than hospital based interventions were excluded.

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To identify relevant articles, all the articles were reviewed twice and all texts were thoroughly evaluate. The details were
provided in the appendix III
Method of review:
In order to evaluate the quality of the method used in the systematic reviews, assessment of multiple systematic reviews
(AMSTAR) were used. It is an effective assessment tool for assessing the quality of methodology that has been undertaken in the
systematic review. The tool consists of 11 questions which are used as the criteria for the assessment. For each criteria “yes “ ( score
1) and no ( score 0 ) were used for evaluation. The score criteria for high quality paper is 8-11,. The medium quality of paper scores
it is 5-7 and low quality of paper it is 0 to 4. The details were provided in the IV.
Data extraction:
In order to extract exact accurate data, data extraction table found in appendix IV was used by researchers. The aim of this
method is to provide clarity regarding extracted articles where readers do not require to reevaluate the original articles. While
obtaining the journals, systematic review containing review designs, participants sample size and details of hospital based intervention
approach was considered. A structured table format was used for evaluating the data of systematic review. As discussed by Miller et
al. (2018) this approach is effective to obtain the data from the systematic review, appraise them followed by identifying proper
result of the review. Considering five systematic reviews, if findings of few studies were similar then finds of each review was

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carefully assessed by researcher. The reviews with similar outcome were carefully assessed for obtaining common finding which
will further generated into themes. The details were provided in the appendix V.
Data synthesis:
In order to synthesize the accurate data, narrative and descriptive approach has been undertaken. As discussed by MacLeod
(2019), narrative approach is effective approach for presenting result since these typically focuses on the experiences of individuals
which will further assist in providing recommendation for best interventions.
Review result:
Description of the studied:
From two electronic data bases such as PubMed and CINAHL , total 964 articles were retrieved where in Medline 705 and
in CINAHL 259 articles were retrieved. The duplication was removed after obtaining articles. After removing duplication, total 130
articles were retrieved which further assessed. After assessment of the abstract as well as the title, 78 articles were removed and 52
articles were subjected to further examination. Out of 52, 41 articles failed to meet the criteria and eliminated immediately. After
elimination, 11 articles were found which were subjected to AMSTAR in order evaluate the methodology. After doing assessment,

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finally 5 systematic reviews were included in the review which was appraised for the quality of method. Prisma of the selection
process is following:

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Total retrieved articles
964
CIHANL : 259
Medline:705
130 paper were
retrieved
834 papers were
removed after
duplication
52 articles were
obtained for further
assessment
78 papers were removed after
assessing titles and abstract
11 articles were
found which were
subjected to
AMSTAR
41 Papers were
removed failed to
meet the criteria
6 Papers were
removed after
Quality assessment
5 articles were
included in the study

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After conducting detailed data extraction, five articles are selected for rapid review to identify hospital-based interventions for
preventing the fall of an older adult above 65 years. Considering the first article, Choi et al. (2016) conducted a systematic literature
review of 25 papers where all papers were focused on the older people above 65 years and tasted exergame based interventions.
Considering the second review, Tricco et al. (2017) conducted a systematic review and meta-analysis of 283 randomized controlled
trials where all paper was focused on fall related interventions for older adults 78 years. In the third paper, Sherrington et al. (2017)
also conducted a meta-analysis of 54 randomized controlled trials. Considering the fourth paper, Okubo, Schoene, and Lord (2017),
conducted a systematic review and meta-analysis of Total 7 RCT which focuses on the older adults. Schoene et al. (2014) conducted a
systematic review of thirty-seven studies obtaining from PubMed, EMBASE, and Cochrane. The researchers focusing on a mean age
of 65 years where suggested that interactive cognitive-motor training with gross physical exercise. Hence the majority of the paper
conducted a meta-analysis and systematic review of RCT. In all cases, participants were older adults of above 65 years.
Choi et al. (2016) highlighted that the exergame is a possible innovative approach which tract body movement and reduces the
risk of fall by improving balance and fear of falling. Tricco et al. (2017) suggested that exercise along with vision assessment and

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treatment is effective in reducing the risk of fall in hospital compared to usual care in hospital. Sherrington et al. (2017) confirm that
exercise as a single intervention can prevent falls in the hospital setting by improving the balance of older adults. Okubo, Schoene, and
Lord (2017), suggested that stepping interventions reduces the incidents of fall by improving balance and gait and reaction time.
Considering the last paper, Schoene et al. (2014), suggested that interactive cognitive-motor training with gross physical exercise
would be an effective method for reducing fall by reducing fall risk in the hospital setting.
Considering outcome measures, Choi et al. (2016) highlighted the improvement of balance and elimination of fear of falling.
Three reviews (Tricco et al. (2017), Sherrington et al. (2017) and Okubo, Schoene, and Lord (2017), highlighted outcome
measurements are improved balance, visual assessment. In all studies, the hospital is selected as the setting for the implementation of
interventions. Schoene et al. (2014), suggested that outcome improved would be physical cognitive and physical measures associated
with fall.
Result:
Quality of systematic reviews:
The quality of five reviews was analyzed using AMSTAR where scores for different criteria were used in the order of low to
the high score. After the assessment, a total of 5 reviews were included in the Review where different kinds of hospital-based
interventions were used where the participants were older adults of above 65 years. No associated condition or injuries were included
in the Review. After the assessment, the data analyzed which further generated into themes.
The themes are the following:

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• Exergame intervention:
Choi et al. (2016) suggested that exergame technology administrate exercise to the patients by providing them a platform for
their body movement. It has an optical sensor for sensing the body segments and movement as well as a gesture. Hence it is effective
for improving the balance and reduces the fear of falling in the clinical setting which will further reduce the incidents of falls in older
adults of above 65 years. The research suggested that the exergame set as 30 min per session 3 sessions per week 6 or 8 weeks may be
effective for reducing fall in the hospital setting. However, this protocol may vary greatly for different population. Hence, this
intervention is effective in hospital setting for improving postural balance, muscle strength and cognitive functioning such as self-
confidence, enjoyment and reaction time. This will empower and boost confidence in patient not in patients with disabilities or
impaired balance but also in healthy adults.
• Exercise intervention:
Three reviews (Tricco et al. (2017), Sherrington et al. (2017) and Schoene et al. (2014), highlighted exercise as an effective
intervention for reducing fall amongst the older adults above 65 years. However, Schoene et al. (2014) suggested that interactive
cognitive-motor training with gross physical exercise would be an effective intervention to reduce fall. The research findings
suggested that interactive cognitive-motor training is equivalent to ameliorating fall risk in terms of efficacy in hospital setting.The
evidence suggested that interactive cognitive-motor training has effect on cognitive functions which further will reduce the fear of
fall. It improves the psychology by improving quality of life. Tricco et al. (2017) suggested that exercise along with vision assessment

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and treatment is effective in reducing the risk of fall in hospital compared to usual care in hospital. The exercise alone or with other
combination is effective in reducing fall associated injuries in hospital setting. . The combination include vitamin D, vision
assessment , treatment and environmental modification. The combination may be depends on the care giver values and preference for
patient. While usual care and associated protocol failed to prevent the falls of older adults above 65 years, exercise with a combination
of visual assessment is crucial to reduce fall since it improves balance, identify the visual problem and rectify it which further reduce
fall risk and associated nerve injury. On the other hand, Sherrington et al. (2017) suggested exercise as a single intervention which can
prevent falls in the hospital setting by improving the balance of the older adults. The research finding highlighted that for at least 2
hours per week on an ongoing basis for 6 months can reduce the risk of fall by enhancing strength in walking. Exercise Programme
has been evident in rates of falls and injurious falls by 35%. While researchers suggested to implement this program in broader
ranges such as community, it is effective intervention for hospital setting for reducing fall. However, the author also highlighted that
individuals who are at high risk of fall should avoid intense exercise. Hence, in order to implement exercise in the hospital setting, it is
crucial to consider the patient’s health status and values of caregiver.
• Step training intervention:
Okubo, Schoene, and Lord (2017) suggested that step training intervention is vital for reducing high fall risk since step
training reduces improvements in reaction time, gait, balance and balance recovery, muscle movement and single leg stance. Reactive
and volitional stepping interventions are effective in reducing the fall rate by improving gait and balance. The research result

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suggested that a single session of step training which is 24 slips in 37 trials can reduce 50% of fall rate. The step training has proved
to increased lower extremity muscle strength resulting from 16 weeks of resistance training. Hence, it is crucial to implement it in the
hospital setting to reduce the incidents of fall amongst older adults.
Discussion:
A wide range of systematic reviews was conducted on older adults in order to identify effective interventions for the reducing
fall where very little studies address the fall prevention strategy for reducing fall in the hospital setting. This rapid review addressed a
few comprehensive interventions for reducing incidents of fall. The review suggested that there are certain hospital-based
interventions such as exercise, exergame, and step training is effective interventions which improve the balance of the older adults
who are at high risk of fall in the clinical setting. On the other hand, Schoene et al. (2014), suggested that interactive cognitive-
motor training along with physical exercise is also an effective intervention because motor execution may improve the balance in
patients. Other researchers also suggested similar findings such as the implementation of exercise, step training, and exergame are able
to improve the movement of the individuals by improving balance, gait and flexibility. Another review by Naseri et al. (2016),
suggested that improving the education of nurses and providing nurses training regarding prevention of fall is effective to reduce
incidents of fall. Since nurses would be aware of their practice and innovative technique for prevention of fall in the clinical setting.
While most of the review showed interventions such as exergame, step training, and exercise, the combined interventions. In all
reviews, it was highlighted that implementation of these interventions will improve the education of nurses and their nursing practice,
able to provide direction of amending policies associated with falls in the clinical setting. After detailed review of systematic review it

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can be said that the exergame along with visual assessment are most effective interventions in reducing falls amongst older adult.
These are most effective interventions because while exergame would track sensing the body segments and movement as well as a
gesture of patient, visual assessment would measure vision of patients which would reduce the risk of falls. Based on the result, the
primary outcome would be reduced incident rate of fall. The secondary outcome would be improved fall prevention strategy because
of the educated nurse and empowered patient, reduced anxiety level and fear of fall in patients and improved quality of life.
Quality of evidence:
In order to evaluate the quality of the review, the AMSTAR tool was used which an effective tool to scrutinize the quality is
according to a set of criteria which further resolve challenges faced by the researchers. This assessment tool able to provide the best
researches conducted by researchers on older adults of above 65 years in a clinical setting
A potential limitation of the Review:
The potential limitation of the Review is that only the Review conducted in-between 2015 to 2018 was included in the reviews.
The review focused on only older adults above 65 years, indicating participant selection bias. The Review only conducted on the
Australian patients, indicating homogeneity of results. The researchers were only able to find visual assessment, education of
patients, balance, and gait as outcome. No other outcome measurement was addressed in this review. Hence further in-depth research
is required to reduce these biases.

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The changes that has been made:
Changes that has
been made
Proposal Report Rationale
Title A summary of most
effective measures to
prevent fall injury
amongst older adults
in health care setting
A summary of most
effective measures to
prevent fall among
older adult in health
care setting.
Most suitable data
has been found
within 5 years which
focused on topic
Sample size The older adults 65
years or above 65
years
The older adult of
above 65 years
This population is
more vulnerable to
fall in the hospital
setting

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Conclusion:
Thus, on a concluding note, it can be said that falls among the aging population are one of the key reasons behind the increased
rate of morbidity and mortality globally. While the majority of the Review undertaken in the community setting for evaluating the
reason behind fall and associated interventions, very few studies focuses on incidents of fall in the hospital setting. The Review
population, in this case, was older adults of above 65 years. The result of this review identified certain strategies such as exergame,
exercise, and step training is effective interventions in reducing the fall in older adults by improving balance, gait and flexibility. The
result from article also suggested that along with exercise, interactive cognitive-motor training also effective to reduce fall. The
review also highlighted that combined interventions such as visual assessment, physical, psychological measurement of patient are
effective measures in reducing fall. After detailed review of systematic review it can be said that the exergame along with visual
assessment are most effective interventions in reducing falls amongst older adult. In all cases, outcome measures would be balance,
muscle flexibility, quality of life and assessment of mental health.
The implication for the practitioner:
• In order to prevent fall incidents, it is recommended to implement multicomponent interventions in the clinical setting.
• It is recommended to focus on fall risk before hospitalization
• It is recommended to include family members in the assessment and intervention to reduce incidents of fall
• It is reminded to evaluate continuously for fall risk in order to reduce the incidents of fall.

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The implication for researchers:
• It is recommended to research on population between 40 to 65 years
• It is recommended to research the various outcome measures in order to gain an understanding regarding effective interventions.
• It is recommended to focus on total physical assessment to reduce the incident of fall.

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Luk, J. K., Chan, T. Y., & Chan, D. K. (2015). Falls prevention in the elderly: translating evidence into practice. Hong Kong Med
J, 21(2), 165-71. https://www.hkmj.org/system/files/hkmj144469.pdf
Lukaszyk, C., Harvey, L. A., Sherrington, C., Close, J. C., Coombes, J., Mitchell, R. J., ... & Ivers, R. (2017). Fall‐related
hospitalisations of older Aboriginal and Torres Strait Islander people and other Australians. Medical journal of
Australia, 207(1), 31-35.https://www.mja.com.au/system/files/issues/207_01/10.5694mja16.01173.pdf

30
PREVENTION OF FALL
Nagayama, H., Tomori, K., Ohno, K., Takahashi, K., & Yamauchi, K. (2016). Cost‐effectiveness of Occupational Therapy in Older
People: Systematic Review of Randomized Controlled Trials. Occupational therapy international, 23(2), 103-120.
https://onlinelibrary.wiley.com/doi/pdf/10.1002/oti.1408
Naseri, C., Haines, T. P., Etherton-Beer, C., McPhail, S., Morris, M. E., Flicker, L., ... & Hill, A. M. (2018). Reducing falls in older
adults recently discharged from hospital: a systematic review and meta-analysis. Age and ageing, 47(4), 512-519.
https://www.researchgate.net/profile/Chiara_Naseri/publication/323994916_Reducing_falls_in_older_adults_recently_dischar
ged_from_hospital_A_systematic_review_and_meta-analysis/links/5b06ba130f7e9b1ed7e8ebb3/Reducing-falls-in-older-
adults-recently-discharged-from-hospital-A-systematic-review-and-meta-analysis.pdf
Okubo, Y., Schoene, D., & Lord, S. R. (2017). Step training improves reaction time, gait and balance and reduces falls in older
people: a systematic review and meta-analysis. Br J Sports Med, 51(7), 586-593. http://dx.doi.org/10.1136/bjsports-2015-
095452
Schoene, D., Valenzuela, T., Lord, S. R., & de Bruin, E. D. (2014). The effect of interactive cognitive-motor training in
reducing fall risk in older people: a systematic review. BMC geriatrics, 14(1), 107.
https://bmcgeriatr.biomedcentral.com/articles/10.1186/1471-2318-14-107
Sherrington, C., & Tiedemann, A. (2015). Physiotherapy in the prevention of falls in older people. Journal of physiotherapy, 61(2),
54-60.https://doi.org/10.1016/j.jphys.2015.02.011

31
PREVENTION OF FALL
Spetz, J., Brown, D. S., & Aydin, C. (2015). The economics of preventing hospital falls: demonstrating ROI through a simple
model. JONA: The Journal of Nursing Administration, 45(1), 50-57. DOI: 10.1097/NNA.0000000000000154
Tricco, A. C., Thomas, S. M., Veroniki, A. A., Hamid, J. S., Cogo, E., Strifler, L., ... & Riva, J. J. (2017). Comparisons of
interventions for preventing falls in older adults: a systematic review and meta-analysis. Jama, 318(17), 1687-1699. Retrieved
from: https://jamanetwork.com/journals/jama/fullarticle/2661578
Uusi-Rasi, K., Patil, R., Karinkanta, S., Kannus, P., Tokola, K., Lamberg-Allardt, C., & Sievänen, H. (2015). Exercise and vitamin D
in fall prevention among older women: a randomized clinical trial. JAMA internal medicine, 175(5), 703-711.
doi:10.1001/jamainternmed.2015.0225
Verma, S. K., Willetts, J. L., Corns, H. L., Marucci-Wellman, H. R., Lombardi, D. A., & Courtney, T. K. (2016). Falls and fall-related
injuries among community-dwelling adults in the United States. PLoS one, 11(3), e0150939.
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0150939
Vlaeyen, E., Coussement, J., Leysens, G., Van der Elst, E., Delbaere, K., Cambier, D., ... & Dejaeger, E. (2015). Characteristics and
effectiveness of fall prevention programs in nursing homes: A systematic review and meta‐analysis of randomized controlled
trials. Journal of the American Geriatrics Society, 63(2), 211-221. https://www.semanticscholar.org/paper/Characteristics-and-
effectiveness-of-fall-programs-Vlaeyen-Coussement/a33524b396d5eddaaeae590b71c23af104ebd30c

32
PREVENTION OF FALL
Appendix I:
Search strategy in CINAHL
 Fall in older adults
 fall in older adults above 65 years in hospital setting
 Fall prevention in elderly at clinical setting
 Fall prevention strategy AND systematic review
 Hospital based interventions for elderly AND systematic review
 hospital based interventions to prevent fall in older adults above 65 years AND systematic review
 (fall prevention in elderly) AND PT (academic journal)
 Limited to 2015 to 2019

33
PREVENTION OF FALL
Appendix II:
# Key words Number of search
S1 (Fall in older adults in
hospital setting ) AND PT
(academic journal)
705
S2 Fall prevention strategy in
older adults in hospital
setting
657
S3  Hospital based
interventions for
elderly AND
systematic review
467
S4 Hospital based interventions
for elderly over 65 years
281

34
PREVENTION OF FALL
AND systematic review
APPENDIX III:
Reason behind exclusion:
References Reason
behind
exclusi
on
Lukaszyk, C., Harvey, L. A., Sherrington, C., Close, J. C., Coombes, J., Mitchell, R. J., ... & Ivers, R. (2017). Fall‐
related hospitalisations of older Aboriginal and Torres Strait Islander people and other Australians. Medical journal of
Australia, 207(1), 31-35.
https://www.mja.com.au/system/files/issues/207_01/10.5694mja16.01173.pdf
Focus
ed on
hospital
rea;lted
fall but
failed
to
focus
on

35
PREVENTION OF FALL
older
adults
above
65
years
Hill, A. M., McPhail, S. M., Francis-Coad, J., Waldron, N., Etherton-Beer, C., Flicker, L., ... & Haines, T. P. (2015).
Educators’ perspectives about how older hospital patients can engage in a falls prevention education programme: a
qualitative process evaluation. BMJ open, 5(12), e009780. http://dx.doi.org/10.1136/bmjopen-2015-009780
Not a
system
atic
review
Sherrington, C., & Tiedemann, A. (2015). Physiotherapy in the prevention of falls in older people. Journal of
physiotherapy, 61(2), 54-60.
https://doi.org/10.1016/j.jphys.2015.02.011
Not a
system
atic
review
Finch, C. F., Stephan, K., Shee, A. W., Hill, K., Haines, T. P., Clemson, L., & Day, L. (2015). Identifying clusters of
falls-related hospital admissions to inform population targets for prioritising falls prevention programmes. Injury
prevention, 21(4), 254-259. doi:10.1136/injuryprev-2014-041351
Focuse
d on
fall
injury

36
PREVENTION OF FALL
rather
than
fall
Matarese, M., Ivziku, D., Bartolozzi, F., Piredda, M., & De Marinis, M. G. (2015). Systematic review of fall risk
screening tools for older patients in acute hospitals. Journal of advanced nursing, 71(6), 1198-1209.
https://s3.amazonaws.com/academia.edu.documents/42009082/Systematic_review_of_fall_risk_screening20160203-
20448-1uglfsh.pdf?AWSAccessKeyId=AKIAIWOWYYGZ2Y53UL3A&Expires=1558590521&Signature=hsqe9VJ
%2BxzIS2qaYPbzkIM3M2q4%3D&response-content-disposition=inline%3B%20filename
%3DSystematic_review_of_fall_risk_screening.pdf
Focuse
d on
fall risk
screeni
ng tool
Nagayama, H., Tomori, K., Ohno, K., Takahashi, K., & Yamauchi, K. (2016). Cost‐effectiveness of Occupational
Therapy in Older People: Systematic Review of Randomized Controlled Trials. Occupational therapy
international, 23(2), 103-120. https://onlinelibrary.wiley.com/doi/pdf/10.1002/oti.1408
Focuse
d on
older
adults
not
above
65

37
PREVENTION OF FALL
years
APPENDIX IV: AMSTAR TOOL
Quality Assessment of 5 articles by AMSTAR
Choi et al. (2016) Tricco et al.
(2017),
Sherrington et al.
(2017)
Okubo, Schoene,
and Lord (2017)
Schoene et al.
(2014)
1. Was an 'a priori'
design provided?
1 1 1 1 1
2. Was there duplicate
Review selection and
data extraction?
0 0 1 1 0
3. Was a
comprehensive
literature search
performed?
1 1 1 0 1
4. Was the status of
publication (i.e. grey
literature) used as an
inclusion criterion?
0 0 0 0 0
5. Was a list of
studies (included and
excluded) provided?
1 1 1 1 1
6. Were the
characteristics of the
included studies
provided?
1 1 1 1 1
7. Was the scientific
quality of the
1 1 1 1 1

38
PREVENTION OF FALL
included studies
assessed and
documented?
8. Was the scientific
quality of the
included studies used
appropriately in
formulating
conclusions?
1 1 1 1 1
9. Were the method
used to combine
finding of studies
appropriate
1 1 1 1 1
10. Was the
likelihood of
publication biased
1 0 1 1 0
11. Was the conflict
of interest included
1 1 1 1 1
Total 9 8 9 9 8
Appendix V
Author
and
Year
Aim Search
details,
range
(database
searched,
articles
Quality of
studies
Number
of
studies
Design of
included
Interventi
ons/
Comparis
on
Measured
outcome
outcome
Positive
outcome
Negative
outcome
Unclear
outcome

39
PREVENTION OF FALL
included) studies
Choi,
Guo
Kang &
Xiong
(2017):
Retriev
ed from
CINAH
L
To
synthesi
ze the
availabl
e
research
reported
on
exergam
e
technolo
gy and
interacti
ve
interven
tions for
fall
preventi
on in the
older
populati
5 major
electronic
database
such as
Scopus,
Science
Direct,
PubMed,
Web of
Science
and
Proquest
used for
search
process:
No. of
articles
retrieved:
Out of
8984
articles, 25
Moderate No. of
studies: 25
Design of
included
studies:
RCT,
quasi-
experiment
al and, pre-
post
control
Review
The key
intervention
s that were
analyzed
include
exergames
for balance
training and
fall
prevention
through
different
exergaming
system.
Two commo
devices
included
Nintendo
Wii and
Xbox
The key
outcome
measures
included
gait and
mobility
performance
and the self-
perceived
risk of
falling. The
assessment
was done
using the
Timed Up
and Go test
and the
rating
obtained on
fall efficacy
The
exergame is
effective in
reducing
self-
perceived
risk of
falling and
reduce rate
of
falling ,impr
ove balance
No
significant
improvemen
t in gait
No
significant
changes in
the balance
for elderly
was found

40
PREVENTION OF FALL
on papers
were
included in
the final
review
Kinect scale
Tricco,
A. C.,
Thomas
, S. M.,
Veronik
i, A. A.,
Hamid,
J. S.,
Cogo,
E.,
Strifler,
L., ... &
Riva, J.
J.
(2017),
Retriev
ed from
To
evaluate
d the
effective
ness of
fall
preventi
on
campaig
ns
The search
for article
was done
in
MEDLINE
, Embase,
Cochrane
Central
Register of
Controlled
trials and
Ageline
database
283 RCTs
were
included in
the review
Moderate No. of
studies:
283
research
articles
Design of
studies:
RCTs of
fall
prevention
interventio
n
Basic fall
risk
assessment,
flooring,
social
engagement,
environment
assessment
and
modificatio
n, vision
assessment ,
and
treatment,
multi-
factorial
assessment
Injurious
fall and fall
related
hospitalizati
on, number
of falls.
Social
engagement
and
environment
and vision
assessment
may
improve risk
of fall
Exercise
may
increase fall
risk in some
individuals.
not found

41
PREVENTION OF FALL
CINAH
L
after
analysis
and exercise
Sherrin
gton,
C.,
Michale
ff, Z.
A.,
Fairhall
, N.,
Paul, S.
S.,
Tiedem
ann, A.,
Whitne
y, J., ...
& Lord,
S. R.
(2017),
Retriev
ed from
To find
the
impact
of
exercise
on
preventi
ng fall
in
elderly
The
database
that were
searched
for review
included
CINAHL,
MEDLINE
, PubMed,
PEDro,
EMBASE
and
SafetyLit
Moderate No. of
studies: 88
Design of
studies:
Randomize
d
controlled
trials that
compared
fall rate
were
included in
the analysis
All single
intervention
s with
exercise as
the main
method of
analysis
were taken
in the
review. The
strength
training and
walking
training can
be given.
The main
outcome
that was
measured
included
number of
falls, rate of
falls or
number of
fallers,
balance and
cataract
surgery.
Moderate
physical
activity,
visual
activity and
cataract
surgery may
reduce the
fall rate
Intensive
exercise
may
increase fall
risk in some
individuals.
No
significant
data found
regarding
strength
training
with
exercise

42
PREVENTION OF FALL
Medline
Okubo,
Y.,
Schoen
e, D., &
Lord, S.
R.
(2017),
Retriev
ed from
Medline
To
evaluate
the
effect of
stepping
interven
tion on
fall risk
factor
and
incidenc
e in
older
people
Electronic
databased
like
PubMed,
Embase,
CINAHL,
Cochrane
and Central
has been
used. The
articles has
selected till
March
2015
Moderate No. of
studies:
Seven
RCTs
Design of
studies:
RCT or
clinical
controlled
trials
Stepping
intervention
s
Rate of falls
and the
proportion
of falls, the
balance and
gait along
with
strength
The
stepping
intervention
may
improve the
balance ,
gait and
balance
recovery
No
significant
measureme
t of strengt
was
observed.
Schoen
e et al.
(2014),
Retriev
ed from
CINAH
L
To
evaluate
the
Person
centered
interven
tion on
The data
bases such
as PubMed,
Embase,
has been
used. The
articles has
No. of
studies:
Thirty-
seven
studies
The
intervention
such as
exercise and
interactive
cognitive-
motor
Rate of
fall , and
balance
The
physical ,
psychologic
al measures
of patients
would
effective in
No
significant
information
was found

43
PREVENTION OF FALL
fall risk
factor
and
incidenc
e in
older
people
selected till
March
2015
Design of
studies:
systematic
review
training reducing
falls
Appendix VI
Gant chart
Since we are not able to copy paste from the proposal, kindly copy paste the chart from the proposal.