School of Dental, Health and Care Professions, University of Portsmouth, Portsmouth, UK.
Department of Psychology, Sport and Health Sciences, University of Portsmouth, Portsmouth, UK.
Cochrane Database Syst Rev. 2024 Oct 3;10(10):CD013480. doi: 10.1002/14651858.CD013480.pub2.
Older adults are at increased risk of both falls and fall-related injuries. Falls have multiple causes and many interventions exist to try and prevent them, including educational and psychological interventions. Educational interventions aim to increase older people's understanding of what they can do to prevent falls and psychological interventions can aim to improve confidence/motivation to engage in activities that may prevent falls. This review is an update of previous evidence to focus on educational and psychological interventions for falls prevention in community-dwelling older people.
To assess the benefits and harms of psychological interventions (such as cognitive behavioural therapy; with or without an education component) and educational interventions for preventing falls in older people living in the community.
We searched CENTRAL, MEDLINE, Embase, four other databases, and two trials registries to June 2023. We also screened reference lists and conducted forward-citation searching.
We included randomised controlled trials of community-dwelling people aged 60 years and older exploring the effectiveness of psychological interventions (such as cognitive behavioural therapy) or educational interventions (or both) aiming to prevent falls.
We used standard methodological procedures expected by Cochrane. Our primary outcome was rate of falls. We also explored: number of people falling; people with fall-related fractures; people with falls that required medical attention; people with fall-related hospital admission; fall-related psychological outcomes (i.e. concerns about falling); health-related quality of life; and adverse events.
We included 37 studies (six on cognitive behavioural interventions; three on motivational interviewing; three on other psychological interventions; nine on multifactorial (personalised) education; 12 on multiple topic education; two on single topic education; one with unclear education type; and one psychological plus educational intervention). Studies randomised 17,478 participants (71% women; mean age 73 years). Most studies were at high or unclear risk of bias for one or more domains. Cognitive behavioural interventions Cognitive behavioural interventions make little to no difference to the number of fallers (risk ratio (RR) 0.92, 95% confidence interval (CI) 0.82 to 1.02; 4 studies, 1286 participants; low-certainty evidence), and there was a slight reduction in concerns about falling (standardised mean difference (SMD) -0.30, 95% CI -0.42 to -0.19; 3 studies, 1132 participants; low-certainty evidence). The evidence is very uncertain or missing about the effect of cognitive behavioural interventions on other outcomes. Motivational interviewing The evidence is very uncertain about the effect of motivational interviewing on rate of falls, number of fallers, and fall-related psychological outcomes. No evidence is available on the effects of motivational interviewing on people experiencing fall-related fractures, falls requiring medical attention, fall-related hospital admission, or adverse events. Other psychological interventions The evidence is very uncertain about the effect of health coaching on rate of falls, number of fallers, people sustaining a fall-related fracture, or fall-related hospital admission; the effect of other psychological interventions on these outcomes was not measured. The evidence is very uncertain about the effect of health coaching, guided imagery, and mental practice on fall-related psychological outcomes. The effect of other psychological interventions on falls needing medical attention or adverse events was not measured. Multifactorial education Multifactorial (personalised) education makes little to no difference to the rate of falls (rate ratio 0.95, 95% CI 0.77 to 1.17; 2 studies, 777 participants; low-certainty evidence). The effect of multifactorial education on people experiencing fall-related fractures was very imprecise (RR 0.66, 95% CI 0.29 to 1.48; 2 studies, 510 participants; low-certainty evidence), and the evidence is very uncertain about its effect on the number of fallers. There was no evidence for other outcomes. Multiple component education Multiple component education may improve fall-related psychological outcomes (MD -2.94, 95% CI -4.41 to -1.48; 1 study, 459 participants; low-certainty evidence). However, the evidence is very uncertain about its effect on all other outcomes. Single topic education The evidence is very uncertain about the effect of single-topic education on rate of falls, number of fallers, and people experiencing fall-related fractures. There was no evidence for other outcomes. Psychological plus educational interventions Motivational interviewing/coaching combined with multifactorial (personalised) education likely reduces the rate of falls (although the size of this effect is not clear; rate ratio 0.65, 95% CI 0.43 to 0.99; 1 study, 430 participants; moderate-certainty evidence), but makes little to no difference to the number of fallers (RR 0.93, 95% CI 0.76 to 1.13; 1 study, 430 participants; high-certainty evidence). It probably makes little to no difference to falls-related psychological outcomes (MD -0.70, 95% CI -1.81 to 0.41; 1 study, 353 participants; moderate-certainty evidence). There were no adverse events detected (1 study, 430 participants; moderate-certainty evidence). There was no evidence for psychological plus educational intervention on other outcomes.
AUTHORS' CONCLUSIONS: The evidence suggests that a combined psychological and educational intervention likely reduces the rate of falls (but not fallers), without affecting adverse events. Overall, the evidence for individual psychological interventions or delivering education alone is of low or very-low certainty; future research may change our confidence and understanding of the effects. Cognitive behavioural interventions may improve concerns about falling slightly, but this may not help reduce the number of people who fall. Certain types of education (i.e. multiple component education) may also help reduce concerns about falling, but not necessarily reduce the number of falls. Future research should adhere to reporting standards for describing the interventions used and explore how these interventions may work, to better understand what could best work for whom in what situation. There is a particular dearth of evidence for low- to middle-income countries.
老年人跌倒和与跌倒相关伤害的风险增加。跌倒有多种原因，有许多干预措施试图预防跌倒，包括教育和心理干预。教育干预旨在提高老年人对预防跌倒的认识，而心理干预可以提高他们对参与预防跌倒活动的信心/积极性。本综述是对以前证据的更新，重点关注社区居住的老年人预防跌倒的教育和心理干预。
评估心理干预（如认知行为疗法；有或没有教育成分）和教育干预预防社区居住老年人跌倒的益处和危害。
我们检索了 CENTRAL、MEDLINE、Embase、其他四个数据库和两个试验注册处，截至 2023 年 6 月。我们还筛选了参考文献列表并进行了前瞻性引文搜索。
我们纳入了随机对照试验，研究了社区居住的年龄在 60 岁及以上的人群中，旨在预防跌倒的心理干预（如认知行为疗法）或教育干预（或两者）的有效性。
我们使用了符合 Cochrane 预期的标准方法学程序。我们的主要结局是跌倒发生率。我们还探讨了：跌倒人数；跌倒相关骨折人数；需要医疗关注的跌倒人数；跌倒相关住院人数；跌倒相关心理结局（即担心跌倒）；健康相关生活质量；和不良事件。
我们纳入了 37 项研究（6 项关于认知行为干预；3 项关于动机访谈；3 项关于其他心理干预；9 项关于多因素（个性化）教育；12 项关于多主题教育；2 项关于单一主题教育；1 项教育类型不明确；和 1 项心理加教育干预）。研究随机分配了 17478 名参与者（71%为女性；平均年龄 73 岁）。大多数研究在一个或多个领域存在高或不确定的偏倚风险。
认知行为干预对跌倒者人数（风险比 (RR) 0.92，95%置信区间 (CI) 0.82 至 1.02；4 项研究，1286 名参与者；低质量证据）和跌倒相关心理结局的担忧（标准化均数差 (SMD) -0.30，95%CI -0.42 至 -0.19；3 项研究，1132 名参与者；低质量证据）几乎没有影响。认知行为干预对其他结局的效果的证据非常不确定或缺失。
动机访谈对跌倒发生率、跌倒人数和跌倒相关心理结局的影响的证据非常不确定。关于动机访谈对跌倒相关骨折、需要医疗关注的跌倒、跌倒相关住院和不良事件的效果，没有证据。
健康指导对跌倒发生率、跌倒人数、跌倒相关骨折或跌倒相关住院的效果的证据非常不确定；对其他心理干预的这些结局的效果没有进行测量。健康指导、意象引导和心理演练对跌倒相关心理结局的效果的证据非常不确定。对需要医疗关注或不良事件的跌倒的其他心理干预的效果没有进行测量。
多因素（个性化）教育对跌倒发生率的影响很小或没有（率比 0.95，95%CI 0.77 至 1.17；2 项研究，777 名参与者；低质量证据）。多因素教育对跌倒相关骨折的效果非常不确定（RR 0.66，95%CI 0.29 至 1.48；2 项研究，510 名参与者；低质量证据），其对跌倒人数的效果的证据也不确定。对其他结局没有证据。
多成分教育可能改善跌倒相关的心理结局（MD -2.94，95%CI -4.41 至 -1.48；1 项研究，459 名参与者；低质量证据）。然而，其对所有其他结局的效果的证据非常不确定。
单一主题教育对跌倒发生率、跌倒人数和跌倒相关骨折的效果的证据非常不确定。对其他结局没有证据。
动机访谈/辅导与多因素（个性化）教育相结合可能降低跌倒率（尽管这种效果的大小并不清楚；率比 0.65，95%CI 0.43 至 0.99；1 项研究，430 名参与者；中等质量证据），但对跌倒人数的影响很小或没有（RR 0.93，95%CI 0.76 至 1.13；1 项研究，430 名参与者；高质量证据）。它对跌倒相关心理结局的影响可能很小或没有（MD -0.70，95%CI -1.81 至 0.41；1 项研究，353 名参与者；中等质量证据）。没有检测到不良事件（1 项研究，430 名参与者；中等质量证据）。心理加教育干预对其他结局没有效果。
证据表明，结合心理和教育干预可能降低跌倒率（但不降低跌倒者人数），且不影响不良事件。总体而言，关于个体心理干预或单独提供教育的证据质量低或非常低；未来的研究可能会改变我们对这些干预效果的信心和理解。认知行为干预可能会略微改善对跌倒的担忧，但这可能无助于减少跌倒人数。某些类型的教育（如多成分教育）也可能有助于减少对跌倒的担忧，但不一定减少跌倒次数。未来的研究应遵守描述所使用干预措施的报告标准，并探索这些干预措施如何发挥作用，以更好地了解哪些干预措施最适合哪些人在什么情况下使用。特别是，在中低收入国家缺乏证据。
