TY - JOUR
T1 - Emergency department-initiated interventions to reduce risk of recurrent falls in older adults
T2 - a systematic review and meta-analysis
AU - Charmant, Wilmar
AU - Jansen, Sofie
AU - van Schoor, Natasja M.
AU - de Vries, Ralph
AU - Nanayakkara, Prabath
AU - Willems, Hanna C.
AU - van der Velde, Nathalie
N1 - Publisher Copyright:
© The Author(s) 2026. Published by Oxford University Press on behalf of the British Geriatrics Society. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
PY - 2026/8/1
Y1 - 2026/8/1
N2 - Background: Older adults presenting to the emergency department (ED) following a fall are at high risk for recurrent falls, injuries and increased healthcare utilisation. This systematic review and meta-analysis evaluated the effectiveness of interventions initiated upon ED presentation in reducing falls (primary outcome) and fall-related outcomes (secondary outcomes) among older adults. Methods: A comprehensive search was performed in Ovid Medline, Embase, CINAHL, PEDro, Web of Science, and Scopus up to June 2025, following PRISMA guidelines. This yielded 9624 references, of which 4811 records remained after deduplication and were screened for eligibility. Meta-analyses and descriptive methods, including vote counting, were applied where appropriate. Sensitivity and subgroup analyses were conducted. Results: Thirty articles were included. Interventions were associated with a significant reduction in fall incidence (rate ratio 0.69; 95% CI 0.54–0.88; I2 = 95%), supported by vote counting. While reductions were also observed in the proportion of fallers (odds ratio 0.87; 95% CI 0.71–1.07; I2 = 61%), fall-related and all-cause ED revisits, hospital admissions, recurrent falls and mortality, these trends did not reach statistical significance. Sensitivity analysis excluding studies with modified usual care showed a significant reduction in fall-related ED revisits and people sustaining an injurious fall. Secondary outcomes including quality of life, fear of falling and physical functioning generally showed trends favouring the intervention group. Considerable heterogeneity and variation in intervention characteristics were noted across studies. Conclusion: Interventions for older adults presenting to the ED after a fall suggest a favourable effect on fall rate. Non-significant trends favouring the intervention group were observed for several other outcomes, but heterogeneity and methodological limitations preclude definitive conclusions.
AB - Background: Older adults presenting to the emergency department (ED) following a fall are at high risk for recurrent falls, injuries and increased healthcare utilisation. This systematic review and meta-analysis evaluated the effectiveness of interventions initiated upon ED presentation in reducing falls (primary outcome) and fall-related outcomes (secondary outcomes) among older adults. Methods: A comprehensive search was performed in Ovid Medline, Embase, CINAHL, PEDro, Web of Science, and Scopus up to June 2025, following PRISMA guidelines. This yielded 9624 references, of which 4811 records remained after deduplication and were screened for eligibility. Meta-analyses and descriptive methods, including vote counting, were applied where appropriate. Sensitivity and subgroup analyses were conducted. Results: Thirty articles were included. Interventions were associated with a significant reduction in fall incidence (rate ratio 0.69; 95% CI 0.54–0.88; I2 = 95%), supported by vote counting. While reductions were also observed in the proportion of fallers (odds ratio 0.87; 95% CI 0.71–1.07; I2 = 61%), fall-related and all-cause ED revisits, hospital admissions, recurrent falls and mortality, these trends did not reach statistical significance. Sensitivity analysis excluding studies with modified usual care showed a significant reduction in fall-related ED revisits and people sustaining an injurious fall. Secondary outcomes including quality of life, fear of falling and physical functioning generally showed trends favouring the intervention group. Considerable heterogeneity and variation in intervention characteristics were noted across studies. Conclusion: Interventions for older adults presenting to the ED after a fall suggest a favourable effect on fall rate. Non-significant trends favouring the intervention group were observed for several other outcomes, but heterogeneity and methodological limitations preclude definitive conclusions.
KW - acute care
KW - emergency department
KW - falls
KW - falls prevention
KW - multifactorial interventions
KW - older people
KW - systematic review
UR - https://www.scopus.com/pages/publications/105046240782
U2 - 10.1093/ageing/afag227
DO - 10.1093/ageing/afag227
M3 - Review article
C2 - 42544467
SN - 0002-0729
VL - 55
JO - Age and ageing
JF - Age and ageing
IS - 8
M1 - afag227
ER -