Emergency department–initiated interventions reduce recurrent falls in older adults
Abstract
Background: Older adults presenting to the emergency department (ED) following a fall are at high risk for recurrent falls, injuries, and increased healthcare utilization. This systematic review and meta-analysis evaluated the effectiveness of interventions initiated upon ED presentation in reducing falls and related outcomes among older adults.
Methods: A comprehensive literature search was performed in six databases (Ovid Medline, Embase, CINAHL, PEDro, Web of Science, and Scopus) up to June 2025, in accordance with PRISMA guidelines. This yielded 9,624 references, of which 4,811 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 also conducted.
Results:Thirty articles representing 27 unique studies were included. Interventions initiated in the ED were associated with a significant reduction in fall incidence (rate ratio 0.69; 95% CI 0.54–0.88; I² = 95%), a finding supported by vote counting. While reductions were also observed in the proportion of fallers (odds ratio 0.87; 95% CI 0.71–1.17; 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 (odds ratio 0.70; 95% CI 0.52–0.95; I² = 0%). Secondary outcomes including quality of life, fear of falling, and physical functioning showed mixed but generally positive trends. 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 favorable effect on fall rate. In addition, positive non-significant trends were observed for several other outcomes, but heterogeneity and methodological limitations preclude definitive conclusions.
Comments
Great work, and a very…
Great work, and a very important topic.
ED interventions
Thank you for your poster. I'm curious to know more about the interventions? Was there much heterogeneity? Were some more effective than others?
ED interventions
Thank you for your comment! The heterogeneity was (from a statistical point of view) caused by differences in effect sizes, but I think that that reflects differences in populations accross countries, as well as the interventions administered. Interventions were very heterogeneous, in that some were directly administered at the ED (for instance physiotherapy and medication review), some comprised a home assessment and community referrals, others included referrals to specialized falls clinics. Our main aim was to investigate whether initiation, but not necessarily administration, of the intervention in the ED is effective, as the population that comes in with a fall is often high risk but motivation to partake in falls preventin declines as patients are further away from the fall incident.
Interesting poster
Very interesting study with important findings that further reinforce the importance of fall prevention following an acute care visit. This aligns closely with my PhD project, which focuses on how emergency departments can work more systematically to initiate fall prevention interventions for older adults presenting after a fall.
Frailty at the front door
Thank you so much for this great work that highlights the importance and need for establishing frailty at the front door services across the board.