Interventions for preventing falls in people who have presented to emergency departments

Introduction: The emergency department (ED) is often the first point of contact with the health system following a fall. After an ED visit for a fall, many will experience subsequent falls and revisit the ED. Although guidelines recommend that ED health care professionals assess fall risk and initiate actions to prevent future falls, there remains substantial uncertainty about the effectiveness of interventions for preventing falls among people who present to the ED. Therefore, we aim to assess the effects of interventions designed to reduce falls in adults and older adults who present to the ED.

Methods: A systematic review of randomised controlled trials (RCTs) evaluating the effect of any fall prevention interventions on falls in adults aged 18+ years who presented to the ED, compared to any other intervention, usual care or no intervention. No restrictions will be applied regarding participants’ discharge destination. Interventions will be grouped in single, multiple, or multifactorial, as defined by the Prevention of Falls Network Europe. Interventions investigating referrals to services will also be included. The primary outcome of this review is the rate of falls. We will search six databases, trial registers and reference lists. Trials with comparable interventions and participants characteristics will be grouped and forest plots will be compiled using generic inverse variance. 

Results: A preliminary search identified 18 eligible studies, including 15 evaluating multifactorial interventions and three evaluating single interventions (fall-risk-increasing-drugs withdrawal, home fall-hazard reduction, and exercise).

Conclusion: We expect to synthesise the evidence on falls prevention for people who present to the ED. This review responds directly to a recognised gap in practice and aligns with the priorities of health services and policymakers seeking to reduce preventable ED re-presentations and improve outcomes for older adults.