The edition · Geriatrics
Falls clinics beat usual care, but not falls advice
The updated Cochrane review — 110 trials, 48,919 people — finds multifactorial assessment cuts the falls rate against usual care and adds nothing over education. Plus prehabilitation in frail cardiac surgery, and what culturally adapted dementia support actually consists of.
The edition in brief
Today's geriatrics desk is led by the updated Cochrane review of multifactorial and multiple component falls prevention in community-dwelling older people, now covering 110 randomised trials and 48,919 participants. Against usual care, multifactorial interventions may reduce the falls rate (rate ratio 0.76, 95% CI 0.67 to 0.87, I squared 92 per cent, low certainty) and recurrent falls (RR 0.87, 0.78 to 0.98), with little or no effect on the risk of falling at all (RR 0.95, 0.90 to 1.01). Against falls advice or education, they provide no additional benefit and probably increase the falls rate slightly (RaR 1.09, 1.00 to 1.18, moderate certainty). Multiple component interventions — the same package for everyone — showed little or no effect on falls rate against any comparator. A pilot trial randomised 51 patients with mild to moderate frailty awaiting coronary or valve surgery to a frailty-specific prehabilitation programme or usual care: Short Physical Performance Battery improved the day before surgery (beta 0.99, 95% CI 0.08 to 1.90) and at three months, Fried frailty fell with large effect sizes, adherence was 89 per cent, and there was no difference in readmission or length of stay. A three-arm trial in 117 long-term care residents in Chongqing found augmented-reality-guided Baduanjin improved Fried frailty more than video or control at 12 weeks. A rapid review of culturally adapted post-diagnostic dementia support for South Asian families found 12 studies, mostly carer education and psychosocial programmes, with almost nothing aimed at the person with dementia.
Prehabilitation before cardiac surgery, in the patients most likely to need it
Offer resistance-focused prehabilitation to frail patients waiting for cardiac surgery — it improves function and frailty, with no evidence yet on complications.
Guided Baduanjin in long-term care, with the feedback loop closed
In long-term care, exercise with corrective feedback outperformed the same exercise delivered by video on frailty at 12 weeks.
Culturally adapted dementia support supports the carer, not the patient
Use culturally adapted carer education and, where possible, a language-matched link worker — but note that nothing here has been shown to help the person with dementia directly.
Ask when they last got up from the floor
Ask whether the patient can get up off the floor unaided, and plan for the answer — the long lie causes more harm than the fall.
Falls prevention: tailored assessment beats usual care, and not much else
Tailor falls interventions to the individual and make sure good falls advice reaches everyone — a fixed multi-component package adds little to either.
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