Older people's recruitment, sustained participation, and adherence to falls prevention interventions in institutional settings: a supplement to the Cochrane systematic review

BACKGROUND: randomised controlled trials (RCTs) of falls prevention conducted in institutional settings have recently been systematically reviewed. OBJECTIVE: to supplement this review by analysing older people's participation in the trials and engagement with the interventions. DESIGN: review of the 41 RCTs included in the Cochrane systematic review of falls prevention interventions. SETTING: hospitals and nursing care facilities. PARTICIPANTS: adults aged/mean age of 65+. METHODS: calculated aggregate data on recruitment (inclusion into the trial), attrition at 12-month follow-up (loss of participants from the trial), adherence (to intervention protocol), and whether adherence moderated the effect of interventions on trial outcomes. RESULTS: the median inclusion rate was 48.5% (38.9-84.5%). At 12 months the median attrition rate was 10.4% (3.9-12.3%, n = 10) or with the inclusion of mortality 16.2% (9.5-17.1%, n = 11). Adherence was high for exercise that was individually targeted (e.g. 89% physical therapy) and group based (72-88%) and for medication interventions (68-88%). For multifactorial interventions, adherence ranged from 11% for attending 60+/88 of exercise classes to 93% for use/repairs of aids. Adherence as a moderator of treatment effectiveness was tested in nursing care facilities (n = 6) and positively identified in three studies for medication and multifactorial interventions. CONCLUSIONS: using median rates for recruitment (50%), attrition (15%) and adherence (80%), by 12 months, it is estimated that on average only a third of nursing care facility residents are likely to be adhering to falls prevention interventions.