Older people's participation in and engagement with falls prevention interventions in community settings: an augment to the cochrane systematic review

Background: randomised controlled trials (RCTs) of fall prevention conducted in community settings have recently been systematically reviewed. Objective: to augment this review by analysing older people's participation in the trials and engagement with the interventions. Design: review of the 99 single and multifactorial RCTs included in the Cochrane systematic review of falls prevention interventions. Setting: community. Participants: adults aged 60+/mean age minus one standard deviation of 60+. Methods: calculated aggregate data on recruitment (proportion who accepted the invitation to participate), attrition at 12 month follow-up (loss of participants), adherence (to intervention protocol) and whether adherence moderated the effect of interventions on trial outcomes. Results: the median recruitment rate was 70.7% (64.2-81.7%, n = 78). At 12 months the median attrition rate including mortality was 10.9% (9.1-16.0%, n = 44). Adherence rates (n = 69) were >= 80% for vitamin D/calcium supplementation; >= 70% for walking and class-based exercise; 52% for individually targeted exercise; approximately 60-70% for fluid/nutrition therapy and interventions to increase knowledge; 58-59% for home modifications; but there was no improvement for medication review/withdrawal of certain drugs. Adherence to multifactorial interventions was generally >= 75% but ranged 28-95% for individual components. The 13 studies that tested for whether adherence moderated treatment effectiveness produced mixed results. Conclusions: using median rates for recruitment (70%), attrition (10%) and adherence (80%), we estimate that, at 12 months, on average half of community-dwelling older people are likely to be adhering to falls prevention interventions in clinical trials.