Table 2 Comparison of main characteristics of interventions shown to be effective and not effective in reducing falls (F, rate of falls) or falls risk (FR, proportion of fallers) in studies conducted in Asia

Suzuki et al., 2004 (Japan) ^Ø[31]

N = 52;

Women only.

Mean age = 78;

Participating in gerontology longitudinal study.

RCT.

Group exercise program strength, balance, walking, Tai Chi, supplemented by home exercise program.

Pamphlet and advice on falls prevention.

Group – 10 × 1 hour session × 6 months;

Home – 30 min 3 x/week.

75.3% average attendance at exercise classes.

Follow-up at 8 and 20 months for falls data.

20 month data reported in the Cochrane review.

✓

• F – RaR = 0.35 [0.14, 0.88]

• FR – RR = 0.25 [0.08, 0.78]

Intervention group significant improvements on tandem walking, Functional Reach and knee extension power.

Bal ✓

Dose ✓

Woo et al., 2007 (Hong Kong, China) [42]

N = 180 (90 men and 90 women);

Mean age 69 years, range 65–74.

RCT with block randomization by gender.

(1) 24 form Yang style Tai Chi

(2) Resistance exercises with thera-band.

Usual care.

(1) Tai Chi 24 form, 3 x/week × 12 months

(2) Resistance exercise 3 x/week 12 months (arm lifting, hip abduction, heel raise, hip flexion, hip extension, squatting ankle dorsiflexion).

High compliance – Tai Chi 81%, resistance training 76%.

12 month follow-up.

(1) ✓ (2) x

• (1) FR – RR = 0.48 [0.29, 0.80]^##

• (2) FR - 0.77 [0.52, 1.14]

No significant between group differences for strength, balance or flexibility measures.

Sub-group analysis in women identified significantly reduced rate of loss of total hip bone mineral density in both exercise groups relative to control group.

(1) Bal ✓

Dose ✓

(2) Bal?

(not clear starting position or hand support)

Dose ✓

Lin et al., 2007 (Taiwan, rural/agricultural area) [38]

N = 150, recent fallers.

51% female.

Mean age = 76.8 years.

RCT.

(1) Home exercise with physio (individualized flexibility, strength & balance exercises)

(2) Home safety assessment and modification by public health worker (see below for results)

Education and social visit every 2 weeks with public health worker + falls prevention brochure.

(1) 40–60 min, 3 x/week × 4 months, physio visit every 2 weeks

(2) 30–40 min visit every 2 weeks to perform safety assessment and make recommendations.

Assessment at 2 and 4 months for quality of life, depression and physical performance measures.

Adherence to exercise program not reported.

x (exercise)

• F – RaR = 0.67 [0.35, 1.28]

Exercise group had significant improvements on Functional Reach, Tinetti POMA, and fear of falling than the Education group.

(1) Home exercise program

Bal ✓

Dose x

Shigematsu et al., 2008 (Japan) [32]

N = 68.

63% female.

Mean age 69 years, range 65–74.

RCT.

Square stepping exercise, included forward, backward, lateral, and oblique stepping patterns on a thin felt mat, added challenge after familiarity by walking on toes; and increased complexity of step pattern.

Supervised outdoor walking program - 40 min, 1 x/week × 12 weeks, emphasis on increasing steps.

70 min, 2 x/week × 12 weeks.

Adherence: Square stepping exercise – 91% of sessions, outdoor walking – 84% of sessions.

Falls data followed up for 8 months.

x

• F – RaR = 0.70 [0.23, 2.13]

• FR – RR = 0.64 [0.21, 1.95]

Significant improvement in the Square stepping exercise group on leg extension power, forward/backward tandem walking, stepping with both feet, simple/choice

reaction time, and perceived health status.

Bal ✓

Dose x

Iwamoto et al., 2009 (Japan) Ø [28]

N = 68.

Attending orthopaedic clinics.

90% female.

Age > 50 (mean age = 76.4 years).

RCT.

Calisthenics, balance, power and walking exercises (home based, but 3 x/week supervision in clinic).

Usual care.

Daily exercise, with supervision in clinic 3 x/week × 30 min. Duration of exercise 5 months.

Exercise adherence reported as 100%.

x

• FR – RR = 0.11 [0.01, 1.52]^#

Study reports significant reduction in falls, but effect not significant in Cochrane review.

Significant improvement in flexibility, balance, mobility and gait measures in the exercise group relative to the control group.

Bal ✓

Dose x

Kamide et al., 2009 (Japan) Ø [29]

N = 57.

100% female.

Attending employment agency (for light work or volunteer activity).

Age > 65 (mean age = 71 years).

RCT.

1 × 1 h education session (focus on osteoporosis fracture prevention and exercise) and 1 h training for home exercise; then home based exercise program (flexibility, balance, strength and impact exercises).

Usual care. Therapist contact by phone or mail each 3 months.

3 days/week × 6 months.

No home visits by therapist re exercise program, but contact by phone or mail monthly to support motivation.

Exercise adherence - 82% of exercise participants completed the study. Of these, 91% performed exercises at least twice weekly.

Follow-up over 12 months.

x

• FR – RR = 0.38 [0.02, 7.91]

Significant improvement in Timed Up and Go in exercise group relative to the control group.

Bal ✓

Dose ✓

Yamada et al., 2010 (Japan) Ø [33]

N = 60.

% female not stated.

Age > 65 (mean age approx 80 years).

RCT.

Exercise class + multi-component trail walking program. Variability in how program was implemented to add challenge and motivation.

Exercise class + simple indoor walking program.

Exercise class 1 x/week × 16 weeks (60 min, included aerobic, strength, balance and flexibility exercises).

Trail walking involved walking to set flags in order, changing direction, focus on speed. 30 min/session.

Indoor walking program was 30 min/session.

Adherence – median for both group 100%

x

• F – RaR = 0.45 [0.14, 1.49]

• FR – RR = 0.45 [0.18, 1.13]

Study reported reduced falls at 6 months, not sustained at 12 months. Cochrane review utilized 12 months falls data.

Significant improvement in Timed Up and Go, walking task, and dual task gait tasks for Trail walking group relative to indoor walking group.

Trail walking program

Bal ✓

Dose x

NB – both groups received multimodal exercise class.

Huang et al., 2010 (Taiwan) Ø [34]

N = 261 randomized, N = 163 follow-up.

48% female after loss to follow-up.

Age > 65 (mean age = 71 years).

Cluster RCT (by village).

5 month intervention and 12 month post intervention follow-up.

(1) Education (falls risk factors, and reducing falls risk)

(2) Tai Chi

(3) Combined education + Tai Chi as above.

Not described.

(1) 5 × 1 h group sessions across 5 months.

(2) 40 min sessions, 3 x/week × 5 months.

(3) Combined education and Tai Chi program.

18 month follow-up for falls data.

High drop-out rates over 5 month intervention period – education (52%), Tai Chi (52%), Education + Tai Chi (34%), control (6%).

(2) x

• FR – RR = 0.51 [0.02, 12.49]

Cochrane review used raw data at 5 months only, as 18 month raw data not provided. Cochrane review reports all interventions as non-significant (although combined education and Tai Chi reported as effective in reducing falls at 5 months, and all three interventions as effective in reducing falls at 18 months in the paper).

Secondary measures only compared pre –post (within group).

(2) Tai Chi

Bal ✓

Dose x

Yamada et al. 2012 (Japan) Ø [43]

N = 157.

87.8% female.

Age ≥ 75 years (mean age 85.5 years).

All participants (intervention and control groups) received 45 min of group training sessions 1 x weekly (strength, balance, cardiovascular, flexibility exercises).

In addition, the intervention group undertook a complex obstacle course negotiation program each session (finding marker to walk to, direction changes, avoiding obstacles).

Same main exercise class as intervention group, but undertook an additional simple obstacle course negotiation program (6 trials / session of 15 m walkway with obstacles interspersed along walkway).

24 weeks, once weekly sessions. Two trials of finding 15 markers/session in addition to common exercise program once weekly, 45 min duration).

Median adherence in both groups – 96%.

No significant difference between groups on balance and mobility measures after intervention (except for a complex obstacle negotiation task, with the Intervention group achieving significantly greater improvement than the Control group).

✓

Fallers – 2 in intervention group (2.8%), and 19

(26.0%) in the control (simple obstacle course group).

IRR for falls in the control group relative to intervention group was 9.37 (2.26–

38.77).

IRR for fall-related fractures in the control group relative to intervention group was 7.89 (1.01–61.49).

Bal ✓

Dose x (comparing difference in exercise time between two groups)

Yamada et al., 2013 (Japan) Ø [44]

N = 264.

57.3% female.

Age ≥ 65 years (mean age 76.7 years).

All participants (Intervention and Control groups) received 30 min of group training session (2 x weekly × 30 min, aerobic, strength, balance and flexibility exercises). In addition, the Intervention group undertook a Multi-task Stepping activity each session, that involved varied stepping pattern along a walkway, at comfortable speed.

Same main exercise class as intervention group, but undertook an additional

Twice weekly for 24 weeks.

Total time

spent walking on the mat during the Multi-task Stepping Intervention was 1 to 2 min/task, repeated 4 times/session (total additional time of Multi-task Stepping/session was 5 to 7 min).

Intervention group achieved significant improvement relative to Control group in walk time and Timed Up and Go.

✓

Fallers: 13 Intervention participants (11.6%) and 39 (33.0%) in the Control group fell during the 12-month follow-up period.

IRR for falls in the Intervention group relative to the Control group was 0.35 (0.19–0.66).

Fall-related fractures: 3 participants in the Intervention group had fall related fractures compared to 13 participants in the Control group

RR for fall-related fractures

in the Intervention group relative to the Control group was 0.22

(0.06–0.80).

Bal ✓

Dose x

Ohtake et al. 2013 (Japan) [45]

N = 196.

83.5% female.

Age > 65 years (mean age = 83.6 years).

Both intervention and control group received a health education program on falls prevention.

Intervention group also undertook a group based exercise program (strength, balance and flexibility).

Health education program on falls prevention (same program also delivered to intervention group)

8 week exercise program once weekly (20–30 min), together with 1–2 x weekly home exercise program

8.9% of the exercise group dropped out after baseline assessment. 97% participation rate in the group exercise sessions, participants also did on average 3.8 days/week of home exercise.

x

Small number of fallers in each group – Intervention group n = 7 (7.6%); and in the control group n = 9 (12.1%) (p = 0.323).

Significant improvement in Functional Reach and falls efficacy in the intervention group relative to control group.

Bal ✓

Dose x

Kim et al., 2014 (Japan) Ø [46]

N = 105.

100% female.

Age > 70 years (mean age = 77.8 years).

Participants had one or more falls in the past year.

Group based strength and balance exercise program.

3 month health education sessions (60 mins each month).

3 month group program twice weekly × 60 min, then 4–12 months 1 x monthly group exercise program supplemented with home exercise ≥3 times weekly.

✓

At 12 months:

Falls – I 19.6%, C 40.4%, (OR 2.78, 1.17–6.96);

Repeated falls - I 20%, C 33.3%, (OR 1.85, 0.33–7.38);

Injurious falls – I 80%, C 62%, (OR 0.82, 0.22–3.05).

The exercise group significantly improved in one leg standing time, knee extension strength and ankle dorsiflexion strength over the 12 months, compared to the education and excluded group who showed no significant improvements.

Bal ✓

Dose ✓

Hirase et al., 2015 (Japan) Ø [47]

N = 93 older adults using community day centers.

69.9% female.

Age > 65 years (mean age 82.1 years)

Group based programs:

(1) Foam rubber balance exercises

(2) Stable surface exercises.

Both interventions were supplemented with a daily home exercise program (2–3 exercises).

Continued activities at the day centres, but did not perform balance or strengthening exercises.

4 months program, Once weekly 60 min exercise class supplemented with home exercise program (for both intervention groups).

7.5% of participants withdrew from the study.

High adherence to the exercise programs: 95.5%, 93.3% of all possible

classes in the foam rubber and stable surface groups.

x

Mean number (SD) of falls for the foam rubber, stable surface, and control

groups was 0.24 (0.51), 0.59 (1.94), and 0.90 (1.45) (p = 0.07).

Significant improvement for both exercise groups compared to the control group for balance and sit to stand measures. Significant improvement for foam exercise group compared to firm surface exercise group for some balance tests at 2, 3 and 4 months.

Bal ✓

Dose ✓

Ashari et al., 2016 (Malaysia) [52]

N = 68.

57.4% female.

Age > 50 (mean age = 63.7 years)

Inclusion criteria of impaired turning performance (Neurocom Force Platform)

Individualised home based exercise program, based on Otago Exercise Program.

6–8 balance and strengthening exercises (including 2 turning exercises).

Maintain usual activities

16 week program, 20–30 min/day, ≥4 times/week, and walking program ≥3 times / week.

91% I group completed 16 week program

x

Fallers in 16 week program – I 5.8%, C 8.8% (underpowered, no significance testing).

I significantly improved relative to C on turning measures, Timed Up and Go (single and dual task) and static stance sway.

Bal ✓

Dose ✓

Hwang et al., 2016 (Taiwan) Ø [49]

N = 456.

67% female.

Age ≥ 60 years (mean age = 72.4 years).

Participants had one or more Emergency Dept presentation due to a fall 6 or more months prior to study.

Compared two 24 week home-based exercise interventions:

(1) Yang style Tai Chi

(2) Lower Extremity Training (LET - balance, strength and flexibility exercises, individualised)

Both groups had one supervised session/week and were encouraged to self practice daily at home. After 6 months (when supervised exercise ceased) participants asked to continue self practice daily.

No control group

(1) Tai Chi - 60 min supervised session (10-min warm-up followed by a review of previous movements, introduction of new movements, and 5 min of relaxation)

(2) Lower Extremity Training - 60 min physio supervised session (10-min warm-up, 45 min of exercise, and a 5-min cool-down).

Results reported for 6 month intervention period, and subsequent 12 months.

Adherence: 78% of Tai Chi participants and 72% of the LET group participated in ≥20 of the 24 (83%) sessions.

During the 6-month intervention, 50% of the Tai Chi participants and 67% of the LET group independently practiced the exercise program

≥7 times per week.

✓

At 6 months-falls:

F: IR (Tai Chi/LET) 0.30 (0.15–0.60)

FR: RR (Tai Chi/LET) 0.76 (0.66–0.87).

At 6 months - Injurious falls:

F: IR (Tai Chi/LET) 0.33 (0.16–0.68)

FR: RR (Tai Chi/LET) 0.86 (0.77–0.96).

At 18 months: falls and injurious falls remained significantly reduced for the Tai Chi group compared to the LET group.

For the Tai Chi group, handgrip strength, Tinetti balance and gait, depression, and cognition scores improved significantly during the 6-month intervention. For the Lower Extremity Training group, handgrip strength,

Tinetti balance and gait, fear of falling, depression, and cognition scores improved significantly during the 6-month intervention.

Bal ✓

Dose ✓

Sato et al., 2005 (Japan) [30]

N = 200.

100% female.

Age > 70 years (mean age = 78 years).

Ambulatory women recruited from an out-patient department with probable Alzheimer’s disease.

RCT.

45 mg menatetrenone (vitamin K2), 1000 IU ergocalciferol (vitamin D2), and 600 mg calcium.

Usual care.

Daily medication for 2 years.

Significant reduction in fractures.

✓

• FR – RR = 0.13 [0.04, 0.43]

Huang et al., 2011 (Taiwan) Ø [37]

N = 186.

59% female

Age ≥ 60 years.

RCT.

(1) Cognitive behavior therapy group, intervention based on previous program, [69] but added newly developed fear of falling management model developed by first author.

(2) Cognitive behavior therapy group + Tai Chi

Usual care.

(1) 60–90 min weekly × 8 weeks

(2) CBT as above + Tai Chi 60 min 5 x/week × 8 weeks.

Outcomes assessed at 2 and 5 months.

NOTE: Tai Chi group total exercise dosage 40 h.

x

• F – RaR = 1.00 [0.37, 2.72]

• FR – RR = 1.00 [0.40, 2.51]

Lin et al., 2007 (Taiwan, rural/agricultural area) [38]

See above.

(1) Home exercise with physio (individualized flexibility, strength & balance exercises) (see above for outcomes)

(2) Home Safety Assessment and Modification by public health worker.

See above.

For the Home Assessment and Modification intervention, 14 inexpensive modifications (of a list of 28 options) were implemented within the first week of the intervention. Other recommended modifications were recommended to the family by the assessor (a public health worker).

No data provided on adherence to home modifications provided, nor for uptake of the additional recommended home modifications.

(2) ✓(Home modification)^##

• F – RaR = 0.46 [0.22, 0.95]

No significant differences for the Home Assessment and Modification group on the WHOQOL-BREF domains relative to the Education group.

Kamei et al., 2015 (Japan) Ø [48]

N = 130.

84.6% female.

Age > 65 years (mean age 75.8 years).

Both groups undertook the same 4 x weekly falls prevention multifactorial

Program (120 min each) covering physical and mental assessment interview; (ii) blood pressure check; (iii) education regarding fall risk factors, food and nutrition,

foot self-care; and (iv) exercise sessions focussed on strength, coordination and balance. Intervention group also received a home hazard checklist, a training program on home hazard awareness and modification

4 weekly multifactorial program as described for intervention group.

4 weeks intervention, 120 min/session.

16.4% of the intervention group did not attend sessions regularly and withdrew from the study.

Intervention group significantly improved falls prevention awareness and home modifications.

x

10.9% reduction in all falls in intervention group compared to control group.

Time to first fall: HR = 0.591 (0.305–1.147), p = 0.116.

Indoor falls – reduced by 11.7% in Intervention group relative to control group HR = 0.397 (0.151–1.045), p = 0.052.

Huang et al., 2010 (Taiwan) Ø [34]

See above.

Education intervention included separate sessions on medications, nutrition, safe home environment, and footwear. It included a component of each session for revision.

x

• FR – RR = 1.62 [0.11, 24.16]

The Education group achieved improved score post relative to pre intervention on indoor environment score, fear of falling, and Timed Up and Go. Significance of differences in change between groups with the intervention relative to control was not provided.

Leung et al., 2014 (China) Ø [51] NOTE: Some vibration studies incorporate exercise during vibration – this intervention involved participants standing with knees straight – no exercise

N = 710.

100% female (post-menopausal).

Aged >60 years (mean age 72.9 years).

Cluster RCT.

Participants recruited through community centres for older people.

Low magnitude high frequency vibration – standing upright without knee bending on a purpose built vibration platform that provided vertical synchronous vibration at 35 Hz, 0.3 g.

Habitual lifestyle, participated in normal interest group activities run by the community centres.

18 months, 5 x/week × 20 min standing on vibration platform.

29.7% of vibration group were lost to follow-up at 18 months (most of these declined to continue participation).

No serious adverse events, though nine vibration participants and seven control participants complained of leg pain; and five vibration and one control participant complained of dizziness.

✓

Fall or fracture incidence:

I – 18.6%

C – 28.7%.

Adjusted Incident Rate Ratio for falls or fractures: 0.54, 95%CI 0.37–0.78, p = 0.001.

Significant improvement for vibration group on secondary measures including leg muscle strength and balance.

Assantachai et al., 2002 (Thailand) Ø [41]

N = 1043.

64% female.

Age > 60 (mean age = 68).

Cluster RCT (by community).

Received information leaflet describing risk factors for falls and strategies to reduce risk. Risk factors covered included nutritional advice (including calcium intake), activities of daily living, hypertension, special sense function and high risk medications.

Also offered free access to geriatric clinic for any health problem patients wanted reviewed.

Usual care

No information provided regarding the proportion of the intervention group who took up the offer of free access to the geriatric clinic, what type of interventions were provided for those who accessed it, and their adherence.

✓

• FR – RR = 0.77 [0.63, 0.94]

Huang et al., 2010 (Taiwan) Ø [34]

See above (Study had three intervention groups and control – Education only, Tai Chi only and combined Tai Chi and Education).

Combined program incorporated 5 x education sessions over 5 months and a Tai Chi (13 forms) exercise program – 40 min/session, 3 x/week for 5 months.

High drop-out rates over 5 month intervention period - Education + Tai Chi group (34%).

NOTE: Tai Chi group total exercise dosage 40 h.

x

• FR – RR = 1.68 [0.16, 17.67]

Cochrane review used raw data at 5 months only, as 18 month raw data not provided. Cochrane review reports all interventions as non-significant (although combined education and Tai Chi group reported as reducing falls at 5 and 18 months in the paper).

Huang et al., 2011 (Taiwan) Ø [37]

See above (Cognitive Behavioral Therapy + Tai Chi) (also compared to Cognitive Behavior Therapy alone)

Cognitive Behavioral Therapy program based on previous program, [69] but added newly developed fear of falling management model developed by first author.

This arm of the intervention combined the cognitive behavior therapy with a Tai Chi exercise program.

Usual care.

Cognitive Behavior Therapy (CBT) and Tai Chi combined program incorporated 60–90 min weekly × 8 weeks for the CBT and 60 min 5 x / week × 8 weeks for the Tai Chi component.

Outcomes assessed at 2 and 5 months.

NOTE: Tai Chi group total exercise dosage 40 h.

x

• F – RaR = 0.38 [0.10, 1.47]

• FR – RR = 0.40 [0.11, 1.45]

The combined Cognitive Behavior Therapy + Tai Chi group achieved significantly improved falls efficacy, improved mobility, higher social support satisfaction, and quality of life than the control or cognitive behavior therapy alone groups.

Lee et al., 2013 (Taiwan) Ø [50]

N = 616.

55% female.

Age > 65 years (mean age 75.7 years).

Participants had high falls risk, with any of: (1) recurrent falls in the previous year; (2)

medical history associated with high falls risk (ie, stroke, Parkinson’s disease, head injury, fractures due to falls); and (3) fell only once in the previous year, and had gait or balance problems (poor TUG score)

All intervention participants received:

1. Strength, balance, cardiovascular and flexibility group exercise program, supplemented with home exercise program.

2. Health education sessions and brochures on falls prevention.

3. Home hazards evaluation/modification.

4. Medication review

5. Ophthalmology/other specialty consults.

Health education brochures, medication reviews and medical referrals without direct exercise interventions or structured health education sessions.

3 month multifactorial intervention

Attrition rate for 3 month intervention period: I 10.9%; C 13.5%.

x

For 12 month followup period:

F: I 128 (0.41 falls/person year), C 132 (0.44 falls/person year) (p = 0.692)

FR: HR 0.90 (0.66–1.23).

At end of 3 month intervention:

Significant improvement in intervention group relative to control group for Physiological Profile Assessment, reaction time, balance, mobility and depression (although control group improved significantly more than intervention group on knee strength and proprioception).

Ng et al., 2015 (Singapore) [53]

N = 246.

61% female.

Age > 65 years (mean age 70).

Factorial design RCT, with nutrition, exercise and cognitive training groups, and combined intervention group.

Recruited frail and pre-frail older people based Cardiovascular Health Study (frailty phenotype) criteria.

Nutrition group: nutritional supplementation with commercial formula, iron and folate, Vit B6 and B12, calcium and vitamin D supplements daily.

Exercise: Strength and balance group program (weeks 1–12) then home program weeks 13–24.

Cognitive training: Cognitive enhancing activities including verbal recall, mazes, problem solving etc.

Combination group: all of the above interventions

Standard care + placebo supplement liquid + placebo capsule and tablets (identical appearance to intervention nutrition supplements), and instructions not to replace their meals with the supplements.

6 month intervention period.

Nutrition: supplements daily.

Exercise: Weeks 1–12, twice weekly group sessions; weeks 13–24 home exercise 2 h weekly.

Cognitive training: Weeks 1–12 - 2 h/week; weeks 13–24 – fortnightly 2 h booster sessions.

Low dropout rate (8% for nutritional supplement; 10%

cognitive training; 4% for exercise; 6% for combination, and 8% for control).

x

Small numbers of fallers/group, analysis only provided across all groups (12 months, p = 0.67). Fallers/group (12 months):

Nutrition: 4 fallers (8.6%)

Exercise: 3 fallers (6.3%)

Cognitive training: 2 fallers (4.1%)

Combination: 2 fallers (4.1%)

Control: 5 fallers (10.4%)

Jitapunkul et al., 1998 (Thailand) [40]

N = 160.

65% female.

Age ≥ 70 years (mean age = 76 years).

Participants recruited from RCT.

Home visit by non-professional with a structured health questionnaire. Referral to a nurse or geriatrician if function declined or ≥1 fall in 3 months, with subsequent nurse or geriatrician home visit to assess, educate, prescribe, or make other referrals.

Usual care. Assessment at end of 3 year period.

Home visit at study commencement, then three monthly visits × 3 years.

Intervention group had significantly less rate of functional decline (Chula ADL Index and Barthel ADL Index) over the study period.

x

• FR – RR = 0.52 [0.14, 1.94]

Huang and Acton, 2004 (Taiwan) Ø [35]

N = 120.

46% female.

Age ≥ 65 years (mean age = 72 years).

RCT.

Falls prevention information brochure + individualized falls prevention information (medication and home safety focus) – brochure and verbal.

Falls prevention information brochure.

Three home visits by nurse in 4 months (a) for initial assessment), (b) to work through individualized risk factors (medication and home safety), and (c) re-assessment at 4 months.

x

• FR – RR = 0.12 [0.01, 1.76]

Improved knowledge of medications and reduced home hazards in intervention group.

Only 2 months follow-up after intervention provided.

Huang et al., 2005 (Taiwan) Ø [36]

N = 141.

69% female.

Age > 65 years (mean age = 77 years).

Hip fracture patients recruited and randomized at hospital discharge.

RCT.

Patients interviewed at discharge, 2 weeks post-discharge and 3 months post-discharge.

Enhanced discharge planning by experienced gerontological nurse, including visits on wards, home visit, and phone contacts post discharge. Included discharge and falls prevention brochure. Involved patient, family and other health care professionals. Included nurse follow-up with physicians.

Usual discharge planning (no brochures, no written discharge summaries, no home visit, no telephone contact).

Visits on wards at least every 2 days, home visit within 3–7 days of discharge, and once weekly phone calls post discharge.

Positive outcomes for the intervention group included significantly reduced hospital length of stay.

x

• FR – RR = 0.67 [0.22, 2.01]

Shyu et al., 2010 (Taiwan) Ø [39]

N = 162.

69% female.

Age ≥ 60 years (mean age = 78 years).

Patients admitted to hospital for hip arthroplasty or internal fixation.

RCT.

Excluded patients with cognitive impairment, marked functional impairment pre-operatively, or those who were terminally ill.

Three components to intervention: (1) geriatrician review; (2) rehabilitation; and (3) discharge planning service.

Usual care, described as limited interdisciplinary involvement, usually no home visit, and no in-home physiotherapy.

(1) Geriatrician/geriatric nurse review and recommendations pre-operatively, and geriatric nurse review and recommendations post-operatively.

(2) Focus on early post-operative rehabilitation, and in-home rehabilitation.

(3) Discharge planning was coordinated by a geriatric nurse, and included a pre-discharge home visit and recommendations, and follow-up phone calls.

On average, there was 1 x geriatrician visit, 5.4 geriatric nurse visits, 3.1 physical therapist visits, and 1 rehabilitation physician visit during hospitalization; and 9.9 geriatric nurse and 3.0 physical therapist home visits after return home.

Intervention group had significant improvement relative to control group on Activities of Daily Living, walking ability, reduced depression and better SF36 scores (two year follow-up).

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• FR – RR = 0.56 [0.34, 0.93]