Table 3 Description of included studies
Study | Report | Setting | Design | Multifactorial falls prevention Interventions | Implementation strategy | Actor | Action target | Outcomes | Justification |
|---|---|---|---|---|---|---|---|---|---|
Study 1 | Clemson, 2004 [27] Ballinger, 2006 [28] | Community group Home of older person Australia | Clemson • RCT Ballinger • QUAL | Screening: No Assessment: Yes • Group exercise: strength and balance • Medication • Environment: community safety, home hazards • Risk behavior • Vision • Footwear and clothing hazards • Vitamin D and calcium • Hip protectors Control group: • Two social visits from OT students • Not discussing falls or falls prevention | Stepping On Multifaceted community-based program using a small-group learning environment to improve fall self-efficacy, encourage behavioral change, and reduce falls Older person: • 2h weekly session for 7 weeks + 1 follow-up home visit by an OT (6 weeks after final session) + booster session (after 3 months) Healthcare professional: • Training | Older person: • OT Healthcare professional: • Researcher | Older person (70+) Healthcare professionals | Clemson • Effectiveness • Adherence/compliance Ballinger • Satisfaction • Experiences/perception • Attitude | Adult education principles [56] Enhancement of self-efficacy (Bandura) [57] Decision-making process (Janis and Mann) [58] |
Study 2 | Mackenzie, 2021 [29] | Medical practices Australia | QUAL | Screening: Yes Assessment: Yes • Exercise • Medication review • Orthostatic hypotension • Environment: home hazards • Incontinence • Vision • Podiatry/footwear • Cognitive decline • Falls prevention in general | Integrated solutions for sustainable falls prevention (iSOLVE) • Decision tool for GPs • Stay independent fall checklist for the older person • Fall-risk assessment • List of recommended individualized and tailored interventions • Training of GPs | Older person: • GP Healthcare professional: • Project coordinator | Older person (65+) GPs | Normalization process theory • Feasibility • Penetration • Adoption • Satisfaction • Experiences/perspective • Beliefs | Knowledge-to-action framework (KAT) [59] Behaviour change wheel [60] Normalization process theory [61] |
Study 3 | Middlebrook, 2012 [30] | Home of older person Australia | QUAL | Screening: Yes Assessment: Yes • Exercise • Medication • Orthostatic hypotension • Environment • Vitamin D • Vision | Chronic disease management plan To offer preventive and coordinated care for older persons with chronic conditions and complex care needs 5 sessions | Older person: • Australian government trough Medicare • GP, PT, OT Healthcare professional: • Government | Older person Healthcare professional | • Acceptability • Sustainability • Challenges/recommendations | No information |
Study 4 | Mora-Pinzon, 2019 [31] | Community organizations • Multipurpose facility that organizes community activities year round • Apartment complex USA | Mixed Method | Screening: No Assessment: Yes • Group exercise (strength and balance) • Medication • Environment • Risk behavior • Vision • Shoes • Bone health • How to talk to your doctor | Stepping On = Pisando fuerte Cultural linguistically — tailored multifaceted falls prevention program (Hispanic seniors) Multifaceted community-based program using a small-group learning environment to improve fall self-efficacy, encourage behavioral change, and reduce falls 8 sessions of 2,5h + booster session 3 months | Older person: • Leader (allied health professional, fitness expert, community health worker, health educator, promotor, peer leader Healthcare professionals: Researchers Organization: Researchers | Older persons (65+) Healthcare professional Organization | RE-AIM model • Effectiveness • Fidelity • Cost • Reach • Knowledge • Adherence/compliance • Maintenance | Adult education principles [56] Enhancement of self-efficacy (Bandura) [57] Decision-making process (Janis and Mann) [58] |
Study 5 | Renehan, 2019 [32] | Home of older person Australia | Mixed method | Screening: No Assessment: Yes • Exercise (based on Otago) • Medication • Environment • Vision • Footwear • Education, recommendations | Posthospital falls prevention intervention Tailored exercise program, medication review, education 20- to 30-min exercise program three to five times per week for 6 months Exercise physiologist visited at 1, 2, 4, and 8 weeks Monthly phone calls | PT, RN, pharmacist | Older person (65+) | • Adoption • Challenges and recommendations • Dose • Experiences/perspective • Adherence/compliance • Effectiveness | No information |
Study 6 | Garner, 1996 [33] Hahn, 1996 [34] Kempton, 2000 [35] Barnett, 2003 [36] Barnett, 2004 [37] | Community setting Australia | Garner, 1996 Descriptive Hahn, 1996 Non-RCT Kempton, 2000 Non-RCT Barnett, 2003 Descriptive Barnett, 2004 Mixed method | Screening: No Assessment: Yes • Group exercise class: insufficient physical activity, poor balance and gait • Medication • Environment: domestic and public environment • Vision • Shoes • Chronic Illness | Stay On Your Feet (SOYF) • Awareness raising and information dissemination • Community education • Policy development • Home safety • Support for GP and health workers | Research group, older persons, local community health teams, community health education groups, community organizations, councils, access committees | Older person(60+) Healthcare professional Organization Community Policy/society | Garner • Penetration • Reach • Challenges and recommendations Hahn • Reach • Effectiveness • Knowledge • Awareness • Attitude Kempton • Reach • Beliefs • Adherence/compliance • Effectiveness • Knowledge • Attitude • Awareness Barnett, 2003 • Penetration • Sustainability • Reach Barnett, 2004 • Sustainability | Goals of the Ottawa Charter for Health promotion (WHO) provided the framework for strategy development [62] |
Study 7 | Milisen, 2006 [38] | Home of older person Belgium | Mixed method | Screening: Yes Assessment: Yes • Exercise (gait, mobility, balance) • Medication • Orthostatic hypotension • Environment • Risk behavior • Incontinence • Vitamin D • Vision • Podiatry/shoes • Cognitive decline Recommendations and referrals Persons not at risk: Falls prevention in general (leaflet) | Nurse-led multifactorial falls prevention intervention (tailored recommendations) Follow-up 1 month after first visit | Two research nurses | Older person(70+) | • Feasibility • Adoption • Adherence/compliance • timeliness • Experiences/perspective • Reach | No information |
Study 8 | Mackenzie, 2020 [39] | Home of older person Australia | Mixed method | Screening: yes Assessment: Yes • Exercise (Otago) • Medication • Environment (also community) | Chronic Disease Management Plan To offer preventive and coordinated care for older people with chronic conditions and complex care needs 6 weeks | Older person: • Australian government trough Medicare • GP, PT, OT Healthcare professional: • Government | Older person(75+) Healthcare professional | • Fidelity • Acceptability • Sustainability • Cost • Effectiveness • Timeliness • Recommendations/challenges • Equity • Experiences/perspective • Adherence/compliance • Beliefs | No information |
Study 9 | Fortinsky, 2008 [17] | Home Health Agencies USA | Descriptive | Screening: Unclear Assessment: Yes • Exercise (mobility and balance) • Medication • Orthostatic hypotension • Environment Conform Yale Frailty and Injuries: Co-operative Studies of Intervention Techniques (FICSIT) trial | Support for implementation & education of healthcare professionals • Implementation team • Training • Supportive material • Champion All 26 HHAs were trained (90min) | Older person: • Home health agencies Healthcare professionals + organization: • Research team, CCFP | Older person(65+) Healthcare professional Organization | • Penetration • Reach | Trans-theoretical model [63] Innovation dissemination theory [64] Behaviour-change strategies |
Study 10 | Gholamzadeh, 2021 [40] | Health Centers Iran | RCT | Screening: No Assessment: Yes • Group exercise: strength and balance • Medication • Environment: community safety, home hazards • Risk behavior • Vision • Footwear and clothing hazards • Vitamin D and calcium Control group: Stepping On program educative materials in the form of DVDs at the end of the study. They also received a booklet. | Stepping On Multifaceted community-based program using a small-group learning environment to improve fall self-efficacy, encourage behavioral change, and reduce falls Older person: 7 training sessions of 30-60 minutes (2 days a week) | Older person: • Unknown | Older person(65+) | • Effectiveness | Adult education principles [56] Enhancement of self-efficacy (Bandura) [57] Decision-making process (Janis and Mann) [58] |
Study 11 | Mahoney, 2016 [41] | Senior apartment buildings Home of older person USA | QUAL | Screening: No Assessment: Yes • Group exercise: strength and balance • Medication • Environment: community safety, home hazards • Risk behavior • Vision • Footwear and clothing hazards • Vitamin D and calcium • Hip protectors Info from Clemson, 2004 | Stepping On Multifaceted community-based program using a small-group learning environment to improve fall self-efficacy, encourage behavioral change, and reduce falls Older person • 2 h weekly session for 7 weeks + 1 follow-up home visit by an occupational therapist (6 weeks after final session) + booster session (after 3 months) Healthcare professional • Training • Training and program manual | Older person: • RN Healthcare professional: Researcher | Older person (65+) Health care professional | Root cause analysis (RCA) • Fidelity • Adherence/compliance • Belief • Challenges/recommendations | Adult education principles [56] Enhancement of self-efficacy (Bandura) [57] Decision-making process (Janis and Mann) [58] |
Study 12 | Elley, 2008 [42] | Home of older person • New Zealand | RCT | Screening: Yes Assessment: Yes • Exercise (Otago) • Medication • Orthostatic hypotension • Environment • Incontinence • Vitamin D and calcium • Vision • Footwear • Cognitive decline • Cardiovascular • Musculoskeletal examination | Nurse-led multifactorial falls prevention intervention Older persons: Tailored recommendations Healthcare professionals: Training Control group: social visit + pamphlet | Older person(75+): RN, PT, OT, GP Healthcare professional: RN,researchers | Older person(75+) Healthcare professional | • Penetration • Reach • Effectiveness • Adherence/compliance | No information |
Study 13 | Kramer, 2011 [43] | Community and senior centers • USA | QUAL | Screening: No Assessment: Yes • Group exercise • Medication • Environment • Cognitive decline | InSTEP A set of three model pilot projects at varying levels of intensity — two each at “high,” “medium,” and “low” Older person: Each model program enrolled small classes for a 12-week program of (a) progressive physical activity classes to improve strength, balance, and gait, (b) home safety evaluation and recommendations for modification, and (c) medical risk assessment and recommendations to discuss any identified risks with a healthcare professional Healthcare professional: • Support implementation • Training Organization: • Training • Support implementation • Collaborations | Older person: Exercise instructor, OT, volunteers, senior center staff, physician, social worker Healthcare professional: Fall Prevention Center of Excellence Organization: Fall Prevention Center of Excellence | Older person Healthcare professional Organization | • Feasibility • Penetration • Awareness • Knowledge • Acceptability • Sustainability • Adoption • Cost • Dose • Challenges/recommendations | Theoretical model based on the extended parallel process model [65] |
Study 14 | Zimmerman, 2017 [44] | Assisted living communities USA | Mixed method | Screening: Yes Assessment: Yes • Exercise • Medication • Environment • footwear | Assisted Living Falls Prevention and Monitoring Program • Tailored implementation • Support for implementation Control group:In service education session | Researchers | Healthcare professional Organization | • Fidelity • Penetration • Reach • Challenges/recommendations • Effectiveness | No information |
Study 15 | Schlotthauer, 2017 [45] | Home of older person Independent Living Retirement Community (ILRC) Parks and Recreation Center Parish Nurse Program USA | Mixed method | Screening: No Assessment: Yes • Group exercise: strength and balance • Medication • Environment: community safety, home hazards • Risk behavior • Vision • Footwear and clothing hazards • Vitamin D and calcium • Hip protectors Info from Clemson, 2004 | Stepping On Multifaceted community-based program using a small-group learning environment to improve fall self-efficacy, encourage behavioral change, and reduce falls • Independent Living Retirement Community: leader health background versus nonhealth background • Parks and Recreation Center: home visits versus phone calls (follow-up) • Parish Nurse Program: home visits versus phone calls (follow-up) | Older person: Healthcare professional and non healthcare professional Healthcare professional: Researchers | Older person Healthcare professional | • Feasibility • Fidelity • Penetration • Sustainability • Acceptability • Reach • Challenges/recommendations • Experiences/perspectives | Adult education principles [56] Enhancement of self-efficacy (Bandura) [57] Decision-making process (Janis and Mann) [58] |
Study 16 | Baker, 2007 [46] | Senior center USA | QUAL | Screening: Yes Assessment: Yes • Exercise • Medication • Orthostatic hypotension • Environment • Vision Based on the Yale Frailty and Injury Cooperative Studies of Intervention Trials (known as the Yale FICSIT) | Step by step Support for implementation & education of healthcare professionals • Implementation team • Training • Supportive material • Champion | Older person: Senior center staff Healthcare professional: Investigators who had conducted Yale FICSIT (CCFP) Organization: Research team: CCFP investigators | Older person Healthcare professional Organization | • Penetration • Sustainability • Reach • Challenges and recommendations | Trans-theoretical model [63] PDSA cycle[66] |
Study 17 | Kittipimpanon, 2012 [47] | Community Home of older person Thailand | Mixed method (action research) | Screening: No Assessment: Yes • Group exercise • Medication • Orthostatic hypotension • Environment • Risk behavior • Vision check • Education | Community-based falls prevention program Community development approach • Falls prevention campaign • Fall management system (surveillance fall notification center and environmental hazards management) • Multifactorial risk assessment • Exercise • Home visits | Public health center, public health nurse, identified leaders of the falls prevention teams, zone team leader, the crown property bureau provided support, researchers | Older person (60+) Organization Community | • Sustainability • Satisfaction • Adherence/compliance • Effectiveness | Appreciation-Influence-Control Technique [67] PRECEDE–PROCEED model Community participation [68] |
Study 18 | Tiedemann, 2021 [48] | Local health districts New South Wales Australia | Non-RCT | Screening: No Assessment: Yes • Group exercise: strength and balance • Medication • Environment: community safety, home hazards • Risk behavior • Vision • Footwear and clothing hazards • Vitamin D and calcium • Hip protectors Info from Clemson, 2004 | Stepping On Multifaceted community-based program using a small-group learning environment to improve fall self-efficacy, encourage behavioral change, and reduce falls Older person • 2h weekly session for 7 weeks + booster session (after 3 months) Healthcare professional • Training | Older person: • OT Healthcare professional: • Stepping On trainer | Older person (65+) Healthcare professional | • Challenges/recommendations • Effectiveness • Satisfaction • Experiences • Motivation • Adherence/compliance • Beliefs | Adult education principles [56] Enhancement of self-efficacy (Bandura) [57] Decision-making process (Janis and Mann) [58] |