Sourish Has picked this paper, in Worthing Emergency Medicine we all have to be collapsologists so I think this is a good choice. Here follows a short summary of paper
Multifactorial assessment and targeted intervention for preventing falls and injuries among older people in community and emergency care settings: systematic review and meta-analysis
Type of study
A meta-analysis and systematic review
Objective ;To assess effective of multifactoral assessment and intervention to prevent falls in a variety of settings.
Studies; 19 Randomised non-blinded trials undertaken in the UK and elsewhere. Mostly home based interventions but some based in Emergency departments. Interventions included supervised exercise, drug review and knowledge(not quite sure what this entailed)
Results; A small non-statistically significant difference in reduction of falls and fall related injuries.
Author's conclusion; Limited evidence this type of intervention is beneficial
Internal validity- Positives
Flow diagram of selection procedure
2 independent reviewers
Good duration of follow- up- generally 12 months plus
Clearly focused question
Interval Validity- Negatives
Inclusion of quasi-randomized trials, some questionable randomisations in the RCT.
Non-blinded interventions- increased chance of false positives
No funnel plot - nice diagram to demonstrate publication bias but less relevant in negative trial
External Validity- Positives
Mostly U.K based studies
Includes Emergency department-based interventions
Largely home based interventions (lack of applicability to ED setting)
Is a preventative treatment - less relevant to a/e
Overall, despite the slight drawbacks of the studies included- this is still the best available evidence to date and would make me hesitant about putting in place a preventive system in the Emergency department, good news for those who favor keeping the ED a treatment only area..
The good news is we will still have many patients falling over and keeping us in a job and further supports the moving of frailty treatment approaches to the front door.