Older people’s participation and engagement in falls prevention interventions: Comparing rates and settings.

Abstract

Objective: Falls among older people remain a major public health issue. The purpose of this article was to facilitate accurate interpretation of the existing evidence-base and facilitate robust planning of future fall prevention randomised controlled trials (RCTs). Method: Two systematic reviews were further developed that evaluated older people’s participation and engagement in RCTs to prevent falls in both community and institutional settings. It is argued that there is a need to differentiate between: 1) Acceptance rates versus recruitment rates, i.e. respectively the proportion of older people willing to participate in the RCTs versus those willing and included; 2) Rates of recruitment and participation in institutional settings distinguishing between nursing care facilities versus hospitals. Results: For community settings (n = 78), the median rates were 41.3% (22.0 - 63.5%) for recruitment and 70.7% (64.2 - 81.7%) for acceptance. For institutional settings (n = 25), the median rates were 48.5% (38.9 - 84.5%) for recruitment and 88.7% (81.2 - 95.4%) for acceptance. In comparing trials from nursing care facilities and hospitals, recruitment and acceptance rates were remarkably similar, though the remaining data - attrition, adherence, and whether adherence acted as a moderator on the effectiveness of the intervention on trial outcomes - was only available from trials from nursing care facilities. Conclusion: Researchers are encouraged to be more inclusive in trials and to conduct more RCTs in hospitals to prevent falls. A consensus on how to define successful engagement with trials and uptake and adherence to trial interventions remains desired.