Falls prevention interventions in older adults with cognitive impairment: a systematic review of reviews

Aim: This critical review explores the review material on falls prevention interventions in older adults with a cognitive impairment such as dementia. Method: A critical, systematic, review of review method was used. Five large electronic databases, MEDLINE, EMBASE, AMED, CINAHL, and the Cochrane electronic library, were searched. The search terms ‘falls’, ‘rehabilitation’, ‘falls prevention’, ‘interventions’, ‘cognitive impairment’, ‘dementia’, and ‘Alzheimer’s disease’, were used. All available reviews were marked against predetermined inclusion and exclusion criteria. Results: There were seven reviews which met the inclusion criteria. Only one of the included reviews had a homogenous population of adults with a cognitive impairment. Exercise was the most commonly reported intervention, included in 91 studies and all seven reviews. Multifactorial and multicomponent falls prevention programmes were also frequently reported. Reports of efficacy were inconsistent for all interventions. Conclusion: Evidence for falls prevention interventions for adults with cognitive impairment is varied and inconclusive. When compared to literature for falls interventions in healthy older adults, both primary and synthesis studies in older adults with cognitive impairment are lacking in quality, number and homogeneity of sample population and interventions. Promising results are emerging but clinical recommendations cannot be made at this time