World guidelines for falls prevention and management for older adults: a global initiative

Manuel Montero-Odasso; Nathalie van der Velde; Finbarr C Martin; Mirko Petrovic; Maw Pin Tan; Jesper Ryg; Sara Aguilar-Navarro; Neil B Alexander; Clemens Becker; Hubert Blain; Robbie Bourke; Ian D Cameron; Richard Camicioli; Lindy Clemson; Jacqueline Close; Kim Delbaere; Leilei Duan; Gustavo Duque; Suzanne M Dyer; Ellen Freiberger; David A Ganz; Fernando Gómez; Jeffrey M Hausdorff; David B Hogan; Susan M W Hunter; Jose R Jauregui; Nellie Kamkar; Rose-Anne Kenny; Sarah E Lamb; Nancy K Latham; Lewis A Lipsitz; Teresa Liu-Ambrose; Pip Logan; Stephen R Lord; Louise Mallet; David Marsh; Koen Milisen; Rogelio Moctezuma-Gallegos; Meg E Morris; Alice Nieuwboer; Monica R Perracini; Frederico Pieruccini-Faria; Alison Pighills; Catherine Said; Ervin Sejdic; Catherine Sherrington; Dawn A Skelton; Sabestina Dsouza; Mark Speechley; Susan Stark; Chris Todd; Bruce R Troen; Tischa van der Cammen; Joe Verghese; Ellen Vlaeyen; Jennifer A Watt; Tahir Masud; Task Force on Global Guidelines for Falls in Older Adults

doi:10.1093/ageing/afac205

World guidelines for falls prevention and management for older adults: a global initiative

Age Ageing. 2022 Sep 2;51(9):afac205. doi: 10.1093/ageing/afac205.

Authors

Manuel Montero-Odasso^{1

2

3}, Nathalie van der Velde^{4

5}, Finbarr C Martin⁶, Mirko Petrovic⁷, Maw Pin Tan^{8

9}, Jesper Ryg^{10

11}, Sara Aguilar-Navarro¹², Neil B Alexander¹³, Clemens Becker¹⁴, Hubert Blain¹⁵, Robbie Bourke¹⁶, Ian D Cameron¹⁷, Richard Camicioli¹⁸, Lindy Clemson¹⁹, Jacqueline Close^{20

21}, Kim Delbaere²², Leilei Duan²³, Gustavo Duque²⁴, Suzanne M Dyer²⁵, Ellen Freiberger²⁶, David A Ganz²⁷, Fernando Gómez²⁸, Jeffrey M Hausdorff^{29

30

31}, David B Hogan³², Susan M W Hunter³³, Jose R Jauregui³⁴, Nellie Kamkar¹, Rose-Anne Kenny¹⁶, Sarah E Lamb³⁵, Nancy K Latham³⁶, Lewis A Lipsitz³⁷, Teresa Liu-Ambrose³⁸, Pip Logan³⁹, Stephen R Lord^{40

41}, Louise Mallet⁴², David Marsh⁴³, Koen Milisen^{44

45}, Rogelio Moctezuma-Gallegos^{46

47}, Meg E Morris⁴⁸, Alice Nieuwboer⁴⁹, Monica R Perracini⁵⁰, Frederico Pieruccini-Faria^{1

2}, Alison Pighills⁵¹, Catherine Said^{52

53

54}, Ervin Sejdic⁵⁵, Catherine Sherrington⁵⁶, Dawn A Skelton⁵⁷, Sabestina Dsouza⁵⁸, Mark Speechley^{3

59}, Susan Stark⁶⁰, Chris Todd^{61

62}, Bruce R Troen⁶³, Tischa van der Cammen^{64

65}, Joe Verghese^{66

67}, Ellen Vlaeyen^{44

68}, Jennifer A Watt^{69

70}, Tahir Masud⁷¹; Task Force on Global Guidelines for Falls in Older Adults

Collaborators

Task Force on Global Guidelines for Falls in Older Adults:
Devinder Kaur Ajit Singh, Sara G Aguilar-Navarro, Edgar Aguilera Caona, Neil B Alexander, Natalie Allen, Cedric Anweiller, Alberto Avila-Funes, Renato Barbosa Santos, Francis Batchelor, Clemens Becker, Marla Beauchamp, Canan Birimoglu, Hubert Blain, Kayla Bohlke, Robert Bourke, Christina Alonzo Bouzòn, Stephanie Bridenbaugh, Patricio Gabriel Buendia, Ian Cameron, Richard Camicioli, Colleen Canning, Carlos Alberto Cano-Gutierrez, Juan Carlos Carbajal, Daniela Cristina Carvalho de Abreu, Alvaro Casas-Herrero, Alejandro Ceriani, Matteo Cesari, Lorenzo Chiari, Lindy Clemson, Jacqueline Close, Luis Manuel Cornejo Alemǻn, Rik Dawson, Kim Delbaere, Paul Doody, Sabestina Dsouza, Leilei Duan, Gustavo Duque, Suzanne Dyer, Toby Ellmers, Nicola Fairhall, Luigi Ferruci, Ellen Freiberger, James Frith, Homero Gac Espinola, David A Ganz, Fabiana Giber, José Fernando Gómez, Luis Miguel Gutiérrez-Robledo, Sirpa Hartikainen, Jeffrey Hausdorff, David B Hogan, Chek Hooi Wong, Simon Howe, Susan Hunter, Javier Perez Jara, Ricardo Jauregui, Anton Jellema, Suen Jenni, Ditte Jepson, Sebastiana Kalula, Nellie Kamkar, Devinder Kaur Ajit Singh, Rose Anne Kenny, Ngaire Kerse, Olive Kobusingye, Reto Kressig, Wing Kwok, Sallie Lamb, Nancy Latham, Mei Ling Lim, Lewis Lipsitz, Teresa Liu-Ambrose, Pip Logan, Stephen Lord, Roberto Alves Lourenço, Kenneth Madden, Louise Mallet, Pedro Marín-Larraín, David R Marsh, Finbarr C Martin, Diego Martínez Padilla, Tahir Masud, Sumaiyah Mat, Lisa McGarrigle, Bill McIlroy, Felipe Melgar-Cuellar, Jasmine Menant, Koen Milisen, Alberto Mimenza, Rogelio Moctezuma-Gallegos, Manuel Montero-Odasso, Meg E Morris, Irfan Muneeb, Hossein Negahban, Alice Nieuwboer, Mireille Norris, Giulia Ogliari, Juliana Oliveira, José F Parodi, Sergio Perez, Monica Perracini, Mirko Petrovic, José Ernesto Picado Ovares, Frederico Pieruccini-Faria, Alison Pighills, Marina Pinheiro, Eveline Poelgeest, Xinia Ramirez Ulate, Katie Robinson, Jesper Ryg, Cathy Said, Ryota Sakurai, Marcelo Schapira, Ervin Sejdic, Lotta J Seppala, Aldo Sgaravatti, Cathie Sherrington, Dawn Skelton, Yu Song, Mark Speechley, Susan Stark, Munira Sultana, Anisha Suri, Maw Pin Tan, Morag Taylor, Katja Thomsen, Anne Tiedemann, Susana Lucia Tito, Chris Todd, Bruce Troen, Tischa Van der Cammen, Nathalie Van der Velde, Joe Verghese, Ellen Vlaeyen, Jennifer Watt, Ana-Karim Welmer, Chang Won Won, G A Rixt Zijlstra

Affiliations

¹ Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, ON, Canada.
² Division of Geriatric Medicine, Department of Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada.
³ Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada.
⁴ Amsterdam UMC location University of Amsterdam, Internal Medicine, Section of Geriatric Medicine, Amsterdam, The Netherlands.
⁵ Amsterdam Public Health, Aging and Later Life, Amsterdam, The Netherlands.
⁶ Population Health Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.
⁷ Department of Internal Medicine and Paediatrics, Section of Geriatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
⁸ Centre for Innovation in Medical Engineering (CIME), Faculty of Engineering, University of Malaya, Kuala Lumpur 50603, Malaysia.
⁹ Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia.
¹⁰ Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark.
¹¹ Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
¹² Department of Geriatric Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
¹³ Department of Internal Medicine, Division of Geriatric and Palliative Medicine, University of Michigan; Veterans Administration Ann Arbor Healthcare System Geriatrics Research Education Clinical Center, Ann Arbor, MI, USA.
¹⁴ Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany.
¹⁵ Department of Geriatrics, Montpellier University hospital and MUSE, Montpellier, France.
¹⁶ Department of Medical Gerontology Trinity College Dublin and Mercers Institute for Successful Ageing, St James's Hospital, Dublin, Ireland.
¹⁷ John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District and Faculty of Medicine and Health, University of Sydney. Department of Medicine (Neurology) and Neuroscience and Mental Health, Sydney, NSW, Australia.
¹⁸ Department of Medicine (Neurology), Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada.
¹⁹ Sydney School of Health Sciences, Faculty of Medicine & Health, The University of Sydney, Sydney, Australia.
²⁰ Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, NSW, Australia.
²¹ Prince of Wales Clinical School, Medicine, University of New South Wales, Sydney, NSW, Australia.
²² Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW, Australia; School of Population Health, University of New South Wales, Kensington, NSW, Australia.
²³ National Centre for Chronic and Noncommunicable Disease Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China.
²⁴ Research Institute of the McGill University HealthCentre, Montreal, Quebec, Canada.
²⁵ Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia.
²⁶ Friedrich-Alexander-University Erlangen-Nürnberg, Institute for Biomedicine of Aging, Nürnberg, Germany.
²⁷ Multicampus Program in Geriatric Medicine and Gerontology, David Geffen School of Medicine at UCLA and Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
²⁸ Research Group on Geriatrics and Gerontology, International Association of Gerontology and Geriatrics Collaborative Center, University Caldas, Manizales, Colombia.
²⁹ Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
³⁰ Department of Physical Therapy, Sackler Faculty of Medicine, and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.
³¹ Department of Orthopaedic Surgery, Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA.
³² Brenda Strafford Centre on Aging, O'BrienInstitute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
³³ School of Physical Therapy, Faculty of Health Sciences, Elborn College, University of Western Ontario, London, ON, Canada.
³⁴ Ageing Biology Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
³⁵ Faculty of Health and Life Sciences, Mireille Gillings Professor of Health Innovation, Medical School Building, Exeter, England, UK.
³⁶ Brigham and Women's Hospital, Boston, MA, USA.
³⁷ Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
³⁸ Djavad Mowafaghian Centre for Brain Health, Center for Hip Health and Mobility, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada.
³⁹ School of Medicine, University of Nottingham, Nottingham, England, UK.
⁴⁰ Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW, Australia.
⁴¹ School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia.
⁴² Department of Pharmacy, Faculty of Pharmacy, McGill University Health Center, Université de Montréal, Montreal, QC, Canada.
⁴³ University College London, London, England, UK.
⁴⁴ Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium.
⁴⁵ Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium.
⁴⁶ Geriatric Medicine & Neurology Fellowship, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán". Mexico City, Mexico.
⁴⁷ Geriatric Medicine Program, Tecnologico de Monterrey, School of Medicine and Health Sciences. Monterrey, Nuevo León, Mexico.
⁴⁸ Healthscope and Academic and Research Collaborative in Health (ARCH), La Trobe University, Australia.
⁴⁹ Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), KU Leuven, Leuven, Belgium.
⁵⁰ Master's and Doctoral programs in Physical Therapy, Universidade Cidade de Sao Paulo (UNICID), Sao Paulo, Brazil.
⁵¹ Mackay Institute of Research and Innovation, Mackay Hospital and Health Service, Mackay, QLD, Australia.
⁵² Western Health, University of Melbourne, Parkville, Melbourne, VIC, Australia.
⁵³ Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, VIC, Australia.
⁵⁴ Melbourne School of Health Sciences The University of Melbourne, Parkville, Australia.
⁵⁵ Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA.
⁵⁶ Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia.
⁵⁷ School of Health and Life Sciences, Research Centre for Health (ReaCH), Glasgow Caledonian University, Cowcaddens Road, Glasgow, Scotland, UK.
⁵⁸ Department of Occupational Therapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India.
⁵⁹ Schulich Interfaculty Program in Public Health, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada.
⁶⁰ Program in Occupational Therapy, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA.
⁶¹ School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, England, UK.
⁶² Manchester University NHS Foundation Trust, Manchester M13 9WL, UK.
⁶³ Division of Geriatrics and Palliative Medicine, Department of Medicine, Jacobs School of Medicine & Biomedical Sciences, University of Buffalo; Research Service, Veterans Affairs Western New York Healthcare System, Buffalo, New York, USA.
⁶⁴ Department of Human-Centred Design, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands.
⁶⁵ Section of Geriatric Medicine, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
⁶⁶ Division of Geriatrics, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA.
⁶⁷ Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.
⁶⁸ Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.
⁶⁹ Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
⁷⁰ Department of Medicine, University of Toronto, Toronto, ON, Canada.
⁷¹ Department of Geriatric Medicine, The British Geriatrics Society, Nottingham University Hospitals NHS Trust, Nottingham, England, UK.

Abstract

Background: falls and fall-related injuries are common in older adults, have negative effects on functional independence and quality of life and are associated with increased morbidity, mortality and health related costs. Current guidelines are inconsistent, with no up-to-date, globally applicable ones present.

Objectives: to create a set of evidence- and expert consensus-based falls prevention and management recommendations applicable to older adults for use by healthcare and other professionals that consider: (i) a person-centred approach that includes the perspectives of older adults with lived experience, caregivers and other stakeholders; (ii) gaps in previous guidelines; (iii) recent developments in e-health and (iv) implementation across locations with limited access to resources such as low- and middle-income countries.

Methods: a steering committee and a worldwide multidisciplinary group of experts and stakeholders, including older adults, were assembled. Geriatrics and gerontological societies were represented. Using a modified Delphi process, recommendations from 11 topic-specific working groups (WGs), 10 ad-hoc WGs and a WG dealing with the perspectives of older adults were reviewed and refined. The final recommendations were determined by voting.

Recommendations: all older adults should be advised on falls prevention and physical activity. Opportunistic case finding for falls risk is recommended for community-dwelling older adults. Those considered at high risk should be offered a comprehensive multifactorial falls risk assessment with a view to co-design and implement personalised multidomain interventions. Other recommendations cover details of assessment and intervention components and combinations, and recommendations for specific settings and populations.

Conclusions: the core set of recommendations provided will require flexible implementation strategies that consider both local context and resources.

Keywords: aged; clinical practice; consensus; falls; global; guidelines; injury; older people; recommendations; world.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Caregivers
Humans
Independent Living*
Quality of Life*
Risk Assessment

Abstract

Publication types

MeSH terms

Grants and funding