（專題）預防計畫對於老人跌倒相關傷害之成效：統合分析
作者:馬偕學校財團法人馬偕醫護管理專科學校高齡服務事業科黃素妃、大智通文化行銷股份有限公司楊婷婷、經國管理暨健康學院高齡照顧福祉系陳雪芬、康寧大學高齡社會健康管理科呂莉婷、萬能科技大學觀光與休閒事業管理系廖容瑜
卷期：63卷第2期
日期：2018年6月
頁碼：163-186
DOI：10.6209/JORIES.201806_63(2).0007
摘要：
本研究目的為評估預防計畫對老人跌倒相關傷害之成效，從Cochrane Library、Medline、PubMed、PsycARTICLES、PsycINFO、ERIC、AgeLine、CINAHL、Behavioral Sciences Collection databases等，蒐集所有相關的臨床隨機試驗研究，文獻年代範圍從1996年至2016年間，並應用探索性統合分析，計算老人跌倒預防計畫之效果量。共計33篇期刊論文納入分析（68,736人），探索性統合分析結果顯示，跌倒預防計畫對因跌倒所造成的傷害具顯著效果（OR＝0.86, 95% CI：0.75-0.97），但是對於骨折的預防效果則介於邊緣性顯著差異（OR＝0.80, 95% CI：0.63-1.03）。此外，跌倒預防計畫若是不分男女、介入內容包含健康照護專家、當參與者超過20%具跌倒經驗、社區為介入場域、包含多元介入等，本研究發現預防計畫對於預防跌倒相關傷害具有小卻顯著的效果，因此，未來規劃跌倒預防計畫時，政策制定者及臨床工作者應考量不同特性的老人，並提出合適的介入計畫。
關鍵詞：老人、統合分析、跌倒預防、意外跌倒、傷害
《詳全文》
參考文獻：
- Alexander, B. H., Rivara, F. P., & Wolf, M. E. (1992). The cost and frequency of hospitalization for fall-related injuries in older adults. American Journal of Public Health, 82(7), 1020-1023. doi: 10.2105/AJPH.82.7.1020
- Baranzini, F., Diurni, M., Ceccon, F., Poloni, N., Cazzamalli, S., Costantini, C., …Callegari, C. (2009). Fall-related injuries in a nursing home setting: Is polypharmacy a risk factor? BMC Health Services Research, 9(1), 228. doi:10.1186/1472-6963-9-228
- Barker, A. L., Morello, R. T., Wolfe, R., Brand, C. A., Haines, T. P., Hill, K. D., ...Kamar, J. (2016). 6-PACK programme to decrease fall injuries in acute hospitals: Cluster randomised controlled trial. BMJ, 352. doi:10.1136/bmj.h6781
- Barnett, A., Smith, B., Lord, S. R., Williams, M., & Baumand, A. (2003). Community‐based group exercise improves balance and reduces falls in at‐risk older people: A randomised controlled trial. Age and Ageing, 32(4), 407-414. doi:10.1093/ageing/32.4.407
- Becker, C., Kron, M., Lindemann, U., Sturm, E., Eichner, B., Walter‐Jung, B., & Nikolaus, T. (2003). Effectiveness of a multifaceted intervention on falls in nursing home residents. Journal of the American Geriatrics Society, 51(3), 306-313. doi:10.1046/j.1532-5415.2003.51103.x
» 展開更多
- Alexander, B. H., Rivara, F. P., & Wolf, M. E. (1992). The cost and frequency of hospitalization for fall-related injuries in older adults. American Journal of Public Health, 82(7), 1020-1023. doi: 10.2105/AJPH.82.7.1020
- Baranzini, F., Diurni, M., Ceccon, F., Poloni, N., Cazzamalli, S., Costantini, C., …Callegari, C. (2009). Fall-related injuries in a nursing home setting: Is polypharmacy a risk factor? BMC Health Services Research, 9(1), 228. doi:10.1186/1472-6963-9-228
- Barker, A. L., Morello, R. T., Wolfe, R., Brand, C. A., Haines, T. P., Hill, K. D., ...Kamar, J. (2016). 6-PACK programme to decrease fall injuries in acute hospitals: Cluster randomised controlled trial. BMJ, 352. doi:10.1136/bmj.h6781
- Barnett, A., Smith, B., Lord, S. R., Williams, M., & Baumand, A. (2003). Community‐based group exercise improves balance and reduces falls in at‐risk older people: A randomised controlled trial. Age and Ageing, 32(4), 407-414. doi:10.1093/ageing/32.4.407
- Becker, C., Kron, M., Lindemann, U., Sturm, E., Eichner, B., Walter‐Jung, B., & Nikolaus, T. (2003). Effectiveness of a multifaceted intervention on falls in nursing home residents. Journal of the American Geriatrics Society, 51(3), 306-313. doi:10.1046/j.1532-5415.2003.51103.x
- Borenstein, M., Hedges, L. V., Higgins, J. P. T., & Rothstein, H. R. (2009). Introduction to Meta-analysis. Chichester, UK: John Wiley & Sons. doi:10.1002/9780470743386
- Campbell, A. J., & Robertson, M. C. (2007). Rethinking individual and community fall prevention strategies: A meta-regression comparing single and multifactorial interventions. Age and Ageing, 36(6), 656-662. doi:10.1093/ageing/afm122
- Campbell, A. J., Robertson, M. C., La Grow, S. J., Kerse, N. M., Sanderson, G. F., Jacobs, R. J., ... Hale, L. A. (2005). Randomised controlled trial of prevention of falls in people aged ≥75 with severe visual impairment: The VIP trial. BMJ, 331(7520), 817. doi:10.1136/bmj.38601. 447731.55
- Chang, J. T., Morton, S. C., Rubenstein, L. Z., Mojica, W. A., Maglione, M., Suttorp, M. J., ... Shekelle, P. G. (2004). Interventions for the prevention of falls in older adults: Systematic review and meta-analysis of randomised clinical trials. BMJ, 328(7441), 680. doi:10.1136/ bmj.328.7441.680
- Clemson, L., Cumming, R. G., Kendig, H., Swann, M., Heard, R., & Taylor, K. (2004). The effectiveness of a community‐based program for reducing the incidence of falls in the elderly: A randomized trial. Journal of the American Geriatrics Society, 52(9), 1487-1494. doi:10.1111/j. 1532-5415.2004.52411.x
- Close, J., Ellis, M., Hooper, R., Glucksman, E., Jackson, S., & Swift, C. (1999). Prevention of falls in the elderly trial (PROFET): A randomised controlled trial. The Lancet, 353(9147), 93-97. doi:10.1016/S0140-6736(98)06119-4
- Coe, R. (2002, September). It’s the effect size, stupid: What effect size is and why it is important. Paper presented at the 2002 Annual Conference of the British Educational Research Association, University of Exeter, Exeter, Devon, England.
- Cumming, R. G., Sherrington, C., Lord, S. R., Simpson, J. M., Vogler, C., Cameron, I. D., & Naganathan, V. (2008). Cluster randomised trial of a targeted multifactorial intervention to prevent falls among older people in hospital. BMJ, 336(7647), 758-760. doi:10.1136/bmj.39499. 546030.BE
- Davison, J., Bond, J., Dawson, P., Steen, I. N., & Kenny, R. A. (2005). Patients with recurrent falls attending accident & emergency benefit from multifactorial intervention – A randomised controlled trial. Age and Ageing, 34(2), 162-168. doi:10.1093/ageing/afi053
- DerSimonian, R., & Laird, N. (1986). Meta-analysis in clinical trials. Controlled Clinical Trials, 7(3), 177-188. doi:10.1016/0197-2456(86)90046-2
- Dyer, C. A. E., Taylor, G. J., Reed, M., Dyer, C. A., Robertson, D. R., & Harrington, R. (2004). Falls prevention in residential care homes: A randomised controlled trial. Age and Ageing, 33(6), 596-602. doi:10.1093/ageing/afh204
- El-Khoury, F., Cassou, B., Charles, M.-A., & Dargent-Molina, P. (2013). The effect of fall prevention exercise programmes on fall induced injuries in community dwelling older adults: Systematic review and meta-analysis of randomised controlled trials. BMJ, 347. doi:10.1136/ bmj.f6234
- El-Khoury, F., Cassou, B., Latouche, A., Aegerter, P., Charles, M.-A., & Dargent-Molina, P. (2015). Effectiveness of two year balance training programme on prevention of fall induced injuries in at risk women aged 75-85 living in community: Ossébo randomised controlled trial. BMJ, 351. doi:10.1136/bmj.h3830
- Elley, C. R., Robertson, M. C., Garrett, S., Kerse, N. M., McKinlay, E., Lawton, B., ...Campbell, A. J. (2008). Effectiveness of a falls‐and‐fracture nurse coordinator to reduce falls: A randomized, controlled trial of at‐risk older adults. Journal of the American Geriatrics Society, 56(8), 1383-1389. doi:10.1111/j.1532-5415.2008.01802.x
- Fitzharris, M. P., Day, L., Lord, S. R., Gordon, I., & Fildes, B. (2010). The Whitehorse no falls trial: Effects on fall rates and injurious fall rates. Age and Ageing, 39(6), 728-733. doi:10.1093/ ageing/afq109
- Gates, S., Fisher, J. D., Cooke, M. W., Carter, Y. H., & Lamb, S. E. (2008). Multifactorial assessment and targeted intervention for preventing falls and injuries among older people in community and emergency care settings: Systematic review and meta-analysis. BMJ, 336(7636), 130-133. doi:10.1136/bmj.39412.525243.BE
- George, D., & Malley, P. (2010). SPSS for windows step by step: A simple study guide and reference, 17.0 update (10th ed.). Boston, MA: Pearson.
- Gill, T. M., Murphy, T. E., Gahbauer, E. A., & Allore, H. G. (2013). Association of injurious falls with disability outcomes and nursing home admissions in community-living older persons. American Journal of Epidemiology, 178(3), 418-425. doi:10.1093/aje/kws554
- Gillespie, L. D., Robertson, M. C., Gillespie, W. J., Lamb, S. E., Gates, S., Cumming, R. G., & Rowe, B. H. (2009). Interventions for preventing falls in older people living in the community. Cochrane Database Systematic Reviews, 2. doi:10.1002/14651858.CD007146.pub2
- Gillespie, L. D., Robertson, M. C., Gillespie, W. J., Sherrington, C., Gates, S., Clemson, L. M., & Lamb, S. E. (2012). Interventions for preventing falls in older people living in the community. Cochrane Database Systematic Reviews, 9. doi:10.1002/14651858.CD007146.pub3
- Goodwin, V. A., Abbott, R. A., Whear, R., Bethel, A., Ukoumunne, O. C., Thompson-Coon, J., & Stein, K. (2014). Multiple component interventions for preventing falls and fall-related injuries among older people: Systematic review and meta-analysis. BMC Geriatrics, 14(1), 15. doi:10.1186/1471-2318-14-15
- Haines, T. P., Hill, A.-M., Hill, K. D., McPhail, S., Oliver, D., Brauer, S., ...Beer, C. (2011). Patient education to prevent falls among older hospital inpatients: A randomized controlled trial. Archives of Internal Medicine, 171(6), 516-524. doi:10.1001/archinternmed.2010.444
- Hartholt, K. A., van Beeck, E. F., Polinder, S., van der Velde, N., van Lieshout, E. M. M., Panneman, M. J. M., ...Patka, P. (2011). Societal consequences of falls in the older population: Injuries, healthcare costs, and long-term reduced quality of life. The Journal of Trauma: Injury Infection, and Critical Care, 71(3), 748-753. doi:10.1097/ TA.0b013e3181f6f5e5
- Heesch, K. C., Byles, J. E., & Brown, W. J. (2008). Prospective association between physical activity and falls in community-dwelling older women. Journal of Epidemiology and Community Health, 62(5), 421-426. doi:10.1136/jech.2007.064147
- Hendriks, M. R. C., Bleijlevens, M. H. C., van Haastregt, J. C. M., Crebolder, H. F. J. M., Diederiks, J. P. M., Evers, S. M. A. A., ...van Eijk, J. T. M. (2008). Lack of effectiveness of a multidisciplinary fall‐prevention program in elderly people at risk: A randomized, controlled trial. Journal of the American Geriatrics Society, 56(8), 1390-1397. doi:10.1111/j.1532-5415. 2008.01803.x
- Higgins, J. P. T., Thompson, S. G., Deeks, J. J., & Altman, D. G. (2003). Measuring inconsistency in meta-analyses. BMJ, 327(7414), 557-560. doi:10.1136/bmj.327.7414.557
- Higgins, J. P. T., Altman, D. G., Gotzsche, P. C., Juni, P., Moher, D., Oxman, A. D., ...Sterne, J. A. C. (2011). The cochrane collaboration’s tool for assessing risk of bias in randomised trials. BMJ, 343. doi:10.1136/bmj.d5928
- Hill, A.-M., Etherton-Beer, C., & Haines, T. P. (2013). Tailored education for older patients to facilitate engagement in falls prevention strategies after hospital discharge – A pilot randomized controlled trial. PLoS One, 8(5). doi:10.1371/journal.pone.0063450
- Hoffman, G. J., Hays, R. D., Shapiro, M. F., Wallace, S. P., & Ettner, S. L. (2017). The costs of fall‐related injuries among older adults: Annual per‐faller, service component, and patient out‐of‐pocket costs. Health Services Research, 52(5), 1794-1816. doi:10.1111/1475-6773.12554
- Hubacher, M., & Wettstein, A. (2001). Acceptance of hip protectors for hip fracture prevention in nursing homes. Osteoporosis International, 12(9), 794-799. doi:10.1007/s001980170057
- Jensen, J., Lundin-Olsson, L., Nyberg, L., & Gustafson, Y. (2002). Fall and injury prevention in older people living in residential care facilities: A cluster randomized trial. Annals of Internal Medicine, 136(10), 733-741. doi:10.7326/0003-4819-136-10-200205210-00008
- Jensen, J., Nyberg, L., Gustafson, Y., & Lundin‐Olsson, L. (2003). Fall and injury prevention in residential care – Effects in residents with higher and lower levels of cognition. Journal of the American Geriatrics Society, 51(5), 627-635. doi:10.1034/j.1600-0579.2003.00206.x
- Karinkanta, S., Kannus, P., Uusi-Rasi, K., Heinonen, A., & Sievänen, H. (2015). Combined resistance and balance-jumping exercise reduces older women’s injurious falls and fractures: 5-year follow-up study. Age and Ageing, 44(5), 784-789. doi:10.1093/ageing/afv064
- Kerse, N., Butler, M., Robinson, E., & Todd, M. (2004). Fall prevention in residential care: A cluster, randomized, controlled trial. Journal of the American Geriatrics Society, 52(4), 524-531. doi:10.1111/j.1532-5415.2004.52157.x
- Kim, H., Yoshida, H., & Suzuki, T. (2014). Falls and fractures in participants and excluded non‐participants of a fall prevention exercise program for elderly women with a history of falls: 1‐year follow‐up study. Geriatrics & Gerontology International, 14(2), 285-292. doi:10.1111/ggi. 12095
- Logan, P. A., Coupland, C. A. C., Gladman, J. R. F., Sahota, O., Stoner-Hobbs, V., Robertson, K., ... Avery, A. J. (2010). Community falls prevention for people who call an emergency ambulance after a fall: Randomised controlled trial. BMJ, 340, c2102. doi:10.1136/bmj.c2102
- Lord, S. R., Tiedemann, A., Chapman, K., Munro, B., Murray, S. M., Georontology, M., …Sherrington, C. (2005). The effect of an individualized fall prevention program on fall risk and falls in older people: A randomized, controlled trial. Journal of the American Geriatrics Society, 53(8), 1296-1304. doi:10.1111/j.1532-5415.2005.53425.x
- Marks, R. (2011). Physical activity and hip fracture disability: A review. Journal of Aging Research, 2011, 1-18. doi:10.4061/2011/741918
- McMurdo, M. E. T., Millar, A. M., & Daly, F. (2000). A randomized controlled trial of fall prevention strategies in old peoples’ homes. Gerontology, 46(2), 83-87. doi:10.1159/000022139
- Ministry of Health and Welfare. (2014). Fall prevention for elderly. Retrieved from https://www.hpa. gov.tw/Pages/EBook.aspx?nodeid=1193
- Oliver, D., Connelly, J. B., Victor, C. R., Shaw, F. E., Whitehead, A., Genc, Y., ...Gosney, M. A. (2007). Strategies to prevent falls and fractures in hospitals and care homes and effect of cognitive impairment: Systematic review and meta-analyses. BMJ, 334(7584), 82. doi:10.1136/ bmj.39049.706493.55
- Palvanen, M., Kannus, P., Piirtola, M., Niemi, S., Parkkari, J., & Järvinen, M. (2014). Effectiveness of the Chaos Falls Clinic in preventing falls and injuries of home-dwelling older adults: A randomised controlled trial. Injury, 45(1), 265-271. doi:10.1016/j.injury.2013.03.010
- Patil, R., Uusi‐Rasi, K., Tokola, K., Karinkanta, S., Kannus, P., & Sievänen, H. (2015). Effects of a multimodal exercise program on physical function, falls, and injuries in older women: A 2‐year community‐based, randomized controlled trial. Journal of the American Geriatrics Society, 63(7), 1306-1313. doi:10.1111/jgs.13489
- Pekkarinen, T., Löyttyniemi, E., & Välimäki, M. (2013). Hip fracture prevention with a multifactorial educational program in elderly community-dwelling Finnish women. Osteoporosis International, 24(12), 2983-2992. doi:10.1007/s00198-013-2381-y
- Robertson, M. C., Campbell, A. J., Gardner, M. M., & Devlin, N. (2002). Preventing injuries in older people by preventing falls: A meta‐analysis of individual‐level data. Journal of the American Geriatrics Society, 50(5), 905-911. doi:10.1046/j.1532-5415.2002.50218.x
- Robertson, M. C., Devlin, N., Gardner, M. M., & Campbell, A. J. (2001). Effectiveness and economic evaluation of a nurse delivered home exercise programme to prevent falls. 1: Randomised controlled trial. BMJ, 322(7288), 697. doi:10.1136/bmj.322.7288.697
- Russell, M. A., Hill, K. D., Day, L. M., Blackberry, I., Schwartz, J., Giummarra, M. J., ...Dharmage, S. C. (2010). A randomized controlled trial of a multifactorial falls prevention intervention for older fallers presenting to emergency departments. Journal of the American Geriatrics Society, 58(12), 2265-2274. doi:10.1111/j.1532-5415.2010.03191.x
- Sanders, K. M., Stuart, A. L., Williamson, E. J., Simpson, J. A., Kotowicz, M. A., Young, D., & Nicholson, G. C. (2010). Annual high-dose oral vitamin D and falls and fractures in older women: A randomized controlled trial. JAMA, 303(18), 1815-1822. doi:10.1001/jama.2010.594
- Sherrington, C., Tiedemann, A., Fairhall, N., Close, J. C. T., & Lord, S. R. (2011). Exercise to prevent falls in older adults: An updated meta-analysis and best practice recommendations. New South Wales Public Health Bulletin, 22(3-4), 78-83. doi:10.1071/NB10056
- Sherrington, C., Whitney, J. C., Lord, S. R., Herbert, R. D., Cumming, R. G., & Close, J. C. (2008). Effective exercise for the prevention of falls: A systematic review and meta‐analysis. Journal of the American Geriatrics Society, 56(12), 2234-2243. doi:10.1111/j.1532-5415.2008.02014.x
- Siegrist, M., Freiberger, E., Geilhof, B., Salb, J., Hentschke, C., Landendoerfer, P., ...Blank, W. A. (2016). Fall prevention in a primary care setting: The effects of a targeted complex exercise intervention in a cluster randomized trial. Deutsches Ärzteblatt International, 113(21), 365-372. doi:10.3238/arztebl.2016.0365
- Spice, C. L., Morotti, W., George, S., Dent, T. H. S., Rose, J., Harris, S., & Gordon, C. J. (2009). The Winchester falls project: A randomised controlled trial of secondary prevention of falls in older people. Age and Ageing, 38(1), 33-40. doi:10.1093/ageing/afn192
- Stevens, J. A., Corso, P. S., Finkelstein, E. A., & Miller, T. R. (2006). The costs of fatal and non-fatal falls among older adults. Injury Prevention, 12(5), 290-295. doi:10.1136/ip.2005.011015
- Stevens, J. A., Mack, K. A., Paulozzi, L. J., & Ballesteros, M. F. (2008). Self-reported falls and fall-related injuries among persons aged ≥65 years? – United States, 2006. Journal of Safety Research, 39(3), 345-349. doi:10.1016/j.jsr.2008.05.002
- Stevens, J. A., & Sogolow, E. D. (2005). Gender differences for non-fatal unintentional fall related injuries among older adults. Injury Prevention, 11(2), 115-119. doi:10.1136/ip.2004.005835
- Tinetti, M. E. (2003). Preventing falls in elderly persons. New England Journal of Medicine, 348(1), 42-49. doi:10.1056/NEJMcp020719
- Vassallo, M., Vignaraja, R., Sharma, J. C., Hallam, H., Binns, K., Briggs, R., ...Allen, S. (2004). The effect of changing practice on fall prevention in a rehabilitative hospital: The hospital injury prevention study. Journal of the American Geriatrics Society, 52(3), 335-339. doi:10.1111/j. 1532-5415.2004.52102.x
- Verma, S. K., Willetts, J. L., Corns, H. L., Marucci-Wellman, H. R., Lombardi, D. A., & Courtney, T. K. (2016). Falls and fall-related injuries among community-dwelling adults in the United States. PLoS One, 11(3). doi:10.1371/journal.pone.0150939
- Vind, A. B., Andersen, H. E., Pedersen, K. D., Jørgensen, T., & Schwarz, P. (2009). An outpatient multifactorial falls prevention intervention does not reduce falls in high‐risk elderly danes. Journal of the American Geriatrics Society, 57(6), 971-977. doi:10.1111/j.1532-5415.2009. 02270.x
- World Health Organization (2008). WHO global report on falls prevention in older age 2007. Retrieved from http://www.who.int/ageing/publications/Falls_prevention7March.pdf?ua=1
| 中文APA引文格式 | 黃素妃、楊婷婷、陳雪芬、呂莉婷、廖容瑜（2018）。預防計畫對於老人跌倒相關傷害之成效：統合分析。教育科學研究期刊，63(2)，163-186。doi: 10.6209/JORIES.201806_63(2).0007 |
|---|
| APA Format | Huang, S. -F., Yang, T. -T., Chen, S. -F., Lu, L. -T., Liao, J -Y.(2018). Effects of Fall Prevention Programs for Older Adults on Fall-Related Injuries: A Systematic Review and Meta-Analysis. Journal of Research in Education Sciences, 63(2), 163-186. doi: 10.6209/JORIES.201806_63(2).0007 |
|---|
Journal directory listing - Volume 63 (2018) - Journal of Research in Education Sciences【63(2)】June (Special Issue: Lifelong Learning and Senior Education)
(Special Issue) Effects of Fall Prevention Programs for Older Adults on Fall-Related Injuries: A Systematic Review and Meta-Analysis
Author: Su-Fei Huang (Department of Senior Citizen Service,Mackay Junior College of Medicine, Nursing, and Management), Ting-Ting Yang(Wisdom Distribution Service Corporation), Shueh-Fen Chen(Department of Senior Citizen Care Welfare, Ching Kuo Institute of Management and Health), Li-Ting Lu(Department of Health Management for Elderly Society, University of Kang Ning), Jung-Yu Liao(Department of Tourism and Leisure Management, Vanung University)
Vol.&No.：Vol. 63, No.2
Date：June 2018
Pages：163-186
DOI：10.6209/JORIES.201806_63(2).0007
Abstract：
This study aimed to evaluate the effects of fall prevention programs on fall-related injuries, and the characteristics of these programs. The Cochrane Library, Medline, PubMed, PsycARTICLES, PsycINFO, ERIC, AgeLine, CINAHL, and the Psychology and Behavioral Sciences Collection databases were searched for randomized clinical trials on fall-related injuries among older adults from 1996 to 2016. A meta-analysis was performed to calculate the combined effects of fall prevention programs on fall-related injuries. A total of 33 research papers were included in the meta-analysis (68,736 participants). The meta-analysis found that fall prevention programs had a significant effect in preventing fall-related injuries (OR=0.86, 95% CI: 0.75-0.97), but a borderline-significant effect in preventing fractures (OR=0.80, 95% CI: 0.63-1.03). The fall prevention programs had a significant effect on fall-related injuries when both male and female participants were included in the study sample, interventions involved healthcare professionals, more than 20% of the patient population had a history of falling, interventions occurred in the community setting, and multiple interventions were used. Thus, fall prevention programs had a small but significant effect in preventing fall-related injuries but only a borderline effect in preventing fractures. When planning fall prevention programs, future policy makers and clinical workers should consider the different characteristics of older adults to propose appropriate intervention programs.
Keywords：accidental falls, fall prevention, injury, meta-analysis, older adults