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

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: firstly, acceptance rates versus recruitment rates, i.e. respectively the proportion of older people willing to participate in the RCTs versus those willing and included; secondly, 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. (C) 2013 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved.