Mike: Hello, I’m Mike Clarke podcast editor for the Cochrane Library. One of our most highly cited and largest reviews, published in 2012, looks at interventions for preventing falls in older people living in the community. During its updating, it’s being split into a series of smaller reviews focused on specific interventions. In this podcast, two authors, Amy Drahota and Heather Mackenzie from the Universities of Portsmouth and Southampton in the UK, talk about the update for the studies of psychological and educational interventions, which was published in October 2024.

Heather: Thanks Mike. So Amy, do you want to start by saying a little about psychological interventions?

Amy: Thanks Heather. Sure. Psychological interventions attempt to modify a person’s thoughts, feelings, or behaviour – for example by increasing their confidence or motivation to do something that may help prevent falls. These include cognitive behavioural therapy, and motivational interviewing, but we also were open to including any other psychological interventions that have been tested. 

Heather: We also looked at education interventions, which covers a wide range of topics related to how to prevent falls. Some of these take a personalised approach where people are provided with topics based on their own risk factors; some give everyone the same thing covering multiple falls-prevention topics (such as exercise, and medication); and others focus on a single topic, such as incontinence or home modification. I’ll pass back to you Amy to say something about why it’s important to look at the effectiveness of all these interventions for falls prevention.

Amy: Thanks. A good starting point is that although World Guidelines for falls prevention offer guidance around using education for falls prevention, this is based on expert opinion, and recommendations have not been formulated around psychological interventions for falls prevention. It is important therefore to have actual evidence on the effects of the interventions on falls, since, sometimes, even when it seems obvious that something will be beneficial based on theory, it is not so good in reality. For example, even if a psychological intervention increases someone’s confidence or their motivation to be more active and reduces their concerns about falling, it might inadvertently result in a person placing themselves in situations that increase their falls risk.

Heather: Right. And although educating people seems like a sensible thing, we need to know if education alone is enough to help reduce falls. So, these interventions needed looking at because falls are a really important issue - it’s estimated that about 1 in 3 older adults fall each year, and falls can have lasting consequences affecting independence, a person’s confidence, and lead to severe injuries such as hip fracture, head injury, and even death.

Amy: Okay, so let’s talk about the evidence we found – what’s out there on this topic?

Heather: In the 2012 review, there were 7 trials on these interventions but a decade or so later, we’ve now identified 37 studies. Of those looking at psychological interventions, there were 6 on cognitive behavioural interventions. 3 on motivational interviewing, and 3 on other psychological interventions. There were 9 studies of personalised educational interventions; 12 that delivered the same education materials to everyone, covering multiple topics; and 2 tested education on a single topic. There was also 1 study of a combination of motivational interviewing and coaching plus personalised education.

Amy: Altogether these involved nearly 17,500 people, who were around 73 years of age on average with about 71% being female. The highest quality evidence came from the study of 430 people that looked at combining motivational interviewing, coaching and personalised education. Based on this study, we can say that this combined psychological and educational intervention makes little to no difference to the number of people who fall, but it probably reduces the number of times people fall, although we cannot be sure if this reduction is small or large. We can also say with moderate certainty that the package makes little to no difference to peoples’ concerns about falling.
For the cognitive behavioural interventions, there is low certainty evidence that these result in little to no effect on the number of fallers, but a small reduction in concerns about falls. The rest of the evidence for psychological interventions is very uncertain or the studies did not assess our review outcomes.

Heather: Things were similar for the education trials, with low certainty evidence that personalised education may have little to no effect on the number of falls. Education covering multiple set topics may improve concerns about falling (which we can say with low certainty), but much of the remaining evidence was very uncertain or didn’t measure the outcomes we were interested in.

Amy: This leads us to the take home message, which is that a combined psychological and educational intervention could help reduce the number of falls but not necessarily the number of people who fall. While we are far less confident about all the other interventions we looked at, and future research may change our understanding.

Heather: Thanks Amy. Finally, if people want to read the review, it’s available online by going to Cochrane library dot com and typing “educational interventions and falls” into the search box to see the link near the top of the list.