Risk factors for falls in community-dwelling older adults: An umbrella review

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Abstract
Background: Falls are a key public health concern, resulting in disability and increased mortality risk. An extensive body of literature has examined risk factors for falls, however results vary across different studies and populations. We aimed to synthesize systematic reviews on fall risk factors in community-dwelling older adults. Methods: A systematic review of systematic reviews. Searches were executed in six databases (Medline, Embase, CINAHL, Cochrane Library, PsychINFO, Ageline) from inception until June 13, 2023. Eligible studies included systematic reviews of prospective cohort studies that included a population of community dwelling older adults (≥60 years) and reported fall risk factors. Three reviewers (SS, CD, QH) screened 8173 records. Summary data were extracted and the units of analyses were the relationships between risk factors and falls. Descriptive results are reported in counts and frequencies. The study was registered in Prospero (CRD42022335392). Findings: Fifty-seven reviews were included. Mobility-related measures (balance, gait, physical function, physical activity, dual task ability, strength, range of motion) accounted for 40% of all relationships. Of these, clinical tests of balance and physical function were consistently predictive of falls. Other consistent predictors were cognition, specifically executive function (76% significant) and processing speed (100%), medications (58%), frailty (100%), and chronic conditions (83%). There was a paucity of evidence for psychosocial, environmental, and sociodemographic factors. The majority of reviews (54%) were rated as low risk of bias. Conclusions: Mobility-related risk factors for falls are well established and can be addressed through interventions. Findings highlight the limited examination of psychosocial, sociodemographic, and environmental risk factors for falls, indicating areas for future research. Highlights: This study synthesized all systematic and scoping reviews from six databases that examined 29 fall risk factors in community-dwelling older adults (≥60 years) from over 300 prospective studies The results highlight the extensive evaluation of mobility-related measures and identifies promising factors for fall risk assessment (i.e., clinical tests of balance and physical function, executive function, processing speed, frailty, chronic conditions) The study synthesizes the magnitude of relationships between risk factors with meta-analysis results The evidence from this study will help researchers refine those risk factors most important for identifying fall risk. Psychosocial, sociodemographic, and environmental factors could be valuable targets for future research on fall prevention.

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