Falls prevention interventions in older adults with cognitive impairment: A systematic review of reviews

Aim: This critical review explores the review material on falls prevention interventions in older adults with cognitive impairment, such as dementia. Method: A systematic review of reviews was conducted using the following bibliographic databases: PubMed/Medline, EMBASE, AMED, CINAHL and the Cochrane electronic library. The search terms used were: 'falls'; 'rehabilitation'; 'falls prevention'; 'interventions'; 'cognitive impairment'; 'dementia'; and 'Alzheimer's disease'. All available studies were marked against predetermined inclusion and exclusion criteria. Results: Of the seven review articles that met the inclusion criteria, only one had a homogenous population of adults with a cognitive impairment. The most reported intervention was exercise, which was included in all seven reviews of 91 studies. Multifactorial and multicomponent falls prevention programmes were also frequently reported. Reports of efficacy were inconsistent for all the interventions reported. Conclusion: Evidence for falls prevention interventions for adults with cognitive impairment is varied and inconclusive. When compared with the literature on falls interventions in healthy older adult populations, both primary and synthesis studies in older adults with cognitive impairment are lacking in number, quality and homogeneity of sample population and interventions. Promising results are emerging but clinical recommendations cannot be made at this time.