TITLE: Fall Prevention in Adults with Mental Health and Substance Use Needs: A Review of the Clinical Evidence and Guidelines

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1 TITLE: Fall Prevention in Adults with Mental Health and Substance Use Needs: A Review of the Clinical Evidence and Guidelines DATE: 11 January 2012 CONTEXT AND POLICY ISSUES: Approximately 30 to 40 percent of falls are preventable. 1 The most effective strategies appear to be multifactorial approaches that target risk factors of falls simultaneously in selected or unselected populations. 1 Mental health conditions influence the risk of fall related injuries through multiple mechanisms. 2 For example, elderly individuals with depression and anxiety may be less physically active and have more disability and impairments in activities of daily living than elderly individuals without mental health conditions. 2 The clinical and economic impact of falls for adults with mental health and substance use needs is not readily available in the literature. The purpose of this report is to review the clinical evidence and evidence-based guidelines for fall prevention among adults in outpatient mental health and substance use programs. RESEARCH QUESTIONS: 1. What is the clinical evidence for fall prevention among adults in outpatient mental health and substance use programs? 2. What are the evidence-based guidelines and recommendations for fall prevention among adults in outpatient mental health and substance use programs? KEY MESSAGE: No evidence on fall prevention for adult outpatients in mental health and substance use programs was identified. Disclaimer: The Rapid Response Service is an information service for those involved in planning and providing health care in Canada. Rapid responses are based on a limited literature search and are not comprehensive, systematic reviews. The intent is to provide a list of sources and a summary of the best evidence on the topic that CADTH could identify using all reasonable efforts within the time allowed. Rapid responses should be considered along with other types of information and health care considerations. The information included in this response is not intended to replace professional medical advice, nor should it be construed as a recommendation for or against the use of a particular health technology. Readers are also cautioned that a lack of good quality evidence does not necessarily mean a lack of effectiveness particularly in the case of new and emerging health technologies, for which little information can be found, but which may in future prove to be effective. While CADTH has taken care in the preparation of the report to ensure that its contents are accurate, complete and up to date, CADTH does not make any guarantee to that effect. CADTH is not liable for any loss or damages resulting from use of the information in the report. Copyright: This report contains CADTH copyright material. It may be copied and used for non-commercial purposes, provided that attribution is given to CADTH. Links: This report may contain links to other information available on the websites of third parties on the Internet. CADTH does not have control over the content of such sites. Use of third party sites is governed by the owners own terms and conditions.

2 METHODS: Literature search strategy A limited literature search was conducted on key resources including PubMed, The Cochrane Library (2011, Issue 11), University of York Centre for Reviews and Dissemination (CRD) databases, Canadian and abbreviated list of major international health technology agencies, as well as a focused Internet search. Methodological filters were applied to limit retrieval to health technology assessments, systematic reviews, meta-analyses, randomized controlled trials and guidelines. Where possible, retrieval was limited to the human population. The search was also limited to English language documents published between January 1, 2006 and December 09, Selection Criteria and Methods One reviewer screened the titles and abstracts of the retrieved publications. Table 1: Selection Criteria Population Adults (18 years or older) Intervention Comparator Outcomes Study Designs Patients with mental health or substance use needs, who are admitted to outpatient, community or outreach programs Fall prevention protocols, strategies, tools, or management programs Education programs on fall prevention Not specified Q1: Clinical outcomes: risk of falls, adverse events (injuries, falls and accidents) Q2: Guidelines and recommendations Health technology assessments (HTAs), systematic reviews (SRs), meta-analyses (MAs), randomized controlled trials (RCTs), nonrandomized studies (if few HTAs/ SRs/MAs/RCTs found), and evidence-based guidelines Exclusion Criteria Studies were excluded if they did not meet the selection criteria, were duplicate publications or included in at least one selected systematic review, involved irrelevant study designs or were published before Critical Appraisal of Individual Studies Critical appraisal of the included systematic reviews were assessed using the AMSTAR criteria. 3 Primary studies were assessed using the Downs and Black instrument. 4 Evidence-based guidelines were assessed using the AGREE instrument. 5 Fall Prevention in Adults with Mental Health and Substance Use Needs 2

3 SUMMARY OF EVIDENCE: Quantity of Research Available The literature search generated 222 citations. Upon screening 219 citations were excluded and three potentially relevant articles were identified for full-text review. No additional potentially relevant reports were identified through the grey literature search. Of the three potentially relevant articles, none of the articles met the inclusion criteria. No relevant literature was found regarding fall prevention mental health and substance use needs, therefore no summary can be provided. CONCLUSIONS AND IMPLICATIONS FOR DECISION OR POLICY MAKING: Given that none of the potentially relevant studies met the criteria for inclusion, conclusions and the implications for decision or policy making cannot be addressed. PREPARED BY: Canadian Agency for Drugs and Technologies in Health Tel: Fall Prevention in Adults with Mental Health and Substance Use Needs 3

4 REFERENCES: 1. Sjosten N, Vaapio S, Kivela SL. The effects of fall prevention trials on depressive symptoms and fear of falling among the aged: a systematic review. Aging Ment Health Jan;12(1): Finkelstein E, Prabhu M, Chen H. Increased prevalence of falls among elderly individuals with mental health and substance abuse conditions. Am J Geriatr Psychiatry Jul;15(7): Shea BJ, Grimshaw JM, Wells GA, Boers M, Andersson N, Hamel C, et al. Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol [Internet] [cited 2011 Nov 28];7:10. Available from: 4. Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health Jun;52(6): The AGREE Collaboration. Appraisal of guidelines for research and evaluation (AGREE) instrument [Internet]. London: The AGREE research trust; 2001 Sep. [cited 2011 Nov 3]. Available from: Fall Prevention in Adults with Mental Health and Substance Use Needs 4

5 APPENDIX 1: Selection of Included Studies 222 citations identified from electronic literature search and screened 219 citations excluded 3 potentially relevant articles retrieved for scrutiny (full text, if available) 0 potentially relevant reports retrieved from other sources (grey literature, hand search) 3 potentially relevant reports 3 reports excluded: -irrelevant population (1) -irrelevant intervention (1) -irrelevant outcomes (1) 0 reports included in review Fall Prevention in Adults with Mental Health and Substance Use Needs 5

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