Preventing and managing falls among people with mental health problems

Background: Falls are a leading cause of mortality and morbidity in older people and these risks are exacerbated by mental health conditions such as depression and dementia. Previous reviews have focused on people with dementia and cognitive impairment, but not those being cared for with other mental health conditions or in mental health settings. Objectives: To evaluate the effectiveness of fall prevention interventions for older people with mental health conditions. Methods: We conducted a systematic review of fall prevention interventions for people aged 65 and over in both inpatient and community health settings providing care for patients with mental health conditions. We searched a range of electronic databases and undertook lateral searches to identify both controlled and uncontrolled studies. Studies were assessed for risk of bias on six domains. Due to heterogeneity results were not pooled but are reported narratively. Results: Fifteen studies met our inclusion criteria. Interventions that include multifactorial, multi-disciplinary interventions and those involving increasing staff awareness appear to reduce the risk of falls but the evidence is mixed and quality of the studies varied. Only 2 studies, both undertaken in the US, were undertaken in mental health settings. We found no data relating to process outcomes or patient views. Conclusion: The review provides evidence that fall prevention interventions can be effective in preventing falls in older people with mental health problems. There is a dearth of falls research undertaken in mental health settings or which focus specifically on patients with mental health problems.