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A systematic review of the economic costs and consequences of fall prevention interventions for older people

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Background: Unintentional falls are a major driver of health and social care costs for older people. We undertook a systematic review to assess what is known about the quality and robustness of economic evaluations of interventions to prevent falls and/or mitigate their consequences. We then considered the extent to which the results of these studies might be generalised across different contexts and settings. Methods: A number of bibliographic databases including Medline, Econlit, AGEINFO, Ageline, Psychinfo and the International Bibliography of the Social Sciences were searched. This was complemented by a hand search of selected journals, key research and governmental websites and a limited Google search. Abstracts were double checked independently by the authors, and assessed against an economic evaluation checklist, with included papers coded in an Access database. Results: More than 300 papers met our includion criteria. The most common economic analyses were cost-consequences and cost effectiveness studies. Measures to reduce the risk of falls and fractures can be grouped largely within six categories :(1) pharmaceutical treatments and/or withdrawal of risk increasing drugs (2) bone mineral density screening initiatives (3) use of hip protectors (4) lifestyle and dietary changes, including food and vitamin supplements (5) exercise and balance training (6) home/environmental risk assessment, adaptation and modification. Conclusions: The economic burden of falls, both from a health/social care and societal perspective is substantial. The majority of studies suggest that interventions are not only cost effective but also cost-saving in the long term. Policy makers might use scarce resources more efficiently by not only focusing on targeted interventions for high-risk individuals (e.g. post-menopausal women, obesity and some cancers) but also augmenting this with population based approaches e.g. low cost health promotion and primary prevention measures.

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