Ambulance responses to older adults who have fallen: a systematic review

Abstract

Background Approximately 10% of emergency ambulance calls are for adults, 65 years and older, who have fallen. Structured management of this group could improve outcomes and cost-effectiveness. This review sought to synthesise evidence for ambulance-based care of older adults who had fallen and the associated impact on patient outcomes. Methods Eligibility. Peer-reviewed primary evidence, assessing older adults (aged = 65) who had fallen and received an ambulance response. Information sources. CINAHL (EBSCO), MEDLINE (Ovid), Embase (Ovid), HMIC (Ovid), Web of Science and AMBER were searched on 20 February 2025 with no date limit. Quality appraisal. Joanna Briggs Institute's critical appraisal tools. Synthesis. PRISMA reporting, with narrative synthesis using Synthesis Without Meta-analysis guidelines. Results Three thousand and forty-nine unique studies were identified. Nine studies were included, ranging from low- to high-quality randomised cluster trials and mixed-methods, prospective and retrospective cohort studies. Patients whose care included fall-specific decision-making tools or referral pathways, were less likely to be conveyed to hospital and more likely to access alternative community healthcare. However, poor uptake of participating paramedics limits the impact on practice. Few fall response or referral schemes were reported in the literature; those that exist have improved outcomes for patients. Where national practice guidelines exist, these were generally adhered to. Patient social characteristics, such as living alone, were the main reason for guideline deviation. Discussion Where fall pathways were implemented, outcomes improved, though implementation is contextual. Ambulance staff adhere to guidelines, but whether the guidelines reflect current presentations and treatment opportunities is unclear. Further research is required to establish generalisable approaches.