Oral Presentation Australian and New Zealand Society for Geriatric Medicine Annual Scientific Meeting 2026

Electrophysiology procedures for preventing falls in older people living in the community: a systematic review and meta-analysis  (#67)

Kristen Gibson 1 2 , Lauren Priest 1 2 , Vasi Naganathan 3 , Jane Masoli 4 , Anand Ganesan 1 2 , Suzanne Dyer 2 5
  1. Flinders Medical Centre Southern Adelaide Local Health Network (SALHN),, SA Health, Adelaide, SA, SA, Australia
  2. College of Medicine and Public Health, Flinders University , Adelaide, SA, 5042
  3. Centre for Education and Research on Ageing, Concord Repatriation General Hospital , Sydney , NSW, Australia
  4. Department of Healthcare for Older People , Royal Devon University Healthcare NHS Foundation Trust , Exeter, United Kingdom
  5. Flinders Health and Medical Research Institute , Adelaide , SA, Australia

Aims: To evaluate the effectiveness of cardiovascular electrophysiology procedures in preventing falls in older adults living in the community. 

Methods: A systematic review was conducted of randomised-controlled trials (RCTs) evaluating electrophysiology interventions in community-dwelling adults aged ≥60 years for falls prevention. We identified studies from a Cochrane review (Gillespie et al. 2012) plus databases (MEDLINE, Embase, CENTRAL, CINAHL) and trial registries (ClinicalTrials.gov, ICTRP) searched February 2012 to May 2025. Study screening was conducted in duplicate. A single author (KG) extracted characteristics and short- (0-6 months), medium- (6-12 months) and long-term (≥12 months) outcomes of rate of falls, risk of falling and quality of life (QoL), conducted risk-of-bias (RoB2 tool) and GRADE certainty of evidence assessments according to Cochrane methods. Primary outcomes were long-term falls outcomes. Outcomes were pooled with generic inverse-variance meta-analysis when possible. 

Results: Three RCTs enrolling participants with carotid sinus hypersensitivity and recurrent unexplained falls examining dual chamber pacing in comparison to usual care or loop recorder were included. Two trials reported long-term outcomes, one medium-term outcomes. The long-term effects on the rate of falls (rate ratio 0.57,95%CI 0.31-1.05, 2 trials, 299 participants, I2=50%), risk of falling (risk ratio 1.34, 95%CI 0.83-2.14,1 trial,128 participants) and QoL (mean EuroQuoL 0.66 pacemaker vs 0.57 loop recorder) were uncertain (very-low certainty evidence). 

Conclusion: Current evidence for pacemakers to prevent falls in community-dwelling older adults is uncertain, despite inclusion in guidelines1.  High-quality, adequately powered trials using standardised fall outcomes are needed to clarify effectiveness and safety in contemporary practice. 

  1. Australian Commission on Safety and Quality in Health Care. Preventing Falls and Harm from Falls in Older People: Best Practice Guidelines for Community Care in Australia. Sydney; ACSQHC, 2025.