Interventions for preventing falls in older people in care facilities
Dyer SM, Kwok WS, Suen J, Dawson R, Kneale D, Sutcliffe K, Seppala LJ, Hill KD, Kerse N, Murray GR, van der Velde N, Sherrington C, Cameron ID. Cochrane Database Syst Rev. 2025 Aug 20;8(8):CD016064.
DOI: 10.1002/14651858.CD016064
Abstract
Rationale: Falls in care facilities are common events, causing considerable morbidity and mortality for older people. This is an update of a review on interventions in care facilities and hospitals first published in 2010 and updated in 2012 and 2018 on interventions in care facilities and hospitals. This review has now been split into separate reviews for each setting.
Objectives: To assess the benefits and harms of interventions designed to reduce the incidence of falls in older people in care facilities.
Eligibility criteria: We included randomised controlled trials (RCTs) of any intervention for preventing falls in older people (aged over 65 years) in care facilities with any comparator. We excluded trials conducted in places of residence that do not provide residential health-related care or rehabilitative services. We excluded trials where falls were recorded as adverse events of the intervention and those recruiting participants post-stroke or living with Parkinson's disease.
Outcomes: Critical outcomes were rate of falls (number of falls per unit time) and number of fallers (risk of experiencing one or more falls). Important outcomes were risk of fracture, adverse events, and economic outcomes.
Included studies: We included 104 trials, 56 individually randomised and 48 cluster-randomised trials, with 68,964 participants. Thirty-three trials (27,492 participants) were added in this update. We assessed most of the included trials as at high risk of bias, often related to lack of blinding, which was rarely feasible for many intervention types. The certainty of evidence for the critical outcomes of falls ranged from high to very low. We have reported the critical outcomes for the main comparisons here. Regarding our important outcomes, adverse events were poorly reported, and the certainty of evidence was very low for all interventions; we have not reported these data here. The important outcomes of risk of fracture and cost-effectiveness are only reported here when the certainty of the evidence was stronger than very low.
Authors' conclusions: Multifactorial interventions implemented with facility staff engagement and tailored intervention delivery according to individual residents' circumstances probably reduce the rate of falls and risk of falling and may be cost-effective. Regarding single interventions, exercise probably reduces the rate of falls and the risk of falling, but if exercise is not sustained it has no ongoing effect on the rate of falls and probably no effect on the risk of falling. Active exercise may reduce the risk of falling in residents with cognitive impairment and may be cost-effective. Medication optimisation interventions were diverse overall and may make little or no difference to the rate of falls and probably little or no difference to the risk of falling. We are very uncertain of the effectiveness of medication review/deprescribing as a single intervention at reducing falls. Vitamin D supplementation probably reduces the rate of falls but probably makes little or no difference to the risk of falling. Addressing nutrition, increasing servings of dairy through dietitian assistance with menu design may decrease the risk of falling and risk of fractures.
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For more fall prevention-related research publications, the NSW Fall Prevention and Healthy Ageing Network collates abstracts each month which can be viewed here.
