Interventions for preventing falls in older people in care
facilities and hospitals (Review)
Cameron ID, Gillespie LD, Robertson MC, Murray GR, Hill KD, Cumming RG, Kerse N

This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library
2012, Issue 12
http://www.thecochranelibrary.com

Interventions for preventing falls in older people in care facilities and hospitals (Review)
Copyright © 2014 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

[Intervention Review]

Interventions for preventing falls in older people in care
facilities and hospitals
Ian D Cameron1 , Lesley D Gillespie2 , M Clare Robertson3 , Geoff R Murray4 , Keith D Hill5 , Robert G Cumming6 , Ngaire Kerse7
1 John Walsh Centre for Rehabilitation Research, University of Sydney, St. Leonards, Australia. 2 c/o Cochrane Bone, Joint and Muscle
Trauma Group, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, The University of Manchester, Manchester,
UK. 3 Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand. 4 Rehabilitation, Aged
and Extended Care, Illawarra Shoalhaven Local Health Network, Warrawong, Australia. 5 School of Physiotherapy, Faculty of Health
Sciences, Curtin University, Perth, Australia. 6 School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia.
7 Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand

Contact address: Ian D Cameron, John Walsh Centre for Rehabilitation Research, University of Sydney, Kolling Institute, St. Leonards,
NSW, 2065, Australia. ian.cameron@sydney.edu.au.
Editorial group: Cochrane Bone, Joint and Muscle Trauma Group.
Publication status and date: Edited (no change to conclusions), comment added to review, published in Issue 12, 2014.
Review content assessed as up-to-date: 30 June 2012.
Citation: Cameron ID, Gillespie LD, Robertson MC, Murray GR, Hill KD, Cumming RG, Kerse N. Interventions for preventing
falls in older people in care facilities and hospitals. Cochrane Database of Systematic Reviews 2012, Issue 12. Art. No.: CD005465. DOI:
10.1002/14651858.CD005465.pub3.
Copyright © 2014 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

ABSTRACT
Background
Falls in care facilities and hospitals are common events that cause considerable morbidity and mortality for older people. This is an
update of a review first published in 2010.
Objectives
To assess the effectiveness of interventions designed to reduce falls by older people in care facilities and hospitals.
Search methods
We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (March 2012); The Cochrane Library 2012, Issue
3; MEDLINE, EMBASE, and CINAHL (all to March 2012); ongoing trial registers (to August 2012), and reference lists of articles.
Selection criteria
Randomised controlled trials of interventions to reduce falls in older people in residential or nursing care facilities or hospitals.
Data collection and analysis
Two review authors independently assessed risk of bias and extracted data. We used a rate ratio (RaR) and 95% confidence interval
(CI) to compare the rate of falls (e.g. falls per person year) between intervention and control groups. For risk of falling we used a risk
ratio (RR) and 95% CI based on the number of people falling (fallers) in each group. We pooled results where appropriate.
Interventions for preventing falls in older people in care facilities and hospitals (Review)
Copyright © 2014 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Main results
We included 60 trials (60,345 participants), 43 trials (30,373 participants) in care facilities, and 17 (29,972 participants) in hospitals.
Results from 13 trials testing exercise interventions in care facilities were inconsistent. Overall, there was no difference between
intervention and control groups in rate of falls (RaR 1.03, 95% CI 0.81 to 1.31; 8 trials, 1844 participants) or risk of falling (RR 1.07,
95% CI 0.94 to 1.23; 8 trials, 1887 participants). Post hoc subgroup analysis by level of care suggested that exercise might reduce falls
in people in intermediate level facilities, and increase falls in facilities providing high levels of nursing care.
In care facilities, vitamin D supplementation reduced the rate of falls (RaR 0.63, 95% CI 0.46 to 0.86; 5 trials, 4603 participants), but
not risk of falling (RR 0.99, 95% CI 0.90 to 1.08; 6 trials, 5186 participants).
For multifactorial interventions in care facilities, the rate of falls (RaR 0.78, 95% CI 0.59 to 1.04; 7 trials, 2876 participants) and risk
of falling (RR 0.89, 95% CI 0.77 to 1.02; 7 trials, 2632 participants) suggested possible benefits, but this evidence was not conclusive.
In subacute wards in hospital, additional physiotherapy (supervised exercises) did not significantly reduce rate of falls (RaR 0.54, 95%
CI 0.16 to 1.81; 1 trial, 54 participants) but achieved a significant reduction in risk of falling (RR 0.36, 95% CI 0.14 to 0.93; 2 trials,
83 participants).
In one trial in a subacute ward (54 participants), carpet flooring significantly increased the rate of falls compared with vinyl flooring
(RaR 14.73, 95% CI 1.88 to 115.35) and potentially increased the risk of falling (RR 8.33, 95% CI 0.95 to 73.37).
One trial (1822 participants) testing an educational session by a trained research nurse targeting individual fall risk factors in patients
at high risk of falling in acute medical wards achieved a significant reduction in risk of falling (RR 0.29, 95% CI 0.11 to 0.74).
Overall, multifactorial interventions in hospitals reduced the rate of falls (RaR 0.69, 95% CI 0.49 to 0.96; 4 trials, 6478 participants)
and risk of falling (RR 0.71, 95% CI 0.46 to 1.09; 3 trials, 4824 participants), although the evidence for risk of falling was inconclusive.
Of these, one trial in a subacute setting reported the effect was not apparent until after 45 days in hospital. Multidisciplinary care in a
geriatric ward after hip fracture surgery compared with usual care in an orthopaedic ward significantly reduced rate of falls (RaR 0.38,
95% CI 0.19 to 0.74; 1 trial, 199 participants) and risk of falling (RR 0.41, 95% CI 0.20 to 0.83). More trials are needed to confirm
the effectiveness of multifactorial interventions in acute and subacute hospital settings.
Authors’ conclusions
In care facilities, vitamin D supplementation is effective in reducing the rate of falls. Exercise in subacute hospital settings appears
effective but its effectiveness in care facilities remains uncertain due to conflicting results, possibly associated with differences in
interventions and levels of dependency. There is evidence that multifactorial interventions reduce falls in hospitals but the evidence
for risk of falling was inconclusive. Evidence for multifactorial interventions in care facilities suggests possible benefits, but this was
inconclusive.

PLAIN LANGUAGE SUMMARY
Interventions for preventing falls in older people in care facilities and hospitals
Falls by older people in residential or nursing care facilities and hospitals are common events that may cause loss of independence,
injuries, and sometimes death as a result of injury. Effective interventions to prevent falls are important as they will have significant
health benefits.
This review included 60 randomised controlled trials involving 60,345 participants. Forty-three trials (30,373 participants) were in
care facilities, and 17 (29,972 participants) in hospitals. Despite the large number of trials, there was limited evidence to support any
one intervention.
In care facilities, the prescription of vitamin D reduced the number of falls, probably because residents have low vitamin D levels.
Results from 13 trials testing exercise interventions in care facilities were inconsistent and overall did not show a benefit. It may be that
exercise programmes increase falls in frail residents and reduce falls in less frail residents. Interventions targeting multiple risk factors
may be effective in reducing the number of falls.
Additional physiotherapy reduced the number of people falling in hospital rehabilitation wards and interventions targeting multiple
risk factors reduced falls in hospital.
Interventions for preventing falls in older people in care facilities and hospitals (Review)
Copyright © 2014 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Interventions for preventing falls in older people in care facilities and hospitals (Review)
Copyright © 2014 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Interventions for preventing falls in older people in care
facilities and hospitals (Review)
Cameron ID, Gillespie LD, Robertson MC, Murray GR, Hill KD, Cumming RG, Kerse N

This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library
2012, Issue 12
http://www.thecochranelibrary.com

Interventions for preventing falls in older people in care facilities and hospitals (Review)
Copyright © 2014 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

[Intervention Review]

Interventions for preventing falls in older people in care
facilities and hospitals
Ian D Cameron1 , Lesley D Gillespie2 , M Clare Robertson3 , Geoff R Murray4 , Keith D Hill5 , Robert G Cumming6 , Ngaire Kerse7
1 John Walsh Centre for Rehabilitation Research, University of Sydney, St. Leonards, Australia. 2 c/o Cochrane Bone, Joint and Muscle
Trauma Group, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, The University of Manchester, Manchester,
UK. 3 Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand. 4 Rehabilitation, Aged
and Extended Care, Illawarra Shoalhaven Local Health Network, Warrawong, Australia. 5 School of Physiotherapy, Faculty of Health
Sciences, Curtin University, Perth, Australia. 6 School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia.
7 Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand

Contact address: Ian D Cameron, John Walsh Centre for Rehabilitation Research, University of Sydney, Kolling Institute, St. Leonards,
NSW, 2065, Australia. ian.cameron@sydney.edu.au.
Editorial group: Cochrane Bone, Joint and Muscle Trauma Group.
Publication status and date: Edited (no change to conclusions), comment added to review, published in Issue 12, 2014.
Review content assessed as up-to-date: 30 June 2012.
Citation: Cameron ID, Gillespie LD, Robertson MC, Murray GR, Hill KD, Cumming RG, Kerse N. Interventions for preventing
falls in older people in care facilities and hospitals. Cochrane Database of Systematic Reviews 2012, Issue 12. Art. No.: CD005465. DOI:
10.1002/14651858.CD005465.pub3.
Copyright © 2014 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

ABSTRACT
Background
Falls in care facilities and hospitals are common events that cause considerable morbidity and mortality for older people. This is an
update of a review first published in 2010.
Objectives
To assess the effectiveness of interventions designed to reduce falls by older people in care facilities and hospitals.
Search methods
We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (March 2012); The Cochrane Library 2012, Issue
3; MEDLINE, EMBASE, and CINAHL (all to March 2012); ongoing trial registers (to August 2012), and reference lists of articles.
Selection criteria
Randomised controlled trials of interventions to reduce falls in older people in residential or nursing care facilities or hospitals.
Data collection and analysis
Two review authors independently assessed risk of bias and extracted data. We used a rate ratio (RaR) and 95% confidence interval
(CI) to compare the rate of falls (e.g. falls per person year) between intervention and control groups. For risk of falling we used a risk
ratio (RR) and 95% CI based on the number of people falling (fallers) in each group. We pooled results where appropriate.
Interventions for preventing falls in older people in care facilities and hospitals (Review)
Copyright © 2014 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Main results
We included 60 trials (60,345 participants), 43 trials (30,373 participants) in care facilities, and 17 (29,972 participants) in hospitals.
Results from 13 trials testing exercise interventions in care facilities were inconsistent. Overall, there was no difference between
intervention and control groups in rate of falls (RaR 1.03, 95% CI 0.81 to 1.31; 8 trials, 1844 participants) or risk of falling (RR 1.07,
95% CI 0.94 to 1.23; 8 trials, 1887 participants). Post hoc subgroup analysis by level of care suggested that exercise might reduce falls
in people in intermediate level facilities, and increase falls in facilities providing high levels of nursing care.
In care facilities, vitamin D supplementation reduced the rate of falls (RaR 0.63, 95% CI 0.46 to 0.86; 5 trials, 4603 participants), but
not risk of falling (RR 0.99, 95% CI 0.90 to 1.08; 6 trials, 5186 participants).
For multifactorial interventions in care facilities, the rate of falls (RaR 0.78, 95% CI 0.59 to 1.04; 7 trials, 2876 participants) and risk
of falling (RR 0.89, 95% CI 0.77 to 1.02; 7 trials, 2632 participants) suggested possible benefits, but this evidence was not conclusive.
In subacute wards in hospital, additional physiotherapy (supervised exercises) did not significantly reduce rate of falls (RaR 0.54, 95%
CI 0.16 to 1.81; 1 trial, 54 participants) but achieved a significant reduction in risk of falling (RR 0.36, 95% CI 0.14 to 0.93; 2 trials,
83 participants).
In one trial in a subacute ward (54 participants), carpet flooring significantly increased the rate of falls compared with vinyl flooring
(RaR 14.73, 95% CI 1.88 to 115.35) and potentially increased the risk of falling (RR 8.33, 95% CI 0.95 to 73.37).
One trial (1822 participants) testing an educational session by a trained research nurse targeting individual fall risk factors in patients
at high risk of falling in acute medical wards achieved a significant reduction in risk of falling (RR 0.29, 95% CI 0.11 to 0.74).
Overall, multifactorial interventions in hospitals reduced the rate of falls (RaR 0.69, 95% CI 0.49 to 0.96; 4 trials, 6478 participants)
and risk of falling (RR 0.71, 95% CI 0.46 to 1.09; 3 trials, 4824 participants), although the evidence for risk of falling was inconclusive.
Of these, one trial in a subacute setting reported the effect was not apparent until after 45 days in hospital. Multidisciplinary care in a
geriatric ward after hip fracture surgery compared with usual care in an orthopaedic ward significantly reduced rate of falls (RaR 0.38,
95% CI 0.19 to 0.74; 1 trial, 199 participants) and risk of falling (RR 0.41, 95% CI 0.20 to 0.83). More trials are needed to confirm
the effectiveness of multifactorial interventions in acute and subacute hospital settings.
Authors’ conclusions
In care facilities, vitamin D supplementation is effective in reducing the rate of falls. Exercise in subacute hospital settings appears
effective but its effectiveness in care facilities remains uncertain due to conflicting results, possibly associated with differences in
interventions and levels of dependency. There is evidence that multifactorial interventions reduce falls in hospitals but the evidence
for risk of falling was inconclusive. Evidence for multifactorial interventions in care facilities suggests possible benefits, but this was
inconclusive.

PLAIN LANGUAGE SUMMARY
Interventions for preventing falls in older people in care facilities and hospitals
Falls by older people in residential or nursing care facilities and hospitals are common events that may cause loss of independence,
injuries, and sometimes death as a result of injury. Effective interventions to prevent falls are important as they will have significant
health benefits.
This review included 60 randomised controlled trials involving 60,345 participants. Forty-three trials (30,373 participants) were in
care facilities, and 17 (29,972 participants) in hospitals. Despite the large number of trials, there was limited evidence to support any
one intervention.
In care facilities, the prescription of vitamin D reduced the number of falls, probably because residents have low vitamin D levels.
Results from 13 trials testing exercise interventions in care facilities were inconsistent and overall did not show a benefit. It may be that
exercise programmes increase falls in frail residents and reduce falls in less frail residents. Interventions targeting multiple risk factors
may be effective in reducing the number of falls.
Additional physiotherapy reduced the number of people falling in hospital rehabilitation wards and interventions targeting multiple
risk factors reduced falls in hospital.
Interventions for preventing falls in older people in care facilities and hospitals (Review)
Copyright © 2014 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Interventions for preventing falls in older people in care facilities and hospitals (Review)
Copyright © 2014 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.