How effective are interventions designed to reduce falls in older people in hospitals?

Key messages

• Tailored education (staff, patient/family and multicomponent) probably reduces the rate of falls and risk of falling.

• Service model changes (where there is a change in the way a hospital delivers care to patients with the goal of reducing falls) in acute hospitals probably reduce the rate of falls.

• Multifactorial interventions (where two or more categories of intervention are given based on an assessment of a person's risk factors for falling) probably reduce the rate of falls and risk of falling, although it is also possible these interventions have no effect or slightly increase falls.

• Exercise may have little or no effect on the risk of falling in hospital settings overall.

• Across all intervention types, fall prevention approaches that include integration with the local setting, tailoring approaches to the needs and abilities of patients, and engaging patients and/or family or carers may reduce the rate of falls in older people in hospitals.

• Further research on the effectiveness of all intervention types aiming to prevent falls in hospitals is needed, particularly for people with cognitive impairment (memory or thinking problems) and in low- and middle-income countries.

Why is reducing falls in older people in hospitals important?

Falls by older people in hospitals are common events that may cause loss of independence, injuries, and sometimes death. Effective interventions to prevent falls are therefore important.

How do we report the interventions used to assess falls?

Trials testing interventions designed to reduce falls in older people are grouped by type, guided by the fall prevention classification system (taxonomy) developed by the Prevention of Falls Network Europe (ProFaNE).

Interventions are classified as single, multifactorial, or multiple, as follows.

• Single interventions: one category of intervention is delivered to all participants in the group. Categories include exercise, interventions aiming to improve medication prescribing (medication optimisation), environment/assistive technology, education, and service model change (where there is a change in the way a hospital delivers care to patients with the goal of reducing falls). Interventions designed to provide education about falls and falls prevention to staff and/or patients or family members are grouped together.

• Multifactorial interventions: two or more categories of intervention are given based on an assessment of a person's risk factors for falling. 

• Multiple interventions: the same combination of interventions is delivered to all participants.

What did we want to find out?

We wanted to know which interventions reduce falls in older people in hospitals in terms of the rate of falls (the actual number of falls over a period of time) and risk of falling (the likelihood that an individual will experience a fall). We also examined the impact on risk of fractures, unwanted effects, and economic outcomes.

What did we do?

We searched for studies that compared falls outcomes in people who received fall prevention interventions with falls outcomes in people who did not receive fall prevention interventions. We compared and summarised the results of the studies and rated our confidence in the evidence based on factors such as study methods and sizes.

What did we find?

We found 55 studies involving a total of 104,474 participants. On average, participants were 79 years old, and 45% were women.

• Education (staff, patient/family and multicomponent) probably reduces the rate of falls and risk of falling.

• Service model changes in acute hospitals probably reduce the rate of falls. We are uncertain about the effect of service model changes on the risk of falling. There were no trials of service model changes in subacute settings.

• We are uncertain about the effect of exercise on the rate of falls. Exercise may have little or no effect on the risk of falling in hospital settings overall.

• We are uncertain about the effect of medication optimisation on falls.

• Multifactorial interventions probably reduce the rate of falls and risk of falling, although it is also possible these interventions have no effect or slightly increase falls.

What are the limitations of the evidence?

We have moderate to very low confidence in the evidence. Our confidence was limited because people in most of the trials were aware of which treatment they were getting, and not all studies provided information about everything that we were interested in. Also, there were problems with the way data were collected in some studies.

How up-to-date is the evidence?

This review updates previous versions of the review published in 2010, 2012, and 2018. The evidence is current to 28 October 2025.