Preventing falls in older people: new evidence on what helps

Sarah Chapman from Cochrane UK shares new evidence on what can be done to reduce falls in older people at home by assessing hazards and making adaptations to the home environment and, importantly, who is likely to benefit most from these. 

Blog updated 20 November 2023 to include the new review on CBT with or without exercise for reducing fear of falling.

Take-home points

There is reliable new Cochrane evidence that interventions to assess fall hazards and make safety adaptations in the home environment, given to older adults at higher risk of falling, reduce the rate of falls and the number of people who fall There is evidence that these interventions make little or no difference if given to older people who are not selected as being at high risk of falling Remaining uncertainties include which parts of the intervention matter most and of other approaches to preventing falls

Many of us worry about the risk of older friends or family members having a fall, and the (often) awful consequences of that.

If you’re an older person, this might be something you worry about for yourself – and maybe that limits what you do. It’s a reasonable fear. Falls are so common (in one year, a third of people aged over 65 and living at home will fall, and half of people aged over 80) and one in three falls happen at home. In an ageing population, this is a growing problem and, with the current pressures on NHS resources, falls prevention feels more important than ever.

Whilst there are many things that contribute to falls, environmental factors are often at work. Among my own older relatives, a cat, a shower tray and a coffee table have all caused falls. But we want our cats and our coffee tables, so what’s to be done? I feel the answer probably doesn’t lie in adopting the shuffling gait my grandmother used to nudge the cat along ahead of her as it tried to wind around her ankles.

However, new evidence from Cochrane does have some answers. The systematic review Environmental interventions for preventing falls in older people living in the community (published March 2023) brings together the best available evidence on this topic, drawing on 22 studies with almost 8500 older people (average age 78). While it highlights things we still don’t know, it also gives us reliable evidence that there are things that help.

Reducing hazards in the home – big gains for people at higher risk of falls

Fourteen of the studies in the review looked at tackling fall hazards in the home. In most of these, there was one home visit (often by an occupational therapist) to assess fall hazards, raise awareness of risks, problem-solve together and make modifications as necessary – things like adding grab rails, improving lighting, putting non-slip strips on steps and removing clutter.

The review authors found reliable (high-certainty) evidence that, among people at higher risk of falling, these kinds of measures:

  • reduce the number of falls by 38%
  • probably also reduce the number of people who fall once or more by just over a quarter.

Those at higher risk include those who have fallen in the past year, have been in hospital recently, or who need help with everyday activities.

When the review authors looked at the effect of these measures in older people not at higher risk of falling, they found they make little or no difference.

The evidence doesn’t tell us whether they make any difference to the number of people breaking a bone or needing medical attention or hospitalisation because of falls.

Uncertainty about other measures to reduce falls

The review authors found only limited evidence on other measures, so we still don’t know with any certainty about the impact of assistive devices such as special footwear, or improving vision, or home modifications designed to help people be independent in doing everyday tasks, or educating people about fall hazards.

Since this review, a new Cochrane Review has been published on Cognitive behavioural therapy (CBT) with and without exercise to reduce fear of falling in older people living in the community (November 2023). Whilst the evidence suggests that CBT with and without exercise probably reduces fear of falling in this population, the effect is small, and it’s unclear whether people have fewer falls after this intervention. It’s a big shortcoming in the studies included in the review that none looked at whether there were any harms caused by CBT, with and without exercise, so let’s hope future research looks at that important aspect.

Getting closer to understanding how to reduce falls

The evidence in this review can encourage us to do things to make our homes safer that don’t entail getting rid of the cat or the coffee table. It may also help to direct resources where they are most needed, establishing the benefit of assessing hazards and making safety adaptations to the home environment for those older people at high risk of falling.

The other story here is of the evolution of research in falls prevention, which is narrowing over time, refining the questions researchers are asking and getting us closer to understanding which interventions work and what components are important, how they should be delivered and who should be given them. The review authors give some detailed suggestions for future research and highlight the importance of studies reporting any harms from environmental changes.



Clemson L, Stark S, Pighills AC, Fairhall NJ, Lamb SE, Ali J, Sherrington C. Environmental interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews 2023, Issue 3. Art. No.: CD013258. DOI: 10.1002/14651858.CD013258.pub2.

Related Cochrane Editorial:

Lewis SR, Griffin XL. Preventing falls in older people: the evidence for environmental interventions and why history matters. Cochrane Database of Systematic Reviews 2023;(3):ED000162.

Lenouvel E, Ullrich P, Siemens W, Dallmeier D, Denkinger M, Kienle G, Zijlstra GA, Hauer K, Klöppel S. Cognitive behavioural therapy (CBT) with and without exercise to reduce fear of falling in older people living in the community. Cochrane Database of Systematic Reviews 2023, Issue 11. Art. No.: CD014666. DOI: 10.1002/14651858.CD014666.pub2.


Join in the conversation on Twitter with @CochraneUK @SarahChapman30 or leave a comment on the blog. 

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Sarah Chapman has nothing to disclose.

Preventing falls in older people: new evidence on what helps by Sarah Chapman

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