Multi-component fall prevention interventions for older adults

Health care providers, such as primary care physicians and physical therapists, often deliver a fixed, multi-component set of fall prevention interventions to older adults living in community settings, as well as long-term care or clinical settings (Goodwin 2014). Interventions can be provided without individual risk assessments and typically include various combinations of exercise (i.e., balance, strength, and endurance training), education, home or environmental modification, medication management, and vitamin D supplementation (Goodwin 2014). Fall prevention efforts are covered as part of the Medicare Annual Wellness Visit (); providers may also connect patients to local fall prevention programs (Phelan 2015). Falls can lead to physical injuries with long lasting effects, increased risk of early death, and psychological concerns such as fear of falling and loss of confidence (CDC-Falls, ).

Expected Beneficial Outcomes (Rated)

  • Reduced falls

Other Potential Beneficial Outcomes

  • Reduced injuries

Evidence of Effectiveness

There is strong evidence that multi-component fall prevention interventions reduce the rate of falls and the risk of falling among older adults (, , Goodwin 2014, ). 

Multi-component interventions have been shown to reduce falls in community and clinical settings (Goodwin 2014). Such efforts can reduce the rate and risk of falls for older adults who live independently in the community, and may also benefit those living in care facilities (, Goodwin 2014). Including an exercise component, particularly exercises that improve balance, may further reduce fall rates (, Goodwin 2014). Combining exercise and vision assessments with treatment may reduce injury rates ().

Multi-component interventions tailored to individual’s needs have consistently been shown to reduce falls for older adults in community settings (). Interventions that include home visits and correct home hazards also reduce fall risk for community-dwelling older adults without cognitive impairments (). Multi-component interventions that include calcium and vitamin D supplements have been shown to reduce falls (, ) and fractures for older adults in community settings ().

Exercise-related multi-component interventions in care facilities benefit patients with cognitive impairments more than those without impairments ().

Impact on Disparities

No impact on disparities likely

Implementation Examples

The National Council on Aging’s National Falls Prevention Resource Center supports fall prevention programs across the country and coordinates the Falls Free Initiative, which includes 43 state-level coalitions (NCOA-Falls prevention). The Centers for Disease Control and Prevention’s (CDC’s) older adult fall prevention program, STEADI (Stopping Elderly Accidents, Deaths, & Injuries), provides tools and educational materials for patients and providers on how to prevent falls (CDC-STEADI).

A Matter of Balance is a nationally recognized fall prevention program for older adults that teaches participants how to reduce their fall risk at home through exercises to improve strength and balance (MaineHealth-MOB).

Implementation Resources

CDC-STEADI - Centers for Disease Control and Prevention (CDC). STEADI (Stopping Elderly Accidents, Deaths & Injuries) tools for health care providers and patients.

IHI-TCAB - Institute for Healthcare Improvement (IHI). Transforming Care at the Bedside how-to guide: Reducing patient injuries from falls.

NCOA-Falls prevention - National Council on Aging (NCOA). National falls prevention resource center.

CDC-Fall guide - National Center for Injury Prevention and Control (NCIPC). Preventing falls: A guide to implementing effective community-based fall prevention programs. 2nd edition. Atlanta: Centers for Disease Control and Prevention (CDC). 2015.

CDC-Stevens 2015 - Stevens JA, Burns ER. CDC compendium of effective fall interventions: What works for community-dwelling older adults. 3rd edition. Atlanta: Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control (NCIPC). 2015.

Citations - Evidence

* Journal subscription may be required for access.

Goodwin 2014 - Goodwin VA, Abbott RA, Whear R, et al. Multiple component interventions for preventing falls and fall-related injuries among older people: Systematic review and meta-analysis. BMC Geriatrics. 2014;14:15.

Cochrane-Gillespie 2012* - Gillespie LD, Robertson MC, Gillespie WJ, et al. Interventions for preventing falls in older people living in the community: Review. The Cochrane Database of Systematic Reviews. 2012;(9):CD007146.

Tricco 2017* - Tricco AC, Thomas SM, Veroniki AA, et al. Comparisons of interventions for preventing falls in older adults: A systematic review and meta-analysis. JAMA. 2017;318(17):1687-1699.

Guo 2014* - Guo JL, Tsai YY, Liao JY, Tu HM, Huang CM. Interventions to reduce the number of falls among older adults with/without cognitive impairment: An exploratory meta-analysis. International Journal of Geriatric Psychiatry. 2014;29(7):661-669.

Stubbs 2015* - Stubbs B, Brefka S, Denkinger MD. What works to prevent falls in community-dwelling older adults? Umbrella review of meta-analyses of randomized controlled trials. Physical Therapy. 2015;95(8):1095-1110.

Citations - Implementation Examples

* Journal subscription may be required for access.

CDC-STEADI - Centers for Disease Control and Prevention (CDC). STEADI (Stopping Elderly Accidents, Deaths & Injuries) tools for health care providers and patients.

NCOA-Falls prevention - National Council on Aging (NCOA). National falls prevention resource center.

MaineHealth-MOB - MaineHealth. A Matter of Balance (MOB): reduce the fear of falling and increase activity levels among older adults.

Date Last Updated

Mar 26, 2018