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Falls: Prevention in community-dwelling older persons

Douglas P Kiel, MD, MPH
Section Editor
Kenneth E Schmader, MD
Deputy Editor
Daniel J Sullivan, MD, MPH


Falls in older persons occur commonly and are major factors threatening the independence of older individuals. As is the case for many geriatric syndromes, falls usually occur when impairments in multiple domains compromise the compensatory ability of the individual [1].

Falls often go without clinical attention for a variety of reasons: the patient never mentions the event to a health care provider; there is no injury at the time of the fall; the provider fails to ask the patient about a history of falls; or either provider or patient erroneously believes that falls are an inevitable part of the aging process. Often, treatment of injuries resulting from a fall does not include investigation of the cause of the fall.

Significant morbidity and mortality may result from falls in older individuals. The importance of preventing falls is emphasized by a study that found that 80 percent of older women preferred death to a "bad" hip fracture that would result in nursing home admission [2].

A number of the physical conditions and environmental situations that predispose to falls are modifiable. Clinicians caring for older patients need to routinely inquire about falls, assess for fall risk, and address modifiable underlying risk factors.

This topic focuses on strategies to prevent falls in older persons. A discussion of risks for falls and evaluation of patients who have had falls is presented separately, as is a discussion of fall prevention in nursing facility and hospital environments. (See "Falls in older persons: Risk factors and patient evaluation" and "Falls: Prevention in nursing care facilities and the hospital setting".)


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Literature review current through: Aug 2017. | This topic last updated: Sep 19, 2017.
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  1. Tinetti ME, Inouye SK, Gill TM, Doucette JT. Shared risk factors for falls, incontinence, and functional dependence. Unifying the approach to geriatric syndromes. JAMA 1995; 273:1348.
  2. Salkeld G, Cameron ID, Cumming RG, et al. Quality of life related to fear of falling and hip fracture in older women: a time trade off study. BMJ 2000; 320:341.
  3. Robertson MC, Gillespie LD. Fall prevention in community-dwelling older adults. JAMA 2013; 309:1406.
  4. Kelsey JL, Procter-Gray E, Berry SD, et al. Reevaluating the implications of recurrent falls in older adults: location changes the inference. J Am Geriatr Soc 2012; 60:517.
  5. Robertson MC, Campbell AJ, Herbison P. Statistical analysis of efficacy in falls prevention trials. J Gerontol A Biol Sci Med Sci 2005; 60:530.
  6. Gillespie LD, Robertson MC, Gillespie WJ, et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 2012; :CD007146.
  7. Michael YL, Whitlock EP, Lin JS, et al. Primary care-relevant interventions to prevent falling in older adults: a systematic evidence review for the U.S. Preventive Services Task Force. Ann Intern Med 2010; 153:815.
  8. Province MA, Hadley EC, Hornbrook MC, et al. The effects of exercise on falls in elderly patients. A preplanned meta-analysis of the FICSIT Trials. Frailty and Injuries: Cooperative Studies of Intervention Techniques. JAMA 1995; 273:1341.
  9. Sherrington C, Whitney JC, Lord SR, et al. Effective exercise for the prevention of falls: a systematic review and meta-analysis. J Am Geriatr Soc 2008; 56:2234.
  10. El-Khoury F, Cassou B, Charles MA, Dargent-Molina P. The effect of fall prevention exercise programmes on fall induced injuries in community dwelling older adults: systematic review and meta-analysis of randomised controlled trials. BMJ 2013; 347:f6234.
  11. Li F, Eckstrom E, Harmer P, et al. Exercise and Fall Prevention: Narrowing the Research-to-Practice Gap and Enhancing Integration of Clinical and Community Practice. J Am Geriatr Soc 2016; 64:425.
  12. Uusi-Rasi K, Patil R, Karinkanta S, et al. Exercise and vitamin D in fall prevention among older women: a randomized clinical trial. JAMA Intern Med 2015; 175:703.
  13. Clemson L, Fiatarone Singh MA, Bundy A, et al. Integration of balance and strength training into daily life activity to reduce rate of falls in older people (the LiFE study): randomised parallel trial. BMJ 2012; 345:e4547.
  14. Okubo Y, Schoene D, Lord SR. Step training improves reaction time, gait and balance and reduces falls in older people: a systematic review and meta-analysis. Br J Sports Med 2017; 51:586.
  15. Gill TM, Pahor M, Guralnik JM, et al. Effect of structured physical activity on prevention of serious fall injuries in adults aged 70-89: randomized clinical trial (LIFE Study). BMJ 2016; 352:i245.
  16. Voukelatos A, Cumming RG, Lord SR, Rissel C. A randomized, controlled trial of tai chi for the prevention of falls: the Central Sydney tai chi trial. J Am Geriatr Soc 2007; 55:1185.
  17. Hwang HF, Chen SJ, Lee-Hsieh J, et al. Effects of Home-Based Tai Chi and Lower Extremity Training and Self-Practice on Falls and Functional Outcomes in Older Fallers from the Emergency Department-A Randomized Controlled Trial. J Am Geriatr Soc 2016; 64:518.
  18. Taylor D, Hale L, Schluter P, et al. Effectiveness of tai chi as a community-based falls prevention intervention: a randomized controlled trial. J Am Geriatr Soc 2012; 60:841.
  19. Lomas-Vega R, Obrero-Gaitán E, Molina-Ortega FJ, Del-Pino-Casado R. Tai Chi for Risk of Falls. A Meta-analysis. J Am Geriatr Soc 2017; 65:2037.
  20. Wolf SL, Sattin RW, Kutner M, et al. Intense tai chi exercise training and fall occurrences in older, transitionally frail adults: a randomized, controlled trial. J Am Geriatr Soc 2003; 51:1693.
  21. Logghe IH, Zeeuwe PE, Verhagen AP, et al. Lack of effect of Tai Chi Chuan in preventing falls in elderly people living at home: a randomized clinical trial. J Am Geriatr Soc 2009; 57:70.
  22. Yamada M, Tanaka B, Nagai K, et al. Trail-walking exercise and fall risk factors in community-dwelling older adults: preliminary results of a randomized controlled trial. J Am Geriatr Soc 2010; 58:1946.
  23. Mirelman A, Rochester L, Maidan I, et al. Addition of a non-immersive virtual reality component to treadmill training to reduce fall risk in older adults (V-TIME): a randomised controlled trial. Lancet 2016; 388:1170.
  24. Trombetti A, Hars M, Herrmann FR, et al. Effect of music-based multitask training on gait, balance, and fall risk in elderly people: a randomized controlled trial. Arch Intern Med 2011; 171:525.
  25. Pit SW, Byles JE, Henry DA, et al. A Quality Use of Medicines program for general practitioners and older people: a cluster randomised controlled trial. Med J Aust 2007; 187:23.
  26. Cranney A, Horsley T, O'Donnell S, et al. Effectiveness and safety of vitamin D in relation to bone health. Evid Rep Technol Assess (Full Rep) 2007; :1.
  27. Moyer VA, U.S. Preventive Services Task Force. Prevention of falls in community-dwelling older adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2012; 157:197.
  28. American Geriatrics Society Consensus Statement. Vitamin D for Prevention of Falls and their Consequences in Older Adults. www.geriatricscareonline.org (Accessed on January 23, 2014).
  29. American Geriatrics Society Workgroup on Vitamin D Supplementation for Older Adults. Recommendations abstracted from the American Geriatrics Society Consensus Statement on vitamin D for Prevention of Falls and Their Consequences. J Am Geriatr Soc 2014; 62:147.
  30. Bischoff-Ferrari HA, Dawson-Hughes B, Orav EJ, et al. Monthly High-Dose Vitamin D Treatment for the Prevention of Functional Decline: A Randomized Clinical Trial. JAMA Intern Med 2016; 176:175.
  31. Sanders KM, Stuart AL, Williamson EJ, et al. Annual high-dose oral vitamin D and falls and fractures in older women: a randomized controlled trial. JAMA 2010; 303:1815.
  32. Visser M, Deeg DJ, Lips P, Longitudinal Aging Study Amsterdam. Low vitamin D and high parathyroid hormone levels as determinants of loss of muscle strength and muscle mass (sarcopenia): the Longitudinal Aging Study Amsterdam. J Clin Endocrinol Metab 2003; 88:5766.
  33. Cauley JA, Lacroix AZ, Wu L, et al. Serum 25-hydroxyvitamin D concentrations and risk for hip fractures. Ann Intern Med 2008; 149:242.
  34. Bischoff-Ferrari HA, Dawson-Hughes B, Willett WC, et al. Effect of Vitamin D on falls: a meta-analysis. JAMA 2004; 291:1999.
  35. Bischoff HA, Stähelin HB, Dick W, et al. Effects of vitamin D and calcium supplementation on falls: a randomized controlled trial. J Bone Miner Res 2003; 18:343.
  36. Flicker L, MacInnis RJ, Stein MS, et al. Should older people in residential care receive vitamin D to prevent falls? Results of a randomized trial. J Am Geriatr Soc 2005; 53:1881.
  37. Bischoff-Ferrari HA, Orav EJ, Dawson-Hughes B. Effect of cholecalciferol plus calcium on falling in ambulatory older men and women: a 3-year randomized controlled trial. Arch Intern Med 2006; 166:424.
  38. Bischoff-Ferrari HA, Dawson-Hughes B, Staehelin HB, et al. Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trials. BMJ 2009; 339:b3692.
  39. Kalyani RR, Stein B, Valiyil R, et al. Vitamin D treatment for the prevention of falls in older adults: systematic review and meta-analysis. J Am Geriatr Soc 2010; 58:1299.
  40. Broe KE, Chen TC, Weinberg J, et al. A higher dose of vitamin d reduces the risk of falls in nursing home residents: a randomized, multiple-dose study. J Am Geriatr Soc 2007; 55:234.
  41. Murad MH, Elamin KB, Abu Elnour NO, et al. Clinical review: The effect of vitamin D on falls: a systematic review and meta-analysis. J Clin Endocrinol Metab 2011; 96:2997.
  42. Trivedi DP, Doll R, Khaw KT. Effect of four monthly oral vitamin D3 (cholecalciferol) supplementation on fractures and mortality in men and women living in the community: randomised double blind controlled trial. BMJ 2003; 326:469.
  43. Smith H, Anderson F, Raphael H, et al. Effect of annual intramuscular vitamin D on fracture risk in elderly men and women--a population-based, randomized, double-blind, placebo-controlled trial. Rheumatology (Oxford) 2007; 46:1852.
  44. DO-HEALTH do-health.eu/wordpress.
  45. VITAL www.vitalstudy.org (Accessed on February 03, 2016).
  46. Keall MD, Pierse N, Howden-Chapman P, et al. Home modifications to reduce injuries from falls in the Home Injury Prevention Intervention (HIPI) study: a cluster-randomised controlled trial. Lancet 2015; 385:2321.
  47. Cumming RG, Ivers R, Clemson L, et al. Improving vision to prevent falls in frail older people: a randomized trial. J Am Geriatr Soc 2007; 55:175.
  48. Haran MJ, Cameron ID, Ivers RQ, et al. Effect on falls of providing single lens distance vision glasses to multifocal glasses wearers: VISIBLE randomised controlled trial. BMJ 2010; 340:c2265.
  49. McKiernan FE. A simple gait-stabilizing device reduces outdoor falls and nonserious injurious falls in fall-prone older people during the winter. J Am Geriatr Soc 2005; 53:943.
  50. Gates S, Fisher JD, Cooke MW, et al. Multifactorial assessment and targeted intervention for preventing falls and injuries among older people in community and emergency care settings: systematic review and meta-analysis. BMJ 2008; 336:130.
  51. de Vries OJ, Peeters GM, Elders PJ, et al. Multifactorial intervention to reduce falls in older people at high risk of recurrent falls: a randomized controlled trial. Arch Intern Med 2010; 170:1110.
  52. Logan PA, Coupland CA, Gladman JR, et al. Community falls prevention for people who call an emergency ambulance after a fall: randomised controlled trial. BMJ 2010; 340:c2102.
  53. Wang X, Pi Y, Chen P, et al. Cognitive motor interference for preventing falls in older adults: a systematic review and meta-analysis of randomised controlled trials. Age Ageing 2015; 44:205.
  54. Mahoney JE. Why multifactorial fall-prevention interventions may not work: Comment on "Multifactorial intervention to reduce falls in older people at high risk of recurrent falls". Arch Intern Med 2010; 170:1117.
  55. The American Geriatrics Society Clinical Practice Guideline: Prevention of falls in older person (2010) http://www.americangeriatrics.org/health_care_professionals/clinical_practice/clinical_guidelines_recommendations/2010/ (Accessed on January 18, 2011).
  56. Gillespie LD, Robertson MC, Gillespie WJ, et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 2009; :CD007146.
  57. Kenny RA, Richardson DA, Steen N, et al. Carotid sinus syndrome: a modifiable risk factor for nonaccidental falls in older adults (SAFE PACE). J Am Coll Cardiol 2001; 38:1491.
  58. Tseng VL, Yu F, Lum F, Coleman AL. Risk of fractures following cataract surgery in Medicare beneficiaries. JAMA 2012; 308:493.
  59. Neelemaat F, Lips P, Bosmans JE, et al. Short-term oral nutritional intervention with protein and vitamin D decreases falls in malnourished older adults. J Am Geriatr Soc 2012; 60:691.
  60. Spink MJ, Menz HB, Fotoohabadi MR, et al. Effectiveness of a multifaceted podiatry intervention to prevent falls in community dwelling older people with disabling foot pain: randomised controlled trial. BMJ 2011; 342:d3411.
  61. Tinetti ME, Baker DI, McAvay G, et al. A multifactorial intervention to reduce the risk of falling among elderly people living in the community. N Engl J Med 1994; 331:821.
  62. Tinetti ME, Baker DI, Garrett PA, et al. Yale FICSIT: risk factor abatement strategy for fall prevention. J Am Geriatr Soc 1993; 41:315.
  63. Feder G, Cryer C, Donovan S, Carter Y. Guidelines for the prevention of falls in people over 65. The Guidelines' Development Group. BMJ 2000; 321:1007.
  64. Vieira ER, Palmer RC, Chaves PH. Prevention of falls in older people living in the community. BMJ 2016; 353:i1419.
  65. Tinetti ME, Kumar C. The patient who falls: "It's always a trade-off". JAMA 2010; 303:258.
  66. Close J, Ellis M, Hooper R, et al. Prevention of falls in the elderly trial (PROFET): a randomised controlled trial. Lancet 1999; 353:93.
  67. Elley CR, Robertson MC, Garrett S, et al. Effectiveness of a falls-and-fracture nurse coordinator to reduce falls: a randomized, controlled trial of at-risk older adults. J Am Geriatr Soc 2008; 56:1383.
  68. Hendriks MR, Bleijlevens MH, van Haastregt JC, et al. Lack of effectiveness of a multidisciplinary fall-prevention program in elderly people at risk: a randomized, controlled trial. J Am Geriatr Soc 2008; 56:1390.
  69. Tinetti ME. Multifactorial fall-prevention strategies: time to retreat or advance. J Am Geriatr Soc 2008; 56:1563.
  70. Tinetti ME, Baker DI, King M, et al. Effect of dissemination of evidence in reducing injuries from falls. N Engl J Med 2008; 359:252.
  71. Parker MJ, Gillespie LD, Gillespie WJ. Hip protectors for preventing hip fractures in the elderly. Cochrane Database Syst Rev 2003; :CD001255.
  72. Parker MJ, Gillespie WJ, Gillespie LD. Effectiveness of hip protectors for preventing hip fractures in elderly people: systematic review. BMJ 2006; 332:571.
  73. van Schoor NM, Smit JH, Bouter LM, et al. Maximum potential preventive effect of hip protectors. J Am Geriatr Soc 2007; 55:507.
  74. Birks YF, Porthouse J, Addie C, et al. Randomized controlled trial of hip protectors among women living in the community. Osteoporos Int 2004; 15:701.
  75. Laing AC, Feldman F, Jalili M, et al. The effects of pad geometry and material properties on the biomechanical effectiveness of 26 commercially available hip protectors. J Biomech 2011; 44:2627.
  76. McCloskey EV, Lenaghan E, Clarke S, et al. Screening based on FRAX fracture risk assessment reduces the incidence of hip fractures in older community-dwelling women - results from the SCOOP study in the UK. Abstract, American Society for Bone and Mineral Research, 2016.
  77. Kiely DK, Kiel DP, Burrows AB, Lipsitz LA. Identifying nursing home residents at risk for falling. J Am Geriatr Soc 1998; 46:551.
  78. French DD, Werner DC, Campbell RR, et al. A multivariate fall risk assessment model for VHA nursing homes using the minimum data set. J Am Med Dir Assoc 2007; 8:115.
  79. Bateni H, Heung E, Zettel J, et al. Can use of walkers or canes impede lateral compensatory stepping movements? Gait Posture 2004; 20:74.
  80. Tinetti ME, Liu WL, Claus EB. Predictors and prognosis of inability to get up after falls among elderly persons. JAMA 1993; 269:65.
  81. Fleming J, Brayne C, Cambridge City over-75s Cohort (CC75C) study collaboration. Inability to get up after falling, subsequent time on floor, and summoning help: prospective cohort study in people over 90. BMJ 2008; 337:a2227.