Changing the environment to prevent falls in older people

There is high-certainty evidence that home fall-hazard interventions are effective in reducing the rate of falls and the number of fallers when targeted at people at higher risk of falling (based on history of falling, recent hospitalisation, and other risk factors). For the selected higher-risk category, based on an illustrative risk of 1847 falls per 1000 person-years in the control group, there were 702 (38%) fewer falls per 1000 person-years in the home fall-hazard intervention group. These interventions aim to reduce falls by assessing fall hazards and making environmental safety adaptations (eg, non-slip strips on steps) or behavioural changes (eg, avoiding clutter).

There was no evidence of effect when interventions were targeted to people not selected for risk of falling. It makes sense that this intervention, which focuses on the home environment and interaction of the person within their environment, would benefit those at higher risk rather than the general community of older people.

It was unclear whether assistive technology, education interventions or home modifications reduce falls, but this evidence was all of low or very-low quality, which was in part due to very low sample numbers.