BACKGROUND: Approximately 30% of people over 65 years of age living in the 
community fall each year. This is an update of a Cochrane review first published 
in 2009.
OBJECTIVES: To assess the effects of interventions designed to reduce the 
incidence of falls in older people living in the community.
SEARCH METHODS: We searched the Cochrane Bone, Joint and Muscle Trauma Group 
Specialised Register (February 2012), CENTRAL (The Cochrane Library 2012, Issue 
3), MEDLINE (1946 to March 2012), EMBASE (1947 to March 2012), CINAHL (1982 to 
February 2012), and online trial registers.
SELECTION CRITERIA: Randomised trials of interventions to reduce falls in 
community-dwelling older people.
DATA COLLECTION AND ANALYSIS: Two review authors independently assessed risk of 
bias and extracted data. We used a rate ratio (RaR) and 95% confidence interval 
(CI) to compare the rate of falls (e.g. falls per person year) between 
intervention and control groups. For risk of falling, we used a risk ratio (RR) 
and 95% CI based on the number of people falling (fallers) in each group. We 
pooled data where appropriate.
MAIN RESULTS: We included 159 trials with 79,193 participants. Most trials 
compared a fall prevention intervention with no intervention or an intervention 
not expected to reduce falls. The most common interventions tested were exercise 
as a single intervention (59 trials) and multifactorial programmes (40 trials). 
Sixty-two per cent (99/159) of trials were at low risk of bias for sequence 
generation, 60% for attrition bias for falls (66/110), 73% for attrition bias 
for fallers (96/131), and only 38% (60/159) for allocation 
concealment.Multiple-component group exercise significantly reduced rate of 
falls (RaR 0.71, 95% CI 0.63 to 0.82; 16 trials; 3622 participants) and risk of 
falling (RR 0.85, 95% CI 0.76 to 0.96; 22 trials; 5333 participants), as did 
multiple-component home-based exercise (RaR 0.68, 95% CI 0.58 to 0.80; seven 
trials; 951 participants and RR 0.78, 95% CI 0.64 to 0.94; six trials; 714 
participants). For Tai Chi, the reduction in rate of falls bordered on 
statistical significance (RaR 0.72, 95% CI 0.52 to 1.00; five trials; 1563 
participants) but Tai Chi did significantly reduce risk of falling (RR 0.71, 95% 
CI 0.57 to 0.87; six trials; 1625 participants).Multifactorial interventions, 
which include individual risk assessment, reduced rate of falls (RaR 0.76, 95% 
CI 0.67 to 0.86; 19 trials; 9503 participants), but not risk of falling (RR 
0.93, 95% CI 0.86 to 1.02; 34 trials; 13,617 participants).Overall, vitamin D 
did not reduce rate of falls (RaR 1.00, 95% CI 0.90 to 1.11; seven trials; 9324 
participants) or risk of falling (RR 0.96, 95% CI 0.89 to 1.03; 13 trials; 
26,747 participants), but may do so in people with lower vitamin D levels before 
treatment.Home safety assessment and modification interventions were effective 
in reducing rate of falls (RR 0.81, 95% CI 0.68 to 0.97; six trials; 4208 
participants) and risk of falling (RR 0.88, 95% CI 0.80 to 0.96; seven trials; 
4051 participants). These interventions were more effective in people at higher 
risk of falling, including those with severe visual impairment. Home safety 
interventions appear to be more effective when delivered by an occupational 
therapist.An intervention to treat vision problems (616 participants) resulted 
in a significant increase in the rate of falls (RaR 1.57, 95% CI 1.19 to 2.06) 
and risk of falling (RR 1.54, 95% CI 1.24 to 1.91). When regular wearers of 
multifocal glasses (597 participants) were given single lens glasses, all falls 
and outside falls were significantly reduced in the subgroup that regularly took 
part in outside activities. Conversely, there was a significant increase in 
outside falls in intervention group participants who took part in little outside 
activity.Pacemakers reduced rate of falls in people with carotid sinus 
hypersensitivity (RaR 0.73, 95% CI 0.57 to 0.93; three trials; 349 participants) 
but not risk of falling. First eye cataract surgery in women reduced rate of 
falls (RaR 0.66, 95% CI 0.45 to 0.95; one trial; 306 participants), but second 
eye cataract surgery did not.Gradual withdrawal of psychotropic medication 
reduced rate of falls (RaR 0.34, 95% CI 0.16 to 0.73; one trial; 93 
participants), but not risk of falling. A prescribing modification programme for 
primary care physicians significantly reduced risk of falling (RR 0.61, 95% CI 
0.41 to 0.91; one trial; 659 participants).An anti-slip shoe device reduced rate 
of falls in icy conditions (RaR 0.42, 95% CI 0.22 to 0.78; one trial; 109 
participants). One trial (305 participants) comparing multifaceted podiatry 
including foot and ankle exercises with standard podiatry in people with 
disabling foot pain significantly reduced the rate of falls (RaR 0.64, 95% CI 
0.45 to 0.91) but not the risk of falling.There is no evidence of effect for 
cognitive behavioural interventions on rate of falls (RaR 1.00, 95% CI 0.37 to 
2.72; one trial; 120 participants) or risk of falling (RR 1.11, 95% CI 0.80 to 
1.54; two trials; 350 participants).Trials testing interventions to increase 
knowledge/educate about fall prevention alone did not significantly reduce the 
rate of falls (RaR 0.33, 95% CI 0.09 to 1.20; one trial; 45 participants) or 
risk of falling (RR 0.88, 95% CI 0.75 to 1.03; four trials; 2555 
participants).No conclusions can be drawn from the 47 trials reporting 
fall-related fractures.Thirteen trials provided a comprehensive economic 
evaluation. Three of these indicated cost savings for their interventions during 
the trial period: home-based exercise in over 80-year-olds, home safety 
assessment and modification in those with a previous fall, and one 
multifactorial programme targeting eight specific risk factors.
AUTHORS' CONCLUSIONS: Group and home-based exercise programmes, and home safety 
interventions reduce rate of falls and risk of falling.Multifactorial assessment 
and intervention programmes reduce rate of falls but not risk of falling; Tai 
Chi reduces risk of falling.Overall, vitamin D supplementation does not appear 
to reduce falls but may be effective in people who have lower vitamin D levels 
before treatment.