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 settings1. 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 supplementation1. Fall prevention efforts are covered as part of the Medicare Annual Wellness Visit2; providers may also connect patients to local fall prevention programs3. 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 confidence4.
What could this strategy improve?
Expected Benefits
Our evidence rating is based on the likelihood of achieving these outcomes:
Reduced falls
Potential Benefits
Our evidence rating is not based on these outcomes, but these benefits may also be possible:
Reduced injuries
What does the research say about effectiveness?
There is strong evidence that multi-component fall prevention interventions reduce the rate of falls and the risk of falling among older adults1, 4, 5, 6, 7, 8, 9.
Multi-component interventions have been shown to reduce falls in community and clinical settings1. These interventions 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 facilities1, 10. Including an exercise component, particularly with exercises that improve balance, may further reduce fall rates1, 5, 6, 8, especially for patients with cognitive impairments in care facilities10. Combining exercise and vision assessments with treatment may reduce injury rates8. Strength training and nutrition education provided by lay volunteers during home visits can increase physical activity and reduce fear of falling11.
Multi-component interventions tailored to individual’s needs have consistently been shown to reduce falls for older adults in community settings9. Interventions that include home visits and address home hazards also reduce fall risk for community-dwelling older adults without cognitive impairments10. Multi-component interventions that include calcium and vitamin D supplements have been shown to reduce falls8, 10 and fractures for older adults in community settings8. Additional research is needed on how older adults and health care providers can work as partners in fall prevention efforts, improving patient engagement and reducing falls12.
How could this strategy advance health equity? This strategy is rated inconclusive impact on disparities.
It is unclear what impact multi-component fall prevention interventions for older adults can have on disparities in health; there is no published literature available about which disparities these interventions could address.
What is the relevant historical background?
Falling is a significant public health issue: 14 million U.S. adults ages 65 or older experience a fall each year, and falls are the leading cause of injury-related deaths in this age group19. Rates of falls double with each additional decade beyond age 7020, increasing the potential for chronic complications and disability among older adults21. Approximately 3 million older adults receive care in emergency departments for fall-related injuries each year, with 20% of falls requiring hospitalization for serious complications such as hip fractures or head injuries21. By 2029, roughly 20% of U.S. residents will be ages 65 or older (71.4 million people)22.
Older adults are at greater risk of falling due to decreased body strength, the use of certain medications, balance-related problems, vision problems, and insufficient levels of vitamin D; women have a higher risk of falling then men21. The American and British Geriatrics Societies clinical practice guideline recommends that all adults ages 65 and older receive annual screening for falls by their primary health care provider, including questions such as if they have fallen two or more times in the past year, if a fall caused injury, or if they have difficulties walking or with balance; patients answering “yes” require additional evaluation20.
Care related to falls by older adults cost Medicare and Medicaid Services roughly $37.5 billion in 201521.
Equity Considerations
- What resources are available for multi-component fall prevention interventions for older adults in your community? Who is less likely to access or receive the care and services available?
- How can programs offering multi-component fall prevention interventions be more equitably delivered? What partnership opportunities exist in your community to increase access to these services?
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 50 state-level coalitions along with one in Washington, D.C.13, 14. 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 falls15.
The National Association of County and City Health Officials (NACCHO) offers numerous resources for local health departments to establish fall prevention programs, identify older adults at higher risk of falling, spread awareness about falling among older adults, and partner with local health systems on broader fall prevention efforts16.
The National Council on Aging (NCOA) features information about numerous multi-component fall prevention programs, such as Bingocize, CAPABLE, Fit & Strong, and Tai Chi, which combine elements of education, exercise, balance training, and home safety modifications17.
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 balance18.
Implementation Resources
‡ Resources with a focus on equity.
NCOA-Falls prevention - National Council on Aging (NCOA). National Falls Prevention Resource Center.
CDC-STEADI - Centers for Disease Control and Prevention (CDC). STEADI (Stopping Elderly Accidents, Deaths & Injuries) tools for health care providers and patients.
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-Burns 2023 - Burns, E., Kakara, R., & Moreland, B. (2023). CDC compendium of effective fall interventions: What works for community-dwelling older adults (4th edition). Atlanta: Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control (NCIPC).
WIHA-Falls Free Wisconsin - Wisconsin Institute for Healthy Aging (WIHA). (2025). Falls Free Wisconsin: You can reduce your risk of a fall – Falls Free Wisconsin can help! Accessed February 28, 2025.
CDC-STEADI Fact sheets - Centers for Disease Control and Prevention (CDC). (2023). Fact sheets: Helping my older patients reduce their risk of falling. STEADI (Stopping Elderly Accidents, Deaths & Injuries) tools for health care providers and patients. Accessed February 28, 2025.
NCOA-EV Fall prevention - National Council on Aging (NCOA). (2023, December 1). Evidence-based programs: Evidence-based falls prevention programs. Accessed February 28, 2025.
Footnotes
* Journal subscription may be required for access.
1 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.
2 Van Voast Moncada 2017 - Van Voast Moncada L, Mire LG. Preventing falls in older persons. American Family Physician. 2017;96(4):240-247.
3 Phelan 2015 - Phelan EA, Mahoney JE, Voit JC, Stevens JA. Assessment and management of fall risk in primary care settings. Medical Clinics of North America. 2015;99(2):281-293.
4 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.
5 Dautzenberg 2021 - Dautzenberg, L., Beglinger, S., Tsokani, S., Zevgiti, S., Raijmann, R. C. M. A., Rodondi, N., Scholten, R. J. P. M., Rutjes, A. W. S., Di Nisio, M., Emmelot‐Vonk, M., Tricco, A. C., Straus, S. E., Thomas, S., Bretagne, L., Knol, W., Mavridis, D., & Koek, H. L. (2021). Interventions for preventing falls and fall‐related fractures in community‐dwelling older adults: A systematic review and network meta‐analysis. Journal of the American Geriatrics Society, 69(10), 2973–2984.
6 Cheng 2018 - Cheng, P., Tan, L., Ning, P., Li, L., Gao, Y., Wu, Y., Schwebel, D. C., Chu, H., Yin, H., & Hu, G. (2018). Comparative effectiveness of published interventions for elderly fall prevention: A systematic review and network meta-analysis. International Journal of Environmental Research and Public Health, 15(3), 498.
7 Elliott 2018a - Elliott, S., & Leland, N. E. (2018). Occupational therapy fall prevention interventions for community-dwelling older adults: A systematic review. The American Journal of Occupational Therapy, 72(4), 7204190040p1-7204190040p11.
8 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.
9 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.
10 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.
11 Kapan 2017 - Kapan, A., Luger, E., Haider, S., Titze, S., Schindler, K., Lackinger, C., & Dorner, T. E. (2017). Fear of falling reduced by a lay led home-based program in frail community-dwelling older adults: A randomised controlled trial. Archives of Gerontology and Geriatrics, 68, 25–32.
12 McMahon 2022 - McMahon, S. K., Greene, E. J., Latham, N., Peduzzi, P., Gill, T. M., Bhasin, S., & Reuben, D. B. (2022). Engagement of older adults in STRIDE ’s multifactorial fall injury prevention intervention. Journal of the American Geriatrics Society, 70(11), 3116–3126.
13 NCOA-Falls prevention - National Council on Aging (NCOA). National Falls Prevention Resource Center.
14 NCOA-Falls Free Initiative - National Council on Aging (NCOA). National Falls Prevention Resource Center. Falls Free Initiative.
15 CDC-STEADI - Centers for Disease Control and Prevention (CDC). STEADI (Stopping Elderly Accidents, Deaths & Injuries) tools for health care providers and patients.
16 NACCHO-Fall prevention - National Association of County & City Health Officials (NACCHO). (n.d.). Older adult fall prevention: Evaluation guidance, issue briefs, guide for local health departments, and resources. Accessed February 28, 2025.
17 NCOA-EV Fall prevention - National Council on Aging (NCOA). (2023, December 1). Evidence-based programs: Evidence-based falls prevention programs. Accessed February 28, 2025.
18 MaineHealth-MOB - MaineHealth. A Matter of Balance (MOB): Reduce the fear of falling and increase activity levels among older adults.
19 Colon-Emeric 2024 - Colón-Emeric, C. S., McDermott, C. L., Lee, D. S., & Berry, S. D. (2024). Risk assessment and prevention of falls in older community-dwelling adults: A review. Journal of the American Medical Association, 331(16), 1397.
20 Phelan 2018 - Phelan, E. A., & Ritchey, K. (2018). Fall prevention in community-dwelling older adults. Annals of Internal Medicine, 169(11), ITC81–ITC96.
21 Ojo 2022 - Ojo, E. O., & Thiamwong, L. (2022). Effects of nurse-led fall prevention programs for older adults: A systematic review. Pacific Rim International Journal of Nursing Research.
22 Polland 2014 - Polland, K., & Scommegna, P. (2014, April 16). Just how many baby boomers are there? Population Reference Bureau (PRB). Accessed February 28, 2025.
Related What Works for Health Strategies
To see all strategies:
countyhealthrankings.org/whatworks