Risk assessments & personalized approaches to fall prevention among older adults
Risk assessments that gauge an individual’s risk of falling allow providers to personalize fall prevention interventions based on that individual’s needs. Such assessments are typically provided to older adults by health professionals such as registered nurses or physicians and can include a functional assessment, balance and gait assessments, and exercise assessments. Following assessment, individuals are provided multi-component interventions designed to reduce their fall risk, which may include exercise (i.e., balance, strength, and endurance training), home or environmental modification, medication management, education, or vitamin D supplementation. Patients can also be referred to specialists such as physical therapists for assessment and personally adapted interventions1. 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 confidence2. Fall prevention efforts are covered as part of the Medicare Annual Wellness Visit3.
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 individual risk assessments and personalized fall prevention interventions reduce the rate of falls among older adults living in community settings1, 2, 4, 5. Such interventions may also reduce falls among older hospital patients, especially those with longer lengths of stay2.
Individual risk assessments and tailored home-based exercise programs significantly reduce falls, and improve balance, strength, and function among older adults in community settings5. Exercise, a typical component of personalized programs, has been shown to reduce fall rates6, 7. Approaches that combine exercise and vision assessments with treatment have been shown to reduce injury rates, and including vitamin D and calcium supplements can reduce falls and fractures4. Tailored balance-challenging exercises have been shown to reduce falls among people with Parkinson’s disease8.
Personalized fall prevention efforts can be incorporated into standard practice in both primary care and long-term care settings9. Experts suggest that clinicians inquire about depression10 along with foot pain and chronic pain during fall risk assessments, as each is associated with an increased risk of falling11.
How could this strategy advance health equity? This strategy is rated inconclusive impact on disparities.
It is unclear what impact individual risk assessments and personalized fall prevention interventions for older adults can have on disparities in health; there is no published research available about which disparities risk assessments and personalized approaches 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 group16. Rates of falls double with each additional decade beyond age 7017, increasing the potential for chronic complications and disability among older adults18. 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 injuries18. By 2029, roughly 20% of U.S. residents will be ages 65 or older (71.4 million people)19.
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 men18. 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 evaluation17.
Care related to falls by older adults cost Medicare and Medicaid Services roughly $37.5 billion in 201518.
Equity Considerations
- What resources are available for risk assessments and personalized approaches to falls prevention for older adults in your community? Who is less likely to access and receive the care and services available?
- How can programs offering risk assessments and personalized approaches to falls prevention be more equitably delivered? What partnership opportunities exist in your community to increase access to these services?
Implementation Examples
The Centers for Disease Control and Prevention’s (CDC’s) older adult fall prevention program, STEADI (Stopping Elderly Accidents, Deaths, & Injuries), provides tools, online trainings, and educational materials for patients and providers on how to prevent falls, including methods to incorporate STEADI in primary care and family medicine practices12, 13. STEADI’s Algorithm for fall risk screening, assessment, and intervention offers guidance for health care providers on how to screen, assess, and intervene to reduce fall risk14.
The Mayo Clinic provides advice on six fall prevention strategies for older adults, including guidance regarding risk factors to discuss with health care providers15.
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.
Mayo Clinic-Falls - Mayo Clinic. (2024). Fall prevention: Simple tips to prevent falls. Accessed February 28, 2025.
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).
Footnotes
* Journal subscription may be required for access.
1 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.
2 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.
3 Van Voast Moncada 2017 - Van Voast Moncada L, Mire LG. Preventing falls in older persons. American Family Physician. 2017;96(4):240-247.
4 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.
5 Hill 2015a - Hill KD, Hunter SW, Batchelor FA, Cavalheri V, Burton E. Individualized home-based exercise programs for older people to reduce falls and improve physical performance: A systematic review and meta-analysis. Maturitas. 2015;82(1):72-84.
6 Sherrington 2020 - Sherrington, C., Fairhall, N., Kwok, W., Wallbank, G., Tiedemann, A., Michaleff, Z. A., Ng, C. A. C. M., & Bauman, A. (2020). Evidence on physical activity and falls prevention for people aged 65+ years: Systematic review to inform the WHO guidelines on physical activity and sedentary behaviour. International Journal of Behavioral Nutrition and Physical Activity, 17(1), 144.
7 Sherrington 2017 - Sherrington C, Michaleff ZA, Fairhall N, et al. Exercise to prevent falls in older adults: An updated systematic review and meta-analysis. British Journal of Sports Medicine. 2017;51(24):1750-1758.
8 Canning 2014 - Canning CG, Paul SS, Nieuwboer A. Prevention of falls in Parkinson’s disease: A review of fall risk factors and the role of physical interventions. Neurodegenerative Disease Management. 2014;4(3):203-221.
9 Eckstrom 2016 - Eckstrom E, Neal MB, Cotrell V, et al. An interprofessional approach to reducing the risk of falls through enhanced collaborative practice. Journal of the American Geriatrics Society. 2016;64(8):1701-1707.
10 Kvelde 2015 - Kvelde T, Lord SR, Close JCT, et al. Depressive symptoms increase fall risk in older people, independent of antidepressant use, and reduced executive and physical functioning. Archives of Gerontology and Geriatrics. 2015;60(1):190-195.
11 Stubbs 2014 - Stubbs B, Binnekade T, Eggermont L, et al. Pain and the risk for falls in community-dwelling older adults: Systematic review and meta-analysis. Archives of Physical Medicine and Rehabilitation. 2014;95(1):175-187.e9.
12 CDC-STEADI - Centers for Disease Control and Prevention (CDC). STEADI (Stopping Elderly Accidents, Deaths & Injuries) tools for health care providers and patients.
13 Sarmiento 2017 - Sarmiento K, Lee R. STEADI: CDC’s approach to make older adult fall prevention part of every primary care practice. Journal of Safety Research. 2017;63:105-109.
14 CDC-STEADI Algorithm - Centers for Disease Control and Prevention (CDC). (2019). Algorithm for fall risk screening, assessment, and intervention. STEADI (Stopping Elderly Accidents, Deaths & Injuries) tools for health care providers and patients. Accessed February 28, 2025.
15 Mayo Clinic-Falls - Mayo Clinic. (2024). Fall prevention: Simple tips to prevent falls. Accessed February 28, 2025.
16 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.
17 Phelan 2018 - Phelan, E. A., & Ritchey, K. (2018). Fall prevention in community-dwelling older adults. Annals of Internal Medicine, 169(11), ITC81–ITC96.
18 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.
19 Polland 2014 - Polland, K., & Scommegna, P. (2014, April 16). Just how many baby boomers are there? Population Reference Bureau (PRB). Accessed February 28, 2025.
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