Falls are a serious problem for older people living in care facilities, often causing injuries and health complications. Researchers reviewed 104 studies involving nearly 69,000 people to find out what actually works to prevent falls. They discovered that personalized exercise programs and tailored safety plans that involve staff members are most effective. Vitamin D supplements may help reduce how often falls happen, and better nutrition with more dairy products might prevent both falls and broken bones. However, simply reviewing medications didn’t help much. The good news is that when care homes use multiple strategies customized to each person’s needs, they can significantly reduce fall rates.

The Quick Take

  • What they studied: What types of programs and treatments actually prevent falls in older people living in nursing homes and assisted living facilities?
  • Who participated: 104 different research studies involving 68,964 older adults (mostly over 65 years old) living in care facilities. The largest single study looked at 7,195 people and focused on nutrition.
  • Key finding: Personalized exercise programs and customized safety plans that involve staff members reduce falls by about 30-40%. Vitamin D supplements reduce how often falls happen, and adding more dairy products to meals may prevent both falls and broken bones.
  • What it means for you: If you or a loved one lives in a care facility, ask about exercise programs and personalized fall prevention plans. These work best when staff members are involved and plans are tailored to each person’s specific needs. However, these findings apply mainly to care facilities, not home settings.

The Research Details

This is a systematic review, which means researchers looked at 104 different studies that tested various ways to prevent falls in care facilities. They searched medical databases through May 2024 and included only the highest-quality studies called randomized controlled trials, where people are randomly assigned to receive different treatments. The researchers combined results from studies testing similar interventions to see overall patterns.

The studies tested many different approaches: exercise programs, medication reviews, vitamin D supplements, nutrition changes, and combinations of these strategies. Some studies involved individual residents, while others involved entire care facilities. The researchers carefully evaluated how well each study was done and how confident they could be in the results.

This approach is important because it combines evidence from many studies rather than relying on just one. Falls in care facilities are extremely common and dangerous—they cause broken bones, head injuries, and can lead to loss of independence. By reviewing all available research, scientists can identify which strategies actually work and which ones don’t, helping care facilities make better decisions about how to protect residents.

Most of the included studies had some limitations, mainly because it’s difficult to hide which treatment people are receiving in fall prevention studies. The researchers rated the certainty of evidence as moderate to high for the most important findings (exercise and personalized interventions), meaning these results are fairly reliable. However, for some outcomes like medication reviews, the certainty was very low, meaning we should be cautious about those conclusions. The researchers used a system called GRADE to rate how confident we should be in each finding.

What the Results Show

Exercise programs were among the most effective single interventions. When residents participated in active exercise, the rate of falls dropped by about 32% compared to usual care, and the risk of someone falling at least once decreased by 14%. However, this only worked while people were actively exercising—once the program stopped, the benefits disappeared.

Personalized, multi-strategy programs worked even better. When care facilities created customized plans addressing each resident’s specific risks (like checking their medications, improving their environment, and providing exercise), combined with staff training and engagement, falls dropped by about 39%. These programs were also likely cost-effective, meaning the money spent prevented enough falls to justify the expense.

Vitamin D supplements showed interesting results. In people with low vitamin D levels, supplements reduced how often falls occurred by about 37%, but didn’t change the overall risk of someone falling. This suggests vitamin D might help people who are deficient, but it’s not a complete solution.

Increasing dairy products in residents’ diets showed promise in one large study of 7,195 people. Adding more dairy through better menu planning reduced the risk of falling by 11% and the risk of fractures from falls by 33%.

Medication reviews and deprescribing (removing unnecessary medications) showed disappointing results. Overall, these interventions made little or no difference to fall rates. Interestingly, one study found that medication reviews actually cost more money without preventing more falls. This was surprising to many researchers who expected that removing medications that increase fall risk would help more.

Exercise appeared to work better for residents with memory problems or dementia, reducing their fall risk by 28%. This is encouraging because people with cognitive impairment often have higher fall rates.

This review updates previous research from 2010, 2012, and 2018. The new findings confirm what earlier research suggested: exercise and personalized programs work best. However, this update includes 33 new studies with nearly 27,500 additional participants, providing much stronger evidence. The focus on personalized, staff-engaged programs is relatively new and represents an important shift from one-size-fits-all approaches.

The studies had several limitations. Most couldn’t hide which treatment people received, which might have influenced results. Some studies were small or didn’t follow residents long enough. The research mainly looked at what happens during the program—only a few studies checked if benefits lasted after the program ended. Most studies didn’t thoroughly report injuries or side effects, so we don’t know much about potential harms. The vitamin D studies only included people with low vitamin D, so results might not apply to people with normal levels. Finally, these findings are specific to care facilities and may not apply to older people living at home.

The Bottom Line

If you’re involved in a care facility, implement personalized exercise programs combined with environmental safety checks and staff training—this has moderate-to-high confidence evidence of effectiveness. Exercise programs should be ongoing to maintain benefits. Consider vitamin D supplements for residents with low vitamin D levels (moderate confidence). Improve nutrition by adding more dairy products to meals (low confidence, but promising). Medication reviews alone are not recommended as a primary fall prevention strategy (moderate confidence). All interventions work best when tailored to individual residents’ needs and when staff are trained and engaged.

These findings apply to older adults living in nursing homes, assisted living facilities, and residential care settings. They’re especially relevant for residents with memory problems or cognitive impairment. Family members of residents in care facilities should ask about fall prevention programs. Care facility administrators and staff should use these findings to design better safety programs. These recommendations don’t apply to healthy older adults living independently at home, though some strategies like exercise may still be helpful.

Exercise programs typically show benefits within weeks to months of starting, but only while the program continues. Once exercise stops, benefits disappear within weeks. Personalized programs may take longer to implement (several months) but can show sustained benefits. Vitamin D supplements may take several weeks to months to show effects. Nutrition changes can be implemented immediately and may show benefits over weeks to months.

Want to Apply This Research?

  • Track weekly exercise sessions completed and fall incidents. For example: “Completed 3 exercise sessions this week, 0 falls reported.” This creates accountability and helps identify patterns.
  • Set up reminders for daily exercise routines and weekly check-ins with care facility staff about fall prevention activities. Create a personalized fall risk profile that includes specific exercises, environmental modifications, and nutrition goals tailored to the individual.
  • Monitor fall frequency monthly, track exercise adherence weekly, and review medication lists quarterly. Set goals like “maintain current exercise program” or “increase dairy servings to 2 per day.” Share data with care facility staff to ensure coordinated, personalized fall prevention efforts.

This review summarizes research evidence about fall prevention in care facilities and should not replace professional medical advice. Individual results vary, and what works best depends on each person’s specific health situation, medications, and abilities. Always consult with healthcare providers, care facility staff, and physicians before starting new exercise programs, supplements, or making significant changes to medications or diet. This information is especially important for people with existing health conditions, those taking multiple medications, or those with cognitive impairment. Care facility residents should work with their healthcare team to develop personalized fall prevention plans.