- Design
- Updated Cochrane systematic review and meta-analysis of randomised trials
- Population
- 110 trials, 48,919 community-dwelling people aged 60 and over
- Primary outcome
- Falls rate, risk of falling, and risk of recurrent falls
- Effect
- Multifactorial vs usual care: falls rate RaR 0.76 (95% CI 0.67–0.87, I² 92%, low certainty). Multifactorial vs falls advice: RaR 1.09 (1.00–1.18, moderate certainty)
This Cochrane update covers 110 randomised trials and 48,919 community-dwelling people aged 60 and over, comparing multifactorial interventions (tailored to each person's risk profile) and multiple component interventions (the same package for everyone) against usual care, against exercise, and against falls advice or education.
Against usual care, multifactorial interventions may reduce falls rate (rate ratio 0.76, 95% CI 0.67–0.87, I² = 92%) and recurrent falls (risk ratio 0.87, 0.78–0.98), with little or no effect on the risk of falling at all (0.95, 0.90–1.01). All low certainty.
The comparison that should change something is against falls advice or education. Here multifactorial interventions gave no additional benefit and probably increased falls rate slightly (rate ratio 1.09, 95% CI 1.00–1.18, moderate certainty), with no effect on risk of falling or recurrent falls. Multiple component interventions were no better than usual care, exercise or advice on falls rate. Adverse effects were mild throughout. The reading is uncomfortable but clear: the expensive, individualised programme is not outperforming structured advice, and the resource question that follows is a real one.
- Give structured falls advice and education to every at-risk older patient — it performs as well as the tailored programme in these comparisons.
- Prioritise exercise, which multifactorial programmes did not convincingly beat.
- Review medication, vision and orthostatic blood pressure as part of advice rather than as a separate multifactorial pathway.
- Where a multifactorial service already exists, this is a reason to audit its outcomes, not an instruction to close it.
- In Indian practice, where formal falls services are rare, the finding is reassuring: structured advice and exercise are the components that carry the benefit.
Why it matters
Falls services are built around tailored multifactorial assessment, and the best comparison in this review does not support the extra effort.
Don't overread it
"Probably increases falls rate by a small amount" describes an interval starting at exactly 1.00 — this is absence of benefit, not demonstrated harm.
The statistics, in plain English
I² of 92% for the falls-rate comparison against usual care means the trials disagree almost entirely, so the pooled 0.76 should be read as a rough direction rather than an estimate. The comparison against advice is the more trustworthy one: heterogeneity was low (I² 27% and 0%), certainty was moderate rather than low, and the interval for falls rate (1.00 to 1.18) sits on or above 1.0 — meaning no benefit, and possibly slight harm.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for neurology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free