How to reduce falls in aged care: the latest Cochrane evidence
- Institute for Musculoskeletal Health
- Aug 27
- 2 min read
Updated: Sep 23
Falls continue to be a major health threat for older individuals in aged care, leading to broken bones, loss of independence, and even death. In Australia alone, they result in over 26,000 hospitalisations each year, underscoring the urgent need for effective preventive strategies.
The new insights: what works?
A recent update to the Cochrane Review, focused specifically on aged care settings, sheds fresh light on effective strategies:
It includes over 100 clinical trials, spanning almost 69,000 residents across 25 countries, with many recent high-quality studies.
Crucially, this is the first version split into separate reports for aged care facilities and hospitals; the hospital-focused review is on the way.
Here are the standout interventions:
1. Ongoing, tailored exercise programs
Consistent exercise, led by physiotherapists or trained staff, cuts fall risks. For meaningful impact, residents should have the opportunity to engage in at least one hour per week.
Short, infrequent sessions (e.g., 20-30 minutes once or twice weekly) rarely make a dent in fall rates.
Noteworthy programs like SUNBEAM (strength & balance) and the telehealth-based TOP-UP trial have proven effective, even for residents with dementia.
2. Improved nutrition: dairy-rich diets
Malnutrition affects around 40% of residents, with 6% severely malnourished.
Providing at least 3.5 servings of dairy foods daily, designed by a dietitian, boosts protein and calcium intake helping to reduce falls and hip fractures.
An Australian trial found increasing dairy servings from 2 to 3.5 per day lowered fractures by 33% and hip fractures by 46%, at a minimal cost of about 66 cents per resident per day.
3. Vitamin D supplements
Given that residents often spend little time outdoors, vitamin D deficiency is common, weakening bones and muscles and leaving residents at great risk of falls and fall-related injury.
Regular daily or weekly supplementation improves muscle function and is tied to fewer falls and fractures, making it a simple, effective preventive measure.
4. Individualised and tailored assessments
Tailoring interventions to a resident’s specific fall risks, and working closely with staff, has emerged as more effective than generic, one-size-fits-all approaches.
Under Australia’s Aged Care Quality Standards, each resident should have a comprehensive falls risk assessment and prevention plan at admission. While assessments are often done, implementation (e.g. exercise programs) remains inconsistent without proper funding.
TOP-UP’s tele-physiotherapy findings further demonstrate that tailored approaches work and are accessible, even for residents with dementia.
Turning evidence into everyday care
To make this evidence part of everyday care, we need to:
Avoid “quick fix” sessions. Ongoing and consistent exercise programs are crucial to long-term fall reduction.
Invest in nutrition. Dairy intake and dietitian-led meal planning deliver major health dividends at low cost.
Make vitamin D a standard practice. Supplementation is straightforward, effective, and essential given residents’ limited sun exposure.
Prioritise personalised care plans. Falls programs should be built around each individual, not just a general template.
Support your staff. Educating and engaging care teams ensures these interventions are delivered effectively.
Dyer SM, et al. (2025). Interventions for preventing falls in older people in care facilities. Cochrane Database of Systematic reviews. DOI: 10.1002/14651858.CD016064
Written by Courtney West.
