Falls in care facilities: what works – and what doesn’t – in the 2025 cochrane evidence

Sustained exercise reduces falls

Active exercise reduces falls in care facilities during the intervention period, but the effect is not maintained after exercise stops. Effective programmes use supervised, tailored, moderate- or low-intensity group exercise, or at least one hour weekly for ambulant residents, including those with cognitive impairment.

Tailored multifactorial interventions work

Multifactorial interventions reduce falls when delivery is tailored to individual resident circumstances and facility staff are actively engaged. The evidence indicates that implementation, rather than the specific intervention components, determines effectiveness in care-facility falls prevention.

Vitamin D and dairy show benefit

Vitamin D supplementation reduces the rate of falls. Dairy food supplementation, using menu design to provide at least three daily servings, reduces the risk of falling and fractures, including hip fractures, although the certainty of evidence for dairy supplementation remains low.

In the educational session “Falls in care facilities: what works – and what doesn’t – in the 2025 Cochrane evidence,” organized by Klinik Barmelweid, Dr. Suzanne Dyer presents the updated 2025 Cochrane review on fall prevention in older people living in care facilities. She reports that the review includes 104 randomized controlled trials with nearly 70,000 participants across 25 countries and uses meta-analysis, subgroup analysis, and novel qualitative methods to explain heterogeneity between trials. Dr. Dyer shows that active exercise reduces both fall rate and risk of falling at the end of the intervention period, but this effect is not maintained after the exercise program stops, indicating that exercise must be sustained. She further states that the most effective exercise approaches are supervised, tailored, moderate- or low-intensity group programs, or at least one hour per week for residents who are able to walk, including those with cognitive impairment. The review also finds moderate-certainty evidence that vitamin D supplementation reduces the rate of falls, while low-certainty evidence from a large Australian trial suggests that increasing dairy intake to at least three servings per day may reduce falls and fractures, including hip fractures. In contrast, stand-alone medication optimization does not show a clear overall effect on falls, although Dr. Dyer emphasizes that medication review remains an important component of effective multifactorial interventions and should be structured and repeated at least every six months. Finally, she concludes that multifactorial interventions reduce falls when they are genuinely individualized to resident characteristics and implemented in close engagement with facility staff, underscoring that effectiveness depends not only on the intervention content but also on how it is delivered.