Interventions to reduce falls in hospitals: a systematic review and meta-analysis

doi:10.1093/ageing/afac077

Meta-Analysis

. 2022 May 1;51(5):afac077.

doi: 10.1093/ageing/afac077.

Interventions to reduce falls in hospitals: a systematic review and meta-analysis

Meg E Morris^{1

2}, Kate Webster³, Cathy Jones¹, Anne-Marie Hill⁴, Terry Haines⁵, Steven McPhail^{6

7}, Debra Kiegaldie⁸, Susan Slade¹, Dana Jazayeri¹, Hazel Heng¹, Ronald Shorr^{9

10}, Leeanne Carey^{3

11}, Anna Barker^{5

12}, Ian Cameron¹³

Affiliations

¹ La Trobe University Academic and Research Collaborative in Health, Melbourne, Victoria, Australia.
² The Victorian Rehabilitation Centre, Healthscope, Glen Waverley, Victoria, Australia.
³ School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia.
⁴ Western Australian Centre for Health & Ageing, School of Allied Health, The University of Western Australia, Perth, Western Australia, Australia.
⁵ School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia.
⁶ Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health & Social Work, Queensland University of Technology, Brisbane, Queensland, Australia Australia.
⁷ Digital Health and Informatics Directorate, Metro South Health, Brisbane, Queensland, Australia.
⁸ Holmesglen Institute and Monash University, Melbourne, Victoria, Australia.
⁹ Geriatric Research Education and Clinical Center, Malcom Randall VAMC, Department of Epidemiology, University of Florida, Gainesville, FL, USA.
¹⁰ Department of Epidemiology, University of Florida, Gainesville, FL, USA.
¹¹ Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia.
¹² Silver Chain, Melbourne, Victoria, Australia.
¹³ John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District and The University of Sydney, Sydney, NSW, Australia.

PMID: 35524748
PMCID: PMC9078046
DOI: 10.1093/ageing/afac077

Meta-Analysis

Interventions to reduce falls in hospitals: a systematic review and meta-analysis

Meg E Morris et al. Age Ageing. 2022.

. 2022 May 1;51(5):afac077.

doi: 10.1093/ageing/afac077.

Authors

Affiliations

¹ La Trobe University Academic and Research Collaborative in Health, Melbourne, Victoria, Australia.
² The Victorian Rehabilitation Centre, Healthscope, Glen Waverley, Victoria, Australia.
³ School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia.
⁴ Western Australian Centre for Health & Ageing, School of Allied Health, The University of Western Australia, Perth, Western Australia, Australia.
⁵ School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia.
⁶ Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health & Social Work, Queensland University of Technology, Brisbane, Queensland, Australia Australia.
⁷ Digital Health and Informatics Directorate, Metro South Health, Brisbane, Queensland, Australia.
⁸ Holmesglen Institute and Monash University, Melbourne, Victoria, Australia.
⁹ Geriatric Research Education and Clinical Center, Malcom Randall VAMC, Department of Epidemiology, University of Florida, Gainesville, FL, USA.
¹⁰ Department of Epidemiology, University of Florida, Gainesville, FL, USA.
¹¹ Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia.
¹² Silver Chain, Melbourne, Victoria, Australia.
¹³ John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District and The University of Sydney, Sydney, NSW, Australia.

PMID: 35524748
PMCID: PMC9078046
DOI: 10.1093/ageing/afac077

Abstract

Background: Falls remain a common and debilitating problem in hospitals worldwide. The aim of this study was to investigate the effects of falls prevention interventions on falls rates and the risk of falling in hospital.

Design: Systematic review and meta-analysis.

Participants: Hospitalised adults.

Intervention: Prevention methods included staff and patient education, environmental modifications, assistive devices, policies and systems, rehabilitation, medication management and management of cognitive impairment. We evaluated single and multi-factorial approaches.

Outcome measures: Falls rate ratios (rate ratio: RaR) and falls risk, as defined by the odds of being a faller in the intervention compared to control group (odds ratio: OR).

Results: There were 43 studies that satisfied the systematic review criteria and 23 were included in meta-analyses. There was marked heterogeneity in intervention methods and study designs. The only intervention that yielded a significant result in the meta-analysis was education, with a reduction in falls rates (RaR = 0.70 [0.51-0.96], P = 0.03) and the odds of falling (OR = 0.62 [0.47-0.83], P = 0.001). The patient and staff education studies in the meta-analysis were of high quality on the GRADE tool. Individual trials in the systematic review showed evidence for clinician education, some multi-factorial interventions, select rehabilitation therapies, and systems, with low to moderate risk of bias.

Conclusion: Patient and staff education can reduce hospital falls. Multi-factorial interventions had a tendency towards producing a positive impact. Chair alarms, bed alarms, wearable sensors and use of scored risk assessment tools were not associated with significant fall reductions.

Keywords: education; exercise; falls; hospital; older people; physiotherapy; prevention; systematic review.

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Figures

**Figure 1**
Meta-analysis education for (a) falls rate (b) falls risk.

**Figure 2**
Meta-analysis assistive devices for (a) falls rate (b) falls risk.

**Figure 3**
Meta-analysis additional rehabilitation for (a) falls rate (b) falls risk.

**Figure 4**
Meta-analysis environmental modifications for (a) falls rate (b) falls risk.

**Figure 5**
Meta-analysis multifactorial interventions for (a) falls rate (b) falls risk.

See this image and copyright information in PMC

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Implementation of Virtual Communities of Practice in Healthcare to Improve Capability and Capacity: A 10-Year Scoping Review.
Shaw L, Jazayeri D, Kiegaldie D, Morris ME. Shaw L, et al. Int J Environ Res Public Health. 2022 Jun 29;19(13):7994. doi: 10.3390/ijerph19137994. Int J Environ Res Public Health. 2022. PMID: 35805649 Free PMC article.
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Luo Y, Liu Y, Tan S, Xu T, Bao G. Luo Y, et al. SAGE Open Med. 2025 Apr 27;13:20503121251335811. doi: 10.1177/20503121251335811. eCollection 2025. SAGE Open Med. 2025. PMID: 40297791 Free PMC article.
Supported implementation of tailored multicomponent fall prevention interventions in hospital: a feasibility study.
McLennan C, Sherrington C, Naganathan V, Tilden W, Richards B, McVeigh T, Hallahan A, Nayak V, Jennings M, Hassett L, Haynes A. McLennan C, et al. BMJ Open Qual. 2025 Jul 7;14(3):e003313. doi: 10.1136/bmjoq-2025-003313. BMJ Open Qual. 2025. PMID: 40623855 Free PMC article.
Enhancing Patient Safety Through an Integrated Internet of Things Patient Care System: Large Quasi-Experimental Study on Fall Prevention.
Wen MH, Chen PY, Lin S, Lien CW, Tu SH, Chueh CY, Wu YF, Tan Cheng Kian K, Hsu YL, Bai D. Wen MH, et al. J Med Internet Res. 2024 Oct 3;26:e58380. doi: 10.2196/58380. J Med Internet Res. 2024. PMID: 39361417 Free PMC article.

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References

1. Cameron ID, Dyer SM, Panagoda CEet al. . Interventions for preventing falls in older people in care facilities and hospitals. Cochrane Database Syst Rev 2018; 9: 1–292. CD005465 - PMC - PubMed
1. Avanecean D, Calliste D, Contreras T, Lim Y, Fitzpatrick A. Effectiveness of patient-centered interventions on falls in the acute care setting compared to usual care: a systematic review. JBI Database System Rev Implement Rep 2017; 15: 3006–48. - PubMed
1. Bouldin ELD, Andresen EM, Dunton NEet al. . Falls among adult patients hospitalized in the United States: prevalence and trends. J Patient Saf 2013; 9: 13–7. - PMC - PubMed
1. Sato N, Hase N, Osaka A, Sairyo K, Katoh S. Falls among hospitalized patients in an acute care hospital: analyses of incident reports. J Med Invest 2018; 65: 81–4. - PubMed
1. Barker AL, Morello RT, Wolfe Ret al. . 6-PACK programme to decrease fall injuries in acute hospitals: cluster randomised controlled trial. BMJ 2016; 352: h6781. - PMC - PubMed

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[1] Cameron ID, Dyer SM, Panagoda CEet al. . Interventions for preventing falls in older people in care facilities and hospitals. Cochrane Database Syst Rev 2018; 9: 1–292. CD005465 - PMC - PubMed

[2] Cameron ID, Dyer SM, Panagoda CEet al. . Interventions for preventing falls in older people in care facilities and hospitals. Cochrane Database Syst Rev 2018; 9: 1–292. CD005465 - PMC - PubMed

[3] Avanecean D, Calliste D, Contreras T, Lim Y, Fitzpatrick A. Effectiveness of patient-centered interventions on falls in the acute care setting compared to usual care: a systematic review. JBI Database System Rev Implement Rep 2017; 15: 3006–48. - PubMed

[4] Avanecean D, Calliste D, Contreras T, Lim Y, Fitzpatrick A. Effectiveness of patient-centered interventions on falls in the acute care setting compared to usual care: a systematic review. JBI Database System Rev Implement Rep 2017; 15: 3006–48. - PubMed

[5] Bouldin ELD, Andresen EM, Dunton NEet al. . Falls among adult patients hospitalized in the United States: prevalence and trends. J Patient Saf 2013; 9: 13–7. - PMC - PubMed

[6] Bouldin ELD, Andresen EM, Dunton NEet al. . Falls among adult patients hospitalized in the United States: prevalence and trends. J Patient Saf 2013; 9: 13–7. - PMC - PubMed

[7] Sato N, Hase N, Osaka A, Sairyo K, Katoh S. Falls among hospitalized patients in an acute care hospital: analyses of incident reports. J Med Invest 2018; 65: 81–4. - PubMed

[8] Sato N, Hase N, Osaka A, Sairyo K, Katoh S. Falls among hospitalized patients in an acute care hospital: analyses of incident reports. J Med Invest 2018; 65: 81–4. - PubMed

[9] Barker AL, Morello RT, Wolfe Ret al. . 6-PACK programme to decrease fall injuries in acute hospitals: cluster randomised controlled trial. BMJ 2016; 352: h6781. - PMC - PubMed

[10] Barker AL, Morello RT, Wolfe Ret al. . 6-PACK programme to decrease fall injuries in acute hospitals: cluster randomised controlled trial. BMJ 2016; 352: h6781. - PMC - PubMed

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Interventions to reduce falls in hospitals: a systematic review and meta-analysis

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Interventions to reduce falls in hospitals: a systematic review and meta-analysis

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