Clinical Question

Do environmental interventions (e.g., home hazard reduction, assistive technology, education) prevent falls in older people living in the community?

Evidence-Based Answer

Programs that assess and address fall hazards in the home decrease the rate of falls among older people living in the community. In a group of 1,000 older patients at risk who would otherwise experience 1,319 falls in a year, a home-based fall-hazard intervention would prevent 343 falls (95% CI, 118 to 514 fewer falls). These programs are even more effective when targeted for patients at high risk (e.g., those who have fallen previously). Assistive devices (e.g., eyeglasses, specialized footwear, bed alarm systems) and patient education programs alone do not decrease the rate of falls. None of these interventions affect health-related quality of life or decrease the risk of fall-related fractures or hospitalizations.¹ (Strength of Recommendation: B, inconsistent or limited-quality patient-oriented evidence.)

Practice Pointers

Up to one-third of community-dwelling older people fall each year.² Physical harms range from minor injuries to hip fractures and life-threatening traumatic brain injuries. There are 36 million reported falls in the United States each year, leading to 6.8 million emergency department visits, 300,000 hip fractures, and 42,000 deaths.^2,3 Environmental factors in the home, such as clutter, uneven surfaces, loose rugs, poor lighting, inappropriate footwear, and unsafe railings, are recognized risk factors for falls.⁴ The authors of this Cochrane review sought to evaluate whether environmental interventions may decrease the risk of falls in community-dwelling older people.