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Injuries Musculoskeletal Preventative medicine

Falls - assessment

Last revised in June 2025

A fall is defined as an unintentional/unexpected loss of balance resulting in coming to rest on the floor, the ground, or an object below knee level.

Falls - assessment: Summary

  • A fall is defined as an event that causes a person to, unintentionally, rest on the ground or other lower level.
    • For the purpose of this CKS topic, a simple fall is defined as one occurring as a result of a chronic impairment of cognition, vision, balance, or mobility. It is distinguished from a collapse, which is caused by an acute medical problem, such as an acute arrhythmia, transient ischaemic attack, or vertigo.
  • Falls are common in older people, especially those aged 65 years and over, and the prevalence increases with age. 
  • The risk of falling is multifactorial, and prevention is usually based on assessing multiple risk factors. 
  • A history of falls is one of the strongest risk factors for a fall, and all older people in regular contact with healthcare professionals should be asked routinely whether they have fallen in the past year.
  • Other risk factors for falls in older people include:
    • Conditions that affect mobility or balance, such as arthritis, diabetes, incontinence, stroke, syncope, or Parkinson's disease.
    • Other conditions, including muscle weakness, poor balance, visual impairment, cognitive impairment, depression, and alcohol misuse.
    • Polypharmacy, or the use of fall-risk increasing drugs.
    • Home hazards, such as loose rugs or mats, poor lighting, wet surfaces (especially in the bathroom), and loose fittings (such as handrails).
  • Between 40–60% of falls result in major lacerations, traumatic brain injuries, or fractures. Other complications of falls include distress, pain, loss of self-confidence, reduced quality of life, loss of independence, and mortality. 
  • Older people who present for medical attention because of a fall, report recurrent falls in the past year, or have other risk factors for falls should be assessed for gait and balance abnormalities.
  • A comprehensive falls assessment should be offered to people who have had one or more falls in the past year and meet the specified criteria. This assessment should be accompanied by a comprehensive falls management programme.
    • A comprehensive falls assessment may include assessing for home hazards, visual impairment, and drug treatments.
    • Interventions commonly offered by specialist falls services include strength and balance training, home hazard assessment and intervention, vision assessment and referral, and medication review (with modification or withdrawal).
  • People who do not have an indication to be referred for a comprehensive falls assessment should be assessed for gait and balance issues. To those who have a gait or balance impairment offer a falls prevention exercise programme and consider a home hazard assessment.
  • Those without gait or balance impairment should be reassessed at least annually and provided with suitable health and wellbeing educational materials on falls prevention.

Have I got the right topic?

From age 65 years onwards.

This CKS topic covers the identification and management of the risk of falling in older people in the community.

This CKS topic does not cover the identification and management of the risk of falling in older people in hospital or the management of a collapse caused by an acute medical problem, such as arrhythmias, stroke, transient ischaemic attack, or vertigo.

There are separate CKS topics on Blackouts and syncope, Osteoporosis - prevention of fragility fractures, Stroke and TIA, Benign paroxysmal positional vertigo, Vertigo, and Palpitations.

The target audience for this CKS topic is healthcare professionals working within the NHS in the UK, and providing first contact or primary healthcare.

How up-to-date is this topic?

Changes

June 2025 — reviewed. A literature search was conducted in April 2025 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. No major changes to clinical recommendations have been made.

Previous changes

January 2019 — reviewed. A literature search was conducted in January 2019 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. No major changes to clinical recommendations have been made.

January 2014 — reviewed. A literature search was conducted in January 2014 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials (RCTs) published since the last revision of the topic. The following changes were made:

  • A definition section has been added in background information to clarify that this topic covers 'simple falls' as opposed to a collapse due to an acute medical problem.
  • The scope of this CKS topic has been revised to clarify the above, and additional links to relevant CKS topics have been included.
  • The section on assessing the risk of falls has been rewritten for clarity.

September 2008 to June 2009 — this is a new CKS topic based on the National Collaborating Centre for Nursing and Supportive Care guideline Clinical practice guideline for the assessment and prevention of falls in older people [National Collaborating Centre for Nursing and Supportive Care, 2004], commissioned by the National Institute for Health and Clinical Excellence (NICE).

Update

New evidence

Evidence-based guidelines

No new evidence-based guidelines since 1 April 2025.

HTAs (Health Technology Assessments)

No new HTAs since 1 April 2025.

Economic appraisals

No new economic appraisals relevant to England since 1 April 2025.

Systematic reviews and meta-analyses

No new systematic reviews since 1 April 2025.

Primary evidence

No new randomized controlled trials since 1 April 2025.

New policies

No new national policies or guidelines since 1 April 2025.

New safety alerts

No new safety alerts since 1 April 2025.

Changes in product availability

No changes in product availability since 1 April 2025.

Goals and outcome measures

Goals

To support primary healthcare professionals to:

  • Make an accurate assessment of a person at risk of falling.
  • Refer people at risk of falling for a multidisciplinary falls assessment.
  • Ensure that people assessed as being at increased risk of falling are offered an individualised multifactorial intervention. 
  • Ensure that people who do not have an indication to be referred for a multifactorial risk assessment are reassessed at least annually.
  • Provide appropriate information and advice on reducing the risk of falls.

Outcome measures

No outcome measures were found during the review of this topic.

Audit criteria

No audit criteria were found during the review of this topic.

QOF indicators

No QOF indicators were found during the review of this topic.

QIPP - Options for local implementation

No QIPP indicators were found during the review of this topic.

NICE quality standards

Falls

  • People aged 50 to 64 with 1 or more factors that could increase their risk of falls and people aged 65 or over are asked about the details of any falls when they attend appointments or assessments in community or hospital settings.
  • People aged 50 to 64 with 1 or more factors that could increase their risk of falls and people aged 65 or over have a comprehensive falls assessment if they meet the criteria for a comprehensive falls assessment.
  • People aged 50 to 64 with 1 or more factors that could increase their risk of falls and people aged 65 or over have tailored interventions that address their individual risk factors if they need comprehensive falls management to reduce their risk of falling.

[NICE, 2025a]

Background information

What is it?

  • A fall is defined as an event which causes a person to, unintentionally, rest on the ground or other lower level [OHID, 2022; Appeadu, 2025]. 
    • Tinetti defined a fall as an event that results in a person coming to rest on the ground or other lower-level unintentionally, which is not as a result of a major intrinsic event (such as stroke) or overwhelming hazard [Tinetti, 1988].
    • For the purpose of this CKS topic, a simple fall is defined as one occurring as a result of a chronic impairment of cognition, vision, balance, or mobility. It is distinguished from a collapse caused by an acute medical problem, such as an acute arrhythmia, transient ischaemic attack, or vertigo.

How common is it?

  • Falls are common in older people, especially those aged 65 years and over, and the prevalence increases with age.
    • About 30% of people aged 65 years and over have a fall at least once each year, increasing to 50% in people aged 80 years and over [OHID, 2022; Montero-Odasso, 2022].
    • According to the public health outcomes framework, the rates of emergency hospital admission in people aged 65 and over due to falls were lower in April 2022 to March 2023 than in April 2010 to March 2011, but have fluctuated over time [OHID, 2024]. 
    • In England, during 2023/24, there were 219,155 emergency hospital admissions (1984 per 100,000 due to falls in people aged 65 and over). Of these hospital admissions, 76,755 (955 per 100,000) occurred in people aged 65-79 years and 142,400 (4969 per 100,000) in people aged 80 plus years [OHID, 2024].

What are the risk factors?

  • The risk of falling is multifactorial, and prevention is usually based on assessing multiple risk factors [NICE, 2025b].
    • A history of falls is one of the strongest risk factors for a fall, and all older people in regular contact with healthcare professionals should be asked routinely whether they have fallen in the past year.
    • Other risk factors for falls in older people include [Hopewell, 2018; Montero-Odasso, 2022]:
      • A history of falls — after a first fall, people have a 66% chance of having another fall within a year [Vieira, 2016].
      • Conditions that affect mobility or balance, such as arthritis, diabetes, incontinence, stroke, syncope, or Parkinson's disease [Chen, 2019; Homann, 2022].
      • Other conditions, including muscle weakness, poor balance, visual impairment, cognitive impairment, depression, and alcohol misuse [Gambaro, 2022; Wang, 2023].
      • Polypharmacy, or the use of psychoactive drugs (such as benzodiazepines) or drugs that can cause postural hypotension (such as anti-hypertensive drugs) [Wong, 2023].
      • Environmental hazards, such as loose rugs or mats, poor lighting, uneven surfaces, wet surfaces (especially in the bathroom), loose fittings (such as handrails), and poor footwear.
    • The more risk factors a person has, the greater their risk of falling. 
      • Over 65% of people aged 65 years and over have two or more long-term conditions (multimorbidity) [Skou, 2022]. 
      • Falls can also be a sign of underlying health issues, such as frailty [Yang, 2023]. 
      • Fall risk correlates with the number of risk factors. The 1-year risk of falling doubles for every added risk factor [Appeadu, 2025].

What are the complications?

  • Falls are the main cause of injury, injury-related disability, and death in older people [Appeadu, 2025].
    • Between 40–60% of falls result in major lacerations, traumatic brain injuries, or fractures [Vieira, 2016].
      • About 5% of falls in older people who live in the community result in a fracture or hospitalization [NICE, 2025b].
      • About 90% of all hip fractures are caused by falls. Following a hip fracture, short and long-term outlooks are generally poor, with an increased one-year mortality of between 18–33% and negative effects on daily living activities, such as shopping and walking. A review of long-term disability found that following a hip fracture, around 20% of people entered long-term care in the first year after the fracture [OHID, 2022; Schroeder, 2022]/
      • The risk of getting a fragility fracture depends on the person's risk of falls, their bone strength (determined by bone mineral density [BMD]), and the presence of other risk factors, such as age (risk increases with age and is at least partly independent of BMD), use of corticosteroids, and smoking. For more information, see the CKS topic on Osteoporosis - prevention of fragility fractures.
    • A longitudinal study that examined the consequences of falls in older men and women found that 68% of people who fell reported some injury, 24% required healthcare, 35% reported functional decline, and more than 15% of people reported impairment of social and physical activities [Stel, 2004].
    • In the United States, unintentional falls are the most common cause of injury and death from injury in people aged
      over 65 years [Kakara, 2023].
  • Other complications of falls include distress, pain, loss of self-confidence, reduced quality of life, and loss of independence. In addition, falls can trigger a cycle of fear of further falls (in more than 25% of cases), leading to activity avoidance, social isolation, increasing frailty, functional decline, reduced quality of life, depression, and institutionalization [OHID, 2022; Delbari, 2023].
  • Falls and fractures place a huge financial burden on the NHS.
    • The total cost of fragility fractures to the UK has been estimated at £4.4 billion, which includes £1.1 billion for social care and £2 billion for hip fractures [OHID, 2022].
    • Unaddressed fall hazards in the home are estimated to cost the NHS in England £435 million [OHID, 2022]. 

Management

Scenario: Falls - risk assessment

From age 65 years onwards.

How should I assess people?

  • Identify people aged 50 years or over with one or more risk factors that could increase their risk of falling, or aged 65 years and over who:
    • Have had one or more falls in the last 12 months.
      • Ask about how often the person has fallen, the circumstances in which the fall(s) occurred (such as place, time, activity being performed, and preceding symptoms; for example, light headedness or loss of consciousness), and the consequences of the fall(s) (such as injuries, fear of falling, difficulty performing daily activities, activity restriction, and/or pain). If possible, obtain an eye-witness account.
      • This will help to distinguish a simple fall (caused by a chronic impairment of cognition, vision, mobility, or balance) from a collapse (caused by an acute medical problem, for example, arrhythmias, transient ischaemic attack, or vertigo).
    • Are at risk of falling because they:
      • Have cognitive impairment.
      • Have a visual impairment.
      • Have a condition that affects mobility or balance, such as arthritis, diabetes, incontinence, stroke, or Parkinson's disease. For more information, see the CKS topics on Rheumatoid arthritis, Diabetes - type 1, Diabetes - type 2, Incontinence - urinary, in women, Stroke and TIA, and Parkinson's disease.
      • Are taking multiple drugs (polypharmacy), or known fall-risk increasing drugs (FRIDs) such as antihypertensives, antihistamines, sedatives-hypnotics, antipsychotics, antidepressants, opioids, and non-steroidal anti-inflammatory drugs.
      • Have a fear of falling.
      • Are physically frail — tools such as the Electronic Frailty Index (eFI) may be used to identify people aged 65 years and over who may be living with moderate or severe frailty.
      • Have other risk factors for falling, such as alcohol misuse, depression, or environmental hazards. For more information, see the CKS topics on Alcohol - problem drinking and Depression.
  • For people who have had one or more falls or are considered to be at risk of a fall, assess their gait and balance, for example, by using the Timed Up & Go test and/or the Turn 180° test.
    • Do not use a falls risk assessment tool.
  •  Offer comprehensive falls assessment and management to people who have fallen in the last year and who meet the following criteria:
    • Are living with frailty.
    • Were injured in a fall and needed medical (including surgical) treatment.
    • Have experienced a loss of consciousness related to a fall.
    • Have been unable to get up independently after a fall.
    • Have had two or more falls in the last year.
  • For people who have fallen in the last year but do not meet criteria for a comprehensive falls assessment:
    • Assess their gait and balance (this can be carried out in the same service or involve an appropriate referral).
    • Those who have a gait or balance impairment:
      • Offer a falls prevention exercise programme and
      • Consider a home hazard assessment.
  • For those who have not had a fall, or those without gait or balance impairment, offer health and wellbeing information on reducing the risk of falls, for example:

Timed Up & Go test and Turn 180° test

Timed Up & Go test

  • Time the person getting up from a chair without using their arms, walking 3 metres, turning around, returning to the chair, and sitting down. If the person usually uses a walking aid, this can be used during the test. 
    • During the test, observe the person's postural stability, gait, stride length, and sway [BGS, 2019].
    • Normal scores are between 8 and 11 seconds for people between 65 and 99 years. If a patient takes more than 12 seconds, then their mobility may be considered impaired [BGS, 2019].
    • Use clinical judgement to interpret the test: in addition to the time taken, also consider other factors, such as the age of the person, the type of footwear, the use of a walking aid, and the general health of the person.
  • The Chartered Society of Physiotherapy has a video demonstrating the timed up and go test.

Turn 180° test

  • Ask the person to stand up and step around until they are facing the opposite direction. If the person takes five or more steps, further assessment should be considered [BGS, 2019].

Basis for recommendation

These recommendations are based largely on the National Institute for Health and Care Excellence (NICE) guideline Falls: Assessment and prevention in older people and in people 50 and over at higher risk [NICE, 2025b], the World guidelines for falls prevention and management for older adults: a global initiative [Montero-Odasso, 2022], and expert opinion in review articles [Leung, 2024; Appeadu, 2025]. 

Identifying people who have had one or more falls or are considered to be at risk of falling
  • NICE found evidence suggesting that a previous fall and/or gait and balance disorders are the strongest risk factors for falls. The other risk factors were reported as statistically significant [NICE, 2025b].
  • CKS recommends distinguishing between a simple fall and a collapse, as the management for both will differ.
  • There is a well-established association between fall-risk increasing drugs (FRIDs) and fall frequency. A 2024 prospective randomised controlled trial of 2157 participants found over 3 years of follow-up, that use of at least one FRID was significantly associated with increased incidence rates of total falls (incidence rate ratio (IRR) [95% Confidence Interval (CI)] = 1.13 [1.01–1.27]), injurious falls (IRR = 1.15 [1.02–1.29]), and recurrent falls (IRR = 1.12 [1.01–1.23]) [de Godoi Rezende Costa Molino, 2024]. These associations were most pronounced among users of multiple FRIDs, with increased incidence rates of total falls (IRR = 1.22 [1.05–1.42]), injurious falls (IRR = 1.33 [1.14–1.54]) and recurrent falls (IRR = 1.14 [1.02–1.29]).
    • However, a 2021 systematic review of deprescribing medication found five trials involving 1305 participants met eligibility criteria [Lee, 2021]. However, deprescribing FRIDs did not change the rate of falls (rate ratio (RaR) 0.98, 95% CI 0.63 to 1.51), the incidence of falls (risk difference 0.01, 95% CI -0.06 to 0.09; relative risk 1.04, 95% CI 0.86 to 1.26) or rate of fall-related injuries (RaR 0.89, 95% CI 0.57 to 1.39) over a follow-up period of 6-12 months. No trials evaluated the impact of deprescribing FRIDs on fall-related fractures or hospitalisations. This systematic review found little to support deprescribing as a sole falls reduction strategy.
    • This is supported by a 2024 Cochrane review which found only very low-certainty evidence [Lewis, 2024]. They concluded that they were unsure whether population-based multicomponent or nutrition and medication interventions were effective at reducing falls and fall-related injuries in older adults. Methodologically robust cluster RCTs with sufficiently large communities and numbers of clusters are needed.
  • The recommendation that tools such as the Electronic Frailty Index (eFI) may be used to identify people who may be living with moderate or severe frailty is based on the NICE Guideline Multimorbidity: clinical assessment and management [NICE, 2016] and BMA advice Identification and management of patients with frailty [BMA, 2025].
Assessing gait and balance
  • Assessment tools predicting falls lack supporting evidence. 
    • NICE found limited evidence that assessment tools identify people at risk of falls in residential care or community settings [NICE, 2025b]. The evidence related to tools was very low quality and did not reach an acceptable threshold of sensitivity or specificity. They were also impractical to use in some settings.
    • The committee discussed the complexity around assessing the risk of falling, including how the environment and individual risk factors can lead to falls, and agreed that it is not possible to predict a fall with any accuracy. They agreed that risk assessment tools are not particularly useful and can be a distraction because they only stratify people into high- or low-risk categories without recommending any further intervention. 
      • This is the major difference from the World Falls Guideline that uses an algorithm to low, intermediate or high risk categories [Montero-Odasso, 2022]. Only those in the high risk category and offered a multifactorial falls risk assessment and targeted interventions.
    • In community settings, a number of studies assessing gait and balance (such as the Timed Up and Go [TUG)] test) were identified. Although the committee agreed that these tests are helpful in observing gait and balance problems, they do not predict a person's risk of falling. The committee acknowledged that case-finding of people who have had a previous injury from a fall or have had multiple falls, are living with frailty or have gait or balance problems, is useful to identify those who may need a more detailed assessment and would benefit from a more comprehensive management approach.
  • NICE reviewed the evidence on the utility, feasibility, and acceptability of a range of assessment tools for gait and balance and concluded that the Timed Up & Go test and the Turn 180° test are pragmatic, can be used in any setting, and require no special equipment [NICE, 2025b].
Reassessing falls risk annually
  • Experts from the British Geriatrics Society and World Fall Guidelines recommend that all adults aged over 65 years be screened annually for a history of falls or balance impairment [BGS, 2019; Montero-Odasso, 2022].
  • Although this is not specifically stated in the NICE guideline, it is implied by the recommendation that older people in regular contact with healthcare professionals should be asked routinely whether they have fallen in the past year [NICE, 2025b].
Providing verbal and written information on reducing the risk of falls
  • This recommendation is based on what CKS considers to be good clinical practice.

How should I manage older people assessed to be at risk of falling?

  • Offer a comprehensive falls assessment by an appropriately skilled and experienced clinician (usually in a specialist falls service) to older people who present for medical attention because of a fall, report recurrent falls in the past year, or demonstrate abnormalities of gait and/or balance. This assessment should be part of an individualized, multifactorial intervention.
  • A comprehensive falls assessment may include assessment of the following:
    • History of falls.
    • Gait, balance/dizziness and mobility, and muscle weakness.
    • Osteoporosis risk.
    • Footwear and foot condition.
    • Perceived impaired functional ability and fear relating to falling.
    • Visual and/or hearing impairment.
    • Cognitive, neurological, and cardiovascular problems.
    • Urinary incontinence.
    • Home hazards.
    • Diet and fluid intake, and weight loss.
    • Alcohol misuse.
    • Medication review; polypharmacy (the use of multiple drugs) and the use of drugs that can increase the risk of falls, for example, drugs that can cause postural hypotension (such as antihypertensive drugs) and psychoactive drugs (such as benzodiazepines and antidepressants).
  • Interventions commonly offered by specialist falls services include:
    • Strength and balance training — most likely to benefit older community-dwelling people with a history of recurrent falls or balance and gait deficit. Falls prevention exercise programmes should:
      • Be delivered by appropriately trained professionals
      • Be progressive and tailored to the individual's specific needs, preferences, goals and abilities
      • Focus on functional components related to the person's risk of falls, such as balance, coordination, strength and power
      • Include regular exercise progress reviews
      • Be delivered in such a way, including duration of programme, to bring about behaviour change related to physical activity and sedentary habits.
    • Home hazard assessment and intervention — should be offered to older people who have received treatment in hospital following a fall.
    • Vision assessment and referral.
    • Medication review — psychotropic drugs are reviewed, with specialist input if appropriate, and discontinued if possible.

Basis for recommendation

These recommendations are based largely on the National Institute for Health and Care Excellence (NICE) guideline Falls: Assessment and prevention in older people and in people 50 and over at higher risk [NICE, 2025b], the World guidelines for falls prevention and management for older adults: a global initiative [Montero-Odasso, 2022], the US Preventative Task Force recommendation statement Interventions to Prevent Falls in Community-Dwelling Older Adults [USPTF, 2024], and review articles on preventing falls in older people [Haddad, 2018; Leung, 2024; Appeadu, 2025].

Comprehensive falls assessment
  • NICE recommends a comprehensive falls assessment for people at risk of falling who meet set criteria, and to create a management plan to identify and address future risks [NICE, 2025b].
    • NICE points out that the benefit of a comprehensive assessment (that is, reduced risk of falls) only appears to be achieved if it is accompanied by an individualized, multifactorial management plan.
Comprehensive falls management
  • The NICE guideline does not give specific information on what a falls service should offer a person identified to be at risk of falling. However, the guideline does state that a personalized intervention aimed at promoting independence and improving physical and psychological function should be offered. Strength and balance training, home hazard and vision assessment and intervention, and medication review are common components in successful comprehensive falls management programmes [USPTF, 2024; NICE, 2025b].
  • A Cochrane systematic review (search date: March 2023) assessed interventions to reduce falls by assessing fall hazards and making environmental safety adaptations (e.g. non-slip strips on steps) or behavioural strategies (e.g. avoiding clutter) [Clemson, 2023].
    • They found that home fall-hazard interventions probably reduce the overall rate of falls by 26% (rate ratio (RaR) 0.74, 95% confidence interval (CI) 0.61 to 0.91; 12 studies, 5293 participants; moderate-certainty evidence); based on a control group risk of 1319 falls per 1000 people a year, this is 343 (95% CI 118 to 514) fewer falls.
    • However, these interventions were more effective in people who are selected for higher risk of falling, with a reduction of 38% (RaR 0.62, 95% CI 0.56 to 0.70; 9 studies, 1513 participants; 702 (95% CI 554 to 812) fewer falls based on a control risk of 1847 falls per 1000 people; high-certainty evidence).
    • They found no evidence of a reduction in rate of falls when people were not selected for fall risk (RaR 1.05, 95% CI 0.96 to 1.16; 6 studies, 3780 participants; high-certainty evidence).
  • A second Cochrane systematic review (search date: January 2019) that assessed exercise interventions for preventing falls in older people living in the community  (n = 23,407) found that [Sherrington, 2019]:
    • Eighty‐one trials (19,684 participants) compared exercise (all types) with control intervention (one not thought to reduce falls).
    • Exercise reduced the rate of falls by 23% (rate ratio (RaR) 0.77, 95% confidence interval (CI) 0.71 to 0.83; 12,981 participants, 59 studies; high‐certainty evidence).
    • Compared with control, balance and functional exercises reduce the rate of falls by 24% (RaR 0.76, 95% CI 0.70 to 0.81; 7920 participants, 39 studies; high‐certainty evidence) and the number of people experiencing one or more falls by 13% (RR 0.87, 95% CI 0.82 to 0.91; 8288 participants, 37 studies; high‐certainty evidence).
    • Multiple types of exercise (most commonly balance and functional exercises plus resistance exercises) probably reduce the rate of falls by 34% (RaR 0.66, 95% CI 0.50 to 0.88; 1374 participants, 11 studies; moderate‐certainty evidence) and the number of people experiencing one or more falls by 22% (RR 0.78, 95% CI 0.64 to 0.96; 1623 participants, 17 studies; moderate‐certainty evidence).
    • Tai Chi may reduce the rate of falls by 19% (RaR 0.81, 95% CI 0.67 to 0.99; 2655 participants, 7 studies; low‐certainty evidence) as well as reducing the number of people who experience falls by 20% (RR 0.80, 95% CI 0.70 to 0.91; 2677 participants, 8 studies; high‐certainty evidence).
    • However, exercise has little or no lasting effect on falls after the end of a programme (high certainty evidence) [Dyer, 2023].
Interventions not recommended
  • NICE does not currently recommend the following interventions because there is insufficient or conflicting evidence to support their use [NICE, 2025b]:
    • Low intensity exercise combined with incontinence programmes.
    • Group exercise (untargeted).
    • Cognitive/behavioural interventions.
    • Referral for correction of visual impairment.
    • Hip protectors.
    • Brisk walking (no evidence).
    • Vitamin D.
      • A Cochrane systematic review (search date: March 2024) that assessed interventions for preventing falls in older people living in the community (n = 79,193) found that in one cluster RCT (a multi-arm study), study authors reported no evidence of a difference in the number of female or male residents with falls leading to hospital admission after either a multicomponent intervention or a combination of this programme and the calcium and vitamin D programme [Lewis, 2024].

Supporting evidence

This CKS topic is based largely on the National Institute for Health and Care Excellence (NICE) guideline Falls: assessment and prevention in older people and in people 50 and over at higher risk [NICE, 2025b]. For a detailed discussion of the evidence NICE used to base their recommendations, see the full NICE guidance.

How this topic was developed

This section briefly describes the processes used in developing and updating this topic. Further details on the full process can be found in the About Us section and on the Clarity Informatics website.

Search strategy

A full literature search was performed. In addition, this CKS topic is primarily based on the National Institute for Health and Care Excellence (NICE) guideline Falls: assessment and prevention in older people and in people aged 50 and over at higher risk [NICE, 2025b].

Search dates

January 2019 - April 2025

Key search terms

The following search strategy was used in The Cochrane Library databases to identify relevant systematic reviews. 

#1    MeSH descriptor: [Accidental Falls] explode all trees
#2    (fall or falls or falling):ti,ab,kw
#3    #1 or #2

Sources of guidelines

Sources of systematic reviews and meta-analyses

  • The Cochrane Library:
    • Systematic reviews
    • Protocols
    • Database of Abstracts of Reviews of Effects
  • Medline (with systematic review filter)
  • EMBASE (with systematic review filter)

Sources of health technology assessments and economic appraisals

Sources of randomized controlled trials

  • The Cochrane Library:
    • Central Register of Controlled Trials
  • Medline (with randomized controlled trial filter)
  • EMBASE (with randomized controlled trial filter)

Sources of evidence based reviews and evidence summaries

Sources of national policy

Patient experiences

Sources of medicines information

The following sources are used by CKS pharmacists and are not necessarily searched by CKS information specialists for all topics. Some of these resources are not freely available and require subscriptions to access content.

Stakeholder engagement

Our policy

The external review process is an essential part of CKS topic development. Consultation with a wide range of stakeholders provides quality assurance of the topic in terms of:

  • Clinical accuracy.
  • Consistency with other providers of clinical knowledge for primary care.
  • Accuracy of implementation of national guidance (in particular NICE guidelines).
  • Usability.

Principles of the consultation process

  • The process is inclusive and any individual may participate.
  • To participate, an individual must declare whether they have any competing interests or not. If they do not declare whether or not they have competing interests, their comments will not be considered.
  • Comments received after the deadline will be considered, but they may not be acted upon before the clinical topic is issued onto the website.
  • Comments are accepted in any format that is convenient to the reviewer, although an electronic format is encouraged.
  • External reviewers are not paid for commenting on the draft topics.
  • Discussion with an individual or an organization about the CKS response to their comments is only undertaken in exceptional circumstances (at the discretion of the Clinical Editor or Editorial Steering Group).
  • All reviewers are thanked and offered a letter acknowledging their contribution for the purposes of appraisal/revalidation.
  • All reviewers are invited to be acknowledged on the website. All reviewers are given the opportunity to feedback about the external review process, enabling improvements to be made where appropriate.

Stakeholders

  • Key stakeholders identified by the CKS team are invited to comment on draft CKS topics. Individuals and organizations can also register an interest to feedback on a specific topic, or topics in a particular clinical area, through the Getting involved section of the Clarity Informatics website.
  • Stakeholders identified from the following groups are invited to review draft topics:
    • Experts in the topic area.
    • Professional organizations and societies (for example, Royal Colleges).
    • Patient organizations, Clarity has established close links with groups such as Age UK and the Alzheimer’s Society specifically for their input into new topic development, review of current topic content and advice on relevant areas of expert knowledge.
    • Guideline development groups where the topic is an implementation of a guideline.
    • The British National Formulary team.
    • The editorial team that develop MeReC Publications.
  • Reviewers are provided with clear instructions about what to review, what comments are particularly helpful, how to submit comments, and declaring interests.

Patient engagement

Clarity Informatics has enlisted the support and involvement of patients and lay persons at all stages in the process of creating the content which include:

  • Topic selection
  • Scoping of topic
  • Selection of clinical scenarios
  • First draft internal review
  • Second draft internal review
  • External review
  • Final draft and pre-publication

Our lay and patient involvement includes membership on the editorial steering group, contacting expert patient groups, organizations and individuals.

Evidence exclusion criteria

Our policy

Scoping a literature search, and reviewing the evidence for CKS is a methodical and systematic process that is carried out by the lead clinical author for each topic. Relevant evidence is gathered in order that the clinical author can make fully informed decisions and recommendations. It is important to note that some evidence may be excluded for a variety of reasons. These reasons may be applied across all CKS topics or may be specific to a given topic.

Studies identified during literature searches are reviewed to identify the most appropriate information to author a CKS topic, ensuring any recommendations are based on the best evidence. We use the principles of the GRADE and PICOT approaches to assess the quality of published research. We use the principles of AGREE II to assess the quality of published guidelines.

Standard exclusions for scoping literature:

  • Animal studies
  • Original research is not written in English

Possible exclusions for reviewed literature:

  • Sample size too small or study underpowered
  • Bias evident or promotional literature
  • Population not relevant
  • Intervention/treatment not relevant
  • Outcomes not relevant
  • Outcomes have no clear evidence of clinical effectiveness
  • Setting not relevant
  • Not relevant to UK
  • Incorrect study type
  • Review article
  • Duplicate reference

Organizational, behavioural and financial barriers

Our policy

The CKS literature searches take into consideration the following concepts, which are discussed at the initial scoping of the topic.

  • Feasibility
    • Studies are selected depending on whether the intervention under investigation is available in the NHS and can be practically and safely undertaken in primary care.
  • Organizational and Financial Impact Analysis
  • Studies are selected and evaluated on whether the intervention under investigations may have an impact on local clinical service provision or national impact on cost for the NHS. The principles of clinical budget impact analysis are adhered to, evaluated and recorded by the author. The following factors are considered when making this assessment and analysis.
    • Eligible population
    • Current interventions
    • Likely uptake of new intervention or recommendation
    • Cost of the current or new intervention mix
    • Impact on other costs
    • Condition-related costs
    • In-direct costs and service impacts
    • Time dependencies
  • Cost-effectiveness or cost-benefit analysis studies are identified where available. 

We also evaluate and include evidence from NICE accredited sources which provide economic evaluations of recommendations, such as NICE guidelines. When a recommended action may not be possible because of resource constraints, this is explicitly indicated to healthcare professionals by the wording of the CKS recommendation.

Declarations of interest

Our policy

Clarity Informatics requests that all those involved in the writing and reviewing of topics, and those involved in the external review process to declare any competing interests. Signed copies are securely held by Clarity Informatics and are available on request with the permission of the individual. A copy of the declaration of interest form which participants are asked to complete annually is also available on request. A brief outline of the declarations of interest policy is described here and full details of the policy is available on the Clarity Informatics website. Declarations of interests of the authors are not routinely published, however competing interests of all those involved in the topic update or development are listed below. Competing interests include:

  • Personal financial interests
  • Personal family interest
  • Personal non-financial interest
  • Non-personal financial gain or benefit

Although particular attention is given to interests that could result in financial gains or losses for the individual, competing interests may also arise from academic competition or for political, personal, religious, and reputational reasons. An individual is not obliged to seek out knowledge of work done for, or on behalf of, the healthcare industry within the departments for which they are responsible if they would not normally expect to be informed.

Who should declare competing interests?

Any individual (or organization) involved in developing, reviewing, or commenting on clinical content, particularly the recommendations should declare competing interests. This includes the authoring team members, expert advisers, external reviewers of draft topics, individuals providing feedback on published topics, and Editorial Steering Group members. Declarations of interest are completed annually for authoring team and editorial steering group members, and are completed at the start of the topic update and development process for external stakeholders.

Competing interests declared for this topic:

None.

References

  • Appeadu, M.K. and Bordoni, B. (2025) Falls and Fall Prevention in Older Adults. StatPearls [Internet]. Treasure Island (FL). [Abstract] [Free Full-text]
  • BGS (2019) Comprehensive Geriatric Assessment: patients presenting with mobility and balance issues. British Geriatrics Society. https://www.bgs.org.uk [Free Full-text]
  • BMA (2025) Identification and management of patients with frailty. British Medical Association. https://www.bma.org.uk [Free Full-text]
  • Chen, S.K., Voaklander, D., Perry, D. and Jones, C.A. (2019) Falls and fear of falling in older adults with total joint arthroplasty: a scoping review. BMC Musculoskeletal Disorders 20(1), 599. [Abstract] [Free Full-text]
  • Clemson, L., Stark, S., Pighills, A.C., et al. (2023) Environmental interventions for preventing falls in older people living in the community. (Cochrane Review/Cochrane Intervention Protocol). Issue 3 (3). John Wiley & Sons, Ltd. http://www.cochranelibrary.com [Free Full-text]
  • de Godoi Rezende Costa Molino, C., Forster, C.K., Wieczorek, M., et al. (2024) Association of fall risk-increasing drugs with falls in generally healthy older adults: a 3-year prospective observational study of the DO-HEALTH trial. BMC Geriatrics 24(1), 980. [Abstract] [Free Full-text]
  • Delbari, A., Azimi, A., Najafi, M., et al. (2023) Prevalence, complications, and risk factors of falls and fear of falling among older adults; based on Ardakan cohort study on aging (ACSA). Archives of Academic Emergency Medicine 12(1). [Abstract] [Free Full-text]
  • Dyer, S.M., Suen, J., Kwok, W.S., et al. (2023) Exercise for falls prevention in aged care: systematic review and trial endpoint meta-analyses. Age and Ageing 52(12). [Abstract] [Free Full-text]
  • Gambaro, E., Gramaglia, C., Azzolina, D., et al. (2022) The complex associations between late life depression, fear of falling and risk of falls. A systematic review and meta-analysis. Ageing Research Reviews 73, 101532. [Abstract] [Free Full-text]
  • Haddad, Y.K., Bergen, G. and Feijun, L. (2018) Reducing fall risk in older adults. American Journal of Nursing 118(7), 21-22. [Abstract] [Free Full-text]
  • Homann, C.N., Homann, B., Ivanic, G. and Urbanic-Purkart, T. (2022) Accidental falls in patients with hyperkinetic movement disorders: a systematic review. Tremor and Other Hyperkinetic Movements 12(30). [Abstract] [Free Full-text]
  • Hopewell, S.,  Adedire, O. and Copsey, B. et al. (2018) Multifactorial and multiple component interventions for preventing falls in older people living in the community (Cochrane Review/Cochrane Intervention Protocol). Issue 7. John Wiley & Sons, Ltd. http://www.cochranelibrary.com [Free Full-text]
  • Kakara, R., Bergen, G., Burns, E. and Stevens, M. (2023) Nonfatal and fatal falls among adults aged ≥65 Years - United States, 2020-2021. Morbidity and Mortality Weekly Report (MMWR) 75(35), 938-943. [Abstract] [Free Full-text]
  • Lee, J., Negm, A., Peters, R., et al. (2021) Deprescribing fall-risk increasing drugs (FRIDs) for the prevention of falls and fall-related complications: a systematic review and meta-analysis. British Medical Journal open 11(2), e035978. [Abstract] [Free Full-text]
  • Leung, P.B., Alexander, J.T. and Ouchida, K.E. (2024) Falls prevention for older adults. Journal of the American Medical Association 331(16), 1409-1410. [Abstract]
  • Lewis, S.R., McGarrigle, L., Pritchard, M.W., et al. (2024) Population-based interventions for preventing falls and fall-related injuries in older people. Cochrane Database of Systematic Reviews 1(1). [Abstract] [Free Full-text]
  • Montero-Odasso, M., van der Velde, N., Martin, F.C., et al. (2022) World guidelines for falls prevention and management for older adults: a global initiative. Age Ageing 51(9). [Abstract] [Free Full-text]
  • NICE (2016) Multimorbidity: clinical assessment and management. National Institute for Health and Care Excellence. http://www.nice.org.uk [Free Full-text]
  • NICE (2025a) Falls. Quality Standard 86. National Institute for Health and Care Excellence. https://www.nice.org.uk [Free Full-text]
  • NICE (2025b) Falls: assessment and prevention in older people and in people 50 and over at higher risk. Clinical guideline 249. National Institute for Health and Care Excellence. https://www.nice.org.uk [Free Full-text]
  • OHID (2022) Falls: applying All Our Health. Office for Health Improvement and Disparities. https://www.gov.uk [Free Full-text]
  • OHID (2024) Public Health Outcomes Framework. Office for Health Improvement and Disparities. https://www.gov.uk [Free Full-text]
  • Schroeder, J.D., Turner, S.P. and Buck, E. (2022) Hip fractures: diagnosis and management. American Family Physician 106(6), 675-678. [Abstract] [Free Full-text]
  • Sherrington, C., Fairhall, N.J. and Wallbank, G.K. (2019) Exercise for preventing falls in older people living in the community. (Cochrane Review/Cochrane Intervention Protocol). Issue 1. Art. No.: CD012424. John Wiley & Sons, Ltd. http://www.cochranelibrary.com [Free Full-text]
  • Skou, S.T., Mair, F.S., Fortin, M., et al. (2022) Multimorbidity. Nature Reviews Disease Primers 8(1), 48. [Abstract]
  • Stel, V.S., Smit, J.H. and Pluijm, S.M.F. et al. (2004) Consequences of falling in older men and women and risk factors for health service use and functional decline. Age and Ageing 33(1), 58-65. [Abstract]
  • Tinetti, M.E., Speechley, M. and Ginter, S.F. (1988) Risk factors for falls among elderly persons living in the community. New England Journal of Medicine 319(26), 1701-1707. [Abstract]
  • US Preventive Services Task Force (2024) Interventions to prevent falls in community-dwelling older adults: US preventive services task force recommendation statement. Journal of the American Medical Association 332(1), 51-57. [Abstract] [Free Full-text]
  • Vieira, E.R., Palmer, R.C. and Chaves, P.H.M. (2016) Prevention of falls in older people living in the community. BMJ 353(i1419). [Abstract]
  • Wang, S., Wang, M., Leung, I.S.H., et al. (2023) The association of cognitive frailty and the risk of falls among older adults: A systematic review and meta-analysis. International Journal of Nursing Practice 29(4), e13181. [Abstract]
  • Wong, H.L., Mandal, A.K.J., Weaver, C., et al. (2023) Polypharmacy and associated cumulative anticholinergic burden are important predictors of falls risk. British Journal of Clinical Pharmacology 89(7), 2332-2333. [Abstract] [Free Full-text]
  • Yang, Z.C., Lin, H., Jiang, G.H., et al. (2023) Frailty is a risk factor for falls in the older adults: a systematic review and meta-analysis. Journal of Nutrition, Health and Aging 27(6), 487-595. [Abstract] [Free Full-text]
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