As with many other strategies used in dealing with older patients, falls prevention needs a multidisciplinary approach [12, 13]. A Cochrane review from 2012 summarized that multifactorial interventions are required to ascertain a patient’s falls risk and then implement treatment or referrals which will minimize the risks identified [14, 15]. For the most part, the most recent evidence available indicates that this type of proactive intervention reduces the number of falls in the elderly community [16].

The multidisciplinary strategies may include:

This may include the use of hip protectors, movement sensors and other biotechnological tools.

Investigating and considering treatment for osteoporosis are beneficial. This may also involve identifying patients at high risk of falls by using fracture risk assessment tools and appropriate treatment for both preventing and managing osteoporosis.

Research results on all these interventions have at times been conflicting. The 2012 Cochrane review examined the healthcare research information to determine which falls prevention interventions are effective for older people living in the community. This involved 159 randomized controlled trials with 79,193 participants. These interventions included:

Obviously certain medications may increase the falls risks for older people. Unfortunately three trials in Cochrane group were unable to reduce the number of falls by reviewing and adjusting medications; however a fourth trial involving general practitioners and their patients in the mediation review process did result in a subsequent reduction in the number of falls.

Additionally, the use of a pacemaker where appropriate can minimize falls in patients whose falls are often a result of carotid sinus hypersensitivity, a condition responsible for unexpected changes in both heart rate and blood pressure. Podiatry input for people with debilitating foot pain through the use of customized insoles, appropriate footwear, orthotic insoles as well as foot and ankle exercises reduced the number of falls for those affected.

A systematic meta-analysis by Sherrington et al. looked at 44 randomized controlled trials with 9603 participants. They concluded that there was a 17% overall risk reduction for falls in those who exercised. The analysis also looked at the variability in results, and the group felt that it was explained by various factors including dose of exercise, level of challenge to balance and presence or absence of a walking programme. The analysis also illustrated the fact that exercise-related interventions could ironically also increase the risk of falls when applied to the inappropriate patient.

The Otago Falls Prevention Programme has been a well-established and well-used programme that examined the role of nurse-led, function-based balance and gait training for at-risk elderly patients in the community. The programme was shown to be very cost-effective; it also primarily addressed balance.

More recently, El-Khoury et al. [22] have shown that a two-year balance training programme, with both a weekly group session and individual sessions, effectively reduced falls resulting in injuries and also was helpful for women aged 75–85 years, at risk of falling, in improving measured and perceived physical function. As it is not always possible to prevent a fall, there is now more emphasize placed on reducing injurious falls and overall risk of injury [23].

Visual impairment is a common problem amongst elderly with cataract and macular degeneration, and detection and treatment have been shown to reduce falls in selected patients [24]. Trials have been limited by small numbers; however one of four trials reviewing cataract treatment as an intervention showed a clear reduction [25, 26].

Campbell et al. [27] showed that a home safety assessment and modification programme by an occupational therapist reduced falls amongst men and women aged 75 years plus, with severe visual impairment.

The following tips are useful in preventing falls in the visually impaired:

Occupational therapists are particularly helpful in instituting interventions to improve home safety, especially in people at higher risk of falling. For example, shoe device might be needed in icy conditions to prevent injurious falls.

The interventions may differ depending on the setting. Falls prevention for elderly patients admitted to hospital as inpatients may require more focused interventions as follows:

Vitamin D supplementation may reduce the number of falls for older people in the community where there is a preexisting vitamin D deficiency; however vitamin D supplementation in itself does not appear to reduce falls in general.

There have been several trials assessing effectiveness of vitamin D in preventing falls. Three of these showed positive effects, and at least one had significant negative result. Trials that assessed patients in long-term facilities as expected did show positive impact of vitamin D supplementation.

There has been significant research into the use of biotechnology in the area of falls and injury prevention over the last decade. A variety of movement sensors, alert/alarm systems, ultralow beds for patients with delirium, appropriate lighting and non-slip flooring have been trialled in preventing falls and injuries with variable success.

Kosse et al. [28] reviewed 12 studies that looked at the use of sensors to prevent falls and related injuries in the elderly living in residential care settings. Although three trials showed a significant reduction in falls-related injuries (77%), the false alarm rate of 16% was felt to be too high to keep the carer staff focused. The group concluded that staff engagement and careful patient selection are needed when using sensors to reduce falls and falls-related injuries in residential care settings.

This has been a controversial issue, but there is now general consensus that use of chemical restraint (sedation) or physical restraint (e.g. bedrails) does not prevent falls: in fact, it can result in worse injuries. Bedrails, for example, have been shown to cause serious injuries in multiple studies—from asphyxiation to lacerations and dislocated joints. These tend to happen while a confused patient tries to climb over the bedrails.