Eliminating hazards around the home, such as clutter, stairs without railings and poor lighting, can reduce the risk of falls for older people by around a quarter, according to a new Cochrane review.
The review did not find any compelling evidence for other measures to reduce falls, such as making sure older people have the correct prescription glasses, special footwear, or education on avoiding falls.
It also found that decluttering and reducing hazards had the most benefit for older people who are at risk of falls, for example because they have recently had a fall and been hospitalised or need support with daily activities such as dressing or using stairs.
Nearly one-third of people aged 65 years and older fall each year. Most falls occur in the home.
Lindy Clemson, Professor Emeritus at the University of Sydney, Australia was lead author of the review.
Falls are very common among older people. They can cause serious injury or even death, but they are preventable. In this review we wanted to examine which measures could have the biggest impact on reducing falls among older people living at home."
Lindy Clemson, Lead Author, Professor Emeritus at the University of Sydney, Australia
Professor Clemson and her colleagues analysed the results of 22 studies including data on 8,463 older people living in the community.
They found that taking measures to reduce fall hazards around the home lowers the overall rate of falls by 26%. This typically includes an assessment of fall hazards in and around the home and recommendations for lowering the risk, for instance by removing clutter and adding handrails and non-slip strips to steps. These measures have the biggest effect (38% fewer falls) for people who are at a higher risk of falls. Based on their analyses, the reviewers found that if 1,000 people who had previously had a fall followed these measures for about a year, the total number of falls would come down from 1,847 to 1,145.
Professor Clemson said: "Having had a fall or starting to need help with everyday activities are markers of underlying risk factors, such as being unsteady on your feet, having poor judgement or weak muscles. These risk factors make negotiating the environment more challenging and increase the risk of a trip or slip in some situations.
"The research shows that, for those at risk of falls, being aware of fall hazards in and around the home, removing hazards and adapting with safe behaviours can significantly reduce the risk of falling. It appears that interventions to reduce fall hazards around the home need certain elements of assessment and support to work, not just a short check list of things to tick off. So, while everyone can take more care about their home environment and should do exercise for balance and lower limb strength, professional support from an occupational therapist is an important intervention for many people living at home.
"We encourage all people, as they age, to reduce fall hazards. These are often simple things like removing or changing slippery floor mats, improving lighting on stairs or de-cluttering the home. It seems this is not always 'common sense'. People tend not to notice clutter around their home or realise that climbing ladders the way they always have is potentially a fall risk, particularly if their mobility or balance is not as it used to be."
While the review showed fewer falls with hazard reduction, there was not enough data from the studies to determine if there were fewer admissions to hospital due to a fall. The authors found limited evidence for the other approaches to prevent falls that they examined – assistive technologies and education. They also found there was a lack of research on the impact on fall reduction of providing equipment or modifications to help older people carry out daily activities, such as showering or as cooking a meal.
Professor Clemson added: "Preventing falls is a really important way of helping people to remain healthy and independent as they grow older, and our review also highlights the need for more research in this area."
Clemson, L., et al. (2023) Environmental interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews. doi.org/10.1002/14651858.CD013258.pub2.