Population‐based interventions for preventing falls and fall‐related injuries in older people

Background Around one‐third of older adults aged 65 years or older who live in the community fall each year. Interventions to prevent falls can be designed to target the whole community, rather than selected individuals. These population‐level interventions may be facilitated by different healthcare, social care, and community‐level agencies. They aim to tackle the determinants that lead to risk of falling in older people, and include components such as community‐wide polices for vitamin D supplementation for older adults, reducing fall hazards in the community or people's homes, or providing public health information or implementation of public health programmes that reduce fall risk (e.g. low‐cost or free gym membership for older adults to encourage increased physical activity). Objectives To review and synthesise the current evidence on the effects of population‐based interventions for preventing falls and fall‐related injuries in older people. We defined population‐based interventions as community‐wide initiatives to change the underlying societal, cultural, or environmental conditions increasing the risk of falling. Search methods We searched CENTRAL, MEDLINE, Embase, three other databases, and two trials registers in December 2020, and conducted a top‐up search of CENTRAL, MEDLINE, and Embase in January 2023. Selection criteria We included randomised controlled trials (RCTs), cluster RCTs, trials with stepped‐wedge designs, and controlled non‐randomised studies evaluating population‐level interventions for preventing falls and fall‐related injuries in adults ≥ 60 years of age. Population‐based interventions target entire communities. We excluded studies only targeting people at high risk of falling or with specific comorbidities, or residents living in institutionalised settings. Data collection and analysis We used standard methodological procedures expected by Cochrane, and used GRADE to assess the certainty of the evidence. We prioritised seven outcomes: rate of falls, number of fallers, number of people experiencing one or more fall‐related injuries, number of people experiencing one or more fall‐related fracture, number of people requiring hospital admission for one or more falls, adverse events, and economic analysis of interventions. Other outcomes of interest were: number of people experiencing one or more falls requiring medical attention, health‐related quality of life, fall‐related mortality, and concerns about falling. Main results We inc