Pacemakers reduced rate of falls in people with carotid sinus hypersensitivity (RaR 0.73, 95% CI 0.57 to 0.93 3 trials 349 participants) but not risk of falling. Conversely, there was a significant increase in outside falls in intervention group participants who took part in little outside activity. When regular wearers of multifocal glasses (597 participants) were given single lens glasses, all falls and outside falls were significantly reduced in the subgroup that regularly took part in outside activities.

Home safety interventions appear to be more effective when delivered by an occupational therapist.Īn intervention to treat vision problems (616 participants) resulted in a significant increase in the rate of falls (RaR 1.57, 95% CI 1.19 to 2.06) and risk of falling (RR 1.54, 95% CI 1.24 to 1.91). These interventions were more effective in people at higher risk of falling, including those with severe visual impairment. Home safety assessment and modification interventions were effective in reducing rate of falls (RaR 0.81, 95% CI 0.68 to 0.97 6 trials 4208 participants) and risk of falling (RR 0.88, 95% CI 0.80 to 0.96 7 trials 4051 participants). Overall, vitamin D did not reduce rate of falls (RaR 1.00, 95% CI 0.90 to 1.11 7 trials 9324 participants) or risk of falling (RR 0.96, 95% CI 0.89 to 1.03 13 trials 26,747 participants), but may do so in people with lower vitamin D levels before treatment. Multifactorial interventions, which include individual risk assessment, reduced rate of falls (RaR 0.76, 95% CI 0.67 to 0.86 19 trials 9503 participants), but not risk of falling (RR 0.93, 95% CI 0.86 to 1.02 34 trials 13,617 participants). Overall, exercise interventions significantly reduced the risk of sustaining a fall‐related fracture (RR 0.34, 95% CI 0.18 to 0.63 6 trials 810 participants). For Tai Chi, the reduction in rate of falls bordered on statistical significance (RaR 0.72, 95% CI 0.52 to 1.00 5 trials 1563 participants) but Tai Chi did significantly reduce risk of falling (RR 0.71, 95% CI 0.57 to 0.87 6 trials 1625 participants). Multiple‐component group exercise significantly reduced rate of falls (RaR 0.71, 95% CI 0.63 to 0.82 16 trials 3622 participants) and risk of falling (RR 0.85, 95% CI 0.76 to 0.96 22 trials 5333 participants), as did multiple‐component home‐based exercise (RaR 0.68, 95% CI 0.58 to 0.80 7 trials 951 participants and RR 0.78, 95% CI 0.64 to 0.94 6 trials 714 participants). Sixty‐two per cent (99/159) of trials were at low risk of bias for sequence generation, 60% for attrition bias for falls (66/110), 73% for attrition bias for fallers (96/131), and only 38% (60/159) for allocation concealment. The most common interventions tested were exercise as a single intervention (59 trials) and multifactorial programmes (40 trials). Most trials compared a fall prevention intervention with no intervention or an intervention not expected to reduce falls. We included 159 trials with 79,193 participants.

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