Fall-Prevention Programs for Older Adults Presenting With an Index Fall: Effectiveness and Safety

Abstract

Background:
Older adults discharged after an index fall emergency presentation face high risks of recurrent falls, injury, and repeat acute-care use; the effectiveness and safety of emergency-linked prevention programs remains uncertain.
Methods:
PubMed was searched from inception to July 2025. Randomized controlled trials of fall-prevention programs initiated at, or directly triggered by, the index-fall emergency encounter were included and synthesized narratively.
Results:
Eight randomized trials (n=2,806; follow-up 6–12 months) assessed emergency-department–initiated interdisciplinary assessment/referral, structured rehabilitation, patient-centred coaching, or emergency-department multidisciplinary consultation. Recurrent falls effects were mixed, ranging from reduced recurrent falling with comprehensive assessment (odds ratio 0.39; 95% CI 0.23–0.66) to no benefit in cognitive impairment/dementia (risk ratio 0.92; 95% CI 0.81–1.05) and neutral referral-based results for fallers (risk ratio 1.11; 95% CI 0.95–1.31). Secondary outcomes showed selective benefit, including reduced falls rate with coaching (incidence rate ratio 0.65; 95% CI 0.43–0.99), fewer fractures (incidence rate ratio 0.37; 95% CI 0.15–0.91), and fewer subsequent ED visits with multidisciplinary consultation (incidence rate ratio 0.47; 95% CI 0.29–0.74) including fall-related ED visits (incidence rate ratio 0.34; 95% CI 0.15–0.76).
Conclusions:
Emergency-linked fall-prevention programs demonstrated variable effectiveness, with more consistent benefits when risk assessment was coupled with active follow-up and service linkage. Caregiver-integrated pathways may be required for cognitively impaired populations