Twenty RCTs (23,646 participants, range 122 to 10,558) were included: eight from the previous review and 12 from the updated search. Follow-up ranged from three to 24 months. Compliance rates for implementation of the intervention ranged from low to good. The authors reported variable trial quality with regards to randomisation procedures (mostly cluster-randomised, few studies used individual randomisation). Blinding of participants and care staff was generally not possible. In general the design, conduct and analyses of the included RCTs were considered to be adequate. No further details on study quality results were reported.
Seven RCTs showed a significant positive effect of the intervention on fall rate (five RCTs), percentage of recurrent fallers (one RCT) and on both the fall rate and the percentage of participants who sustained fractures (one RCT).
Multifactor programmes: A comprehensive structured individual assessment with specific safety recommendations (one RCT), environmental and personal safety assessments and improvements (three RCTs), a multifaceted intervention that included education, environmental adaptation, balance and resistance training and provision of hip protectors (one RCT) and an intervention that combined fall risk evaluation with general and specific interventions (one RCT) had a statistically significant positive effect.
Single-factor interventions: Calcium plus vitamin D supplementation (one RCT), vitamin D supplementation (one RCT) and a review of medication (one RCT) showed statistically significant positive effects.
A programme that included a fall-risk assessment-tool, a warning sign for high fall risk and strategies to address identified risks (one RCT) showed a statistically significant adverse effect of the intervention on the fall rate.
Provision of hip protectors (three RCTs), physical exercise (four RCTs), drug prescriptions (one RCT) and vitamin D supplementation (two RCTs) did not have any statistically significant effect.
All studies provided possible reasons for reduced programme effectiveness: low compliance, inability to target most important risk factors, insufficient vigour of the intervention, lack of support from staff and limited resources.