Query: bed alarm falls

title: Bed exit alarm effectiveness.
abstract: This study describes the accuracy of two types of bed exit alarms to detect bed exiting body movements: pressure sensitive and a pressure sensitive combined with infrared (IR) beam detectors (dual sensor system) We also evaluated the occurrence of nuisance alarms, or alarms that are activated when a participant does not attempt to get out of bed. Fourteen nursing home residents were directly observed for a total of 256 nights or 1636.5h; an average of 18.3+ 22.3 S.D. nights/participant for an average of 6.4+ 1.2 h/night. After adjusting for body movements via repeated measures, Poisson regression modeling, the least squares adjusted means (LSM) show a marginally significant difference between the type of alarm groups on the number of true positives (NTP) (mean/S.E.M.=0.086/1.617) for pressure sensitive versus dual sensor alarm (0.593/1.238; p=0.0599) indicating that the dual sensor alarm may have a higher NTP. While the dual sensor bed exit alarm was more accurate than the pressure sensitive alarm in identifying bed exiting body movements and reducing the incidence of false alarms, false alarms were not eliminated altogether. Alarms are not a substitute for staff; adequate staff availability is still necessary when residents need or wish to exit bed.

title: Falls in the Nursing Home
abstract: Falls are responsible for considerable morbidity, immobility, and mortality among older persons, especially those living in nursing homes. Falls have many different causes, and several risk factors that predispose patients to falls have been identified. To prevent falls, a systematic therapeutic approach to residents who have fallen is necessary, and close attention must be paid to identifying and reducing risk factors for falls among frail older persons who have not yet fallen. We review the problem of falls in the nursing home, focusing on identifiable causes, risk factors, and preventive approaches. Epidemiology Both the incidence of falls in older adults and the severity of complications increase steadily with age and increased physical disability. Accidents are the fifth leading cause of death in older adults, and falls constitute two thirds of these accidental deaths. About three fourths of deaths caused by falls in the United States occur in the 13% of the population aged 65 years and older [1, 2] Approximately one third of older adults living at home will fall each year, and about 5% will sustain a fracture or require hospitalization. The incidence of falls and fall related injuries among persons living in institutions has been reported in numerous epidemiologic studies [3 18] These data are presented in Table 1. The mean fall incidence calculated from these studies is about three times the rate for community living elderly persons (mean, 1.5 falls/bed per year) caused both by the more frail nature of persons living in institutions and by more accurate reporting of falls in institutions. Table 1. Incidence of Falls and Fall Related Injuries in Long Term Care Facilities* As shown in Table 1, only about 4% of falls (range, 1% to 10% result in fractures, whereas other serious injuries such as head trauma, soft tissue injuries, and severe lacerations occur in about 11% of falls (range, 1% to 36% However, once injured, an elderly person who has fallen has a much higher case fatality rate than does a younger person who has fallen [1, 2] Each year, about 1800 fatal falls occur in nursing homes. Among persons 85 years and older, 1 of 5 fatal falls occurs in a nursing home [19] Nursing home residents also have a disproportionately high incidence of hip fracture and have been shown to have higher mortality rates after hip fracture than community living elderly persons [20] Furthermore, because of the high frequency of recurrent falls in nursing homes, the likelihood of sustaining an injurious fall is substantial. In addition to injuries, falls can have serious consequences for physical functioning and quality of life. Loss of function can result from both fracture related disability and self imposed functional limitations caused by fear of falling and the postfall anxiety syndrome. Decreased confidence in the ability to ambulate safely can lead to further functional decline, depression, feelings of helplessness, and social isolation. In addition, the use of physical or chemical restraints by institutional staff to prevent high risk persons from falling also has negative effects on functioning. Causes of Falls The major reported immediate causes of falls and their relative frequencies as described in four detailed studies of nursing home populations [14, 15, 17, 21] are presented in Table 2. The Table also contains a comparison column of causes of falls among elderly persons not living in institutions as summarized from seven detailed studies  The distribution of causes clearly differs among the populations studied. Frail, high risk persons living in institutions tend to have a higher incidence of falls caused by gait disorders, weakness, dizziness, and confusion, whereas the falls of community living persons are more related to their environment. Table 2. Comparison of Causes of Falls in Nursing Home and Community  Studies have reported that the prevalence of detectable lower extremity weakness ranges from 48% among community living older persons [29] to 57% among residents of an intermediate care facility [30] to more than 80% of residents of a skilled nursing facility  Gait disorders affect 20% to 50% of elderly persons [31] and nearly three quarters of nursing home residents require assistance with ambulation or cannot ambulate [32] Investigators of casecontrol studies in nursing homes have reported that more than two thirds of persons who have fallen have substantial gait disorders, a prevalence 2.4 to 4.8 times higher than the prevalence among persons who have not fallen [27, 30] The cause of muscle weakness and gait problems is multifactorial. Aging introduces physical changes that affect strength and gait. On average, healthy older persons score 20% to 40% lower on strength tests than young adults [33] and, among chronically ill nursing home residents, strength is considerably less than that. Much of the weakness seen in the nursing home stems from deconditioning due to prolonged bedrest or limited physical activity and chronic debilitating medical conditions such as heart failure, stroke, or pulmonary disease. Aging is also associated with other deteriorations that impair gait, including increased postural sway; decreased gait velocity, stride length, and step height; prolonged reaction time; and decreased visual acuity and depth perception. Gait problems can also stem from dysfunction of the nervous, musculoskeletal, circulatory, or respiratory systems, as well as from simple deconditioning after a period of inactivity. Dizziness is commonly reported by elderly persons who have fallen and was the attributed cause in 25% of reported nursing home falls. This symptom is often difficult to evaluate because dizziness means different things to different people and has diverse causes. True vertigo, a sensation of rotational movement, may indicate a disorder of the vestibular apparatus such as benign positional vertigo, acute labyrinthitis, or Meniere disease. Symptoms described as imbalance on walking often reflect a gait disorder. Many residents describe a vague light headedness that may reflect cardiovascular problems, hyperventilation, orthostatic hypotension, drug side effect, anxiety, or depression. Accidents, or falls stemming from environmental hazards, are a major cause of reported falls16% of nursing home falls and 41% of community falls. However, the circumstances of accidents are difficult to verify, and many falls in this category may actually stem from interactions between environmental hazards or hazardous activities and increased individual susceptibility to hazards because of aging and disease. Among impaired residents, even normal activities of daily living might be considered hazardous if they are done without assistance or modification. Factors such as decreased lower extremity strength, poor posture control, and decreased step height all interact to impair the ability to avoid a fall after an unexpected trip or while reaching or bending. Age associated impairments of vision, hearing, and memory also tend to increase the number of trips. Studies have shown that most falls in nursing homes occurred during transferring from a bed, chair, or wheelchair [3, 11] Attempting to move to or from the bathroom and nocturia (which necessitates frequent trips to the bathroom) have also been reported to be associated with falls [34, 35] and fall related fractures  Environmental hazards that frequently contribute to these falls include wet floors caused by episodes of incontinence, poor lighting, bedrails, and improper bed height. Falls have also been reported to increase when nurse staffing is low, such as during breaks and at shift changes [4, 7, 9, 13] presumably because of lack of staff supervision. Confusion and cognitive impairment are frequently cited causes of falls and may reflect an underlying systemic or metabolic process (for example, electrolyte imbalance or fever) Dementia can increase the number of falls by impairing judgment, visual spatial perception, and ability to orient oneself geographically. Falls also occur when residents with dementia wander, attempt to get out of wheelchairs, or climb over bed siderails. Orthostatic (postural) hypotension, usually defined as a decrease of 20 mm or more of systolic blood pressure after standing, has a 5% to 25% prevalence among normal elderly persons living at home [36] It is even more common among persons with certain predisposing risk factors, including autonomic dysfunction, hypovolemia, low cardiac output, parkinsonism, metabolic and endocrine disorders, and medications (particularly sedatives, antihypertensives, vasodilators, and antidepressants)  The orthostatic drop may be more pronounced on arising in the morning because the baroreflex response is diminished after prolonged recumbency, as it is after meals and after ingestion of nitroglycerin [38, 39] Yet, despite its high prevalence, orthostatic hypotension infrequently causes falls, particularly outside of institutions. This is perhaps because of its transient nature, which makes it difficult to detect after the fall, or because most persons with orthostatic hypotension feel light headed and will deliberately find a seat rather than fall. Drop attacks are defined as sudden falls without loss of consciousness and without dizziness, often precipitated by a sudden change in head position. This syndrome has been attributed to transient vertebrobasilar insufficiency, although it is probably caused by more diverse pathophysiologic mechanisms. Although early descriptions of geriatric falls identified drop attacks as a substantial cause, more recent studies have reported a smaller proportion of perso

title: A smart sensor to detect the falls of the elderly
abstract: Falls are a major health hazard for the elderly and a major obstacle to independent living. The estimated incidence of falls for both institutionalized and independent persons aged over 75 is at least 30 percent per year. In the SIMBAD (Smart Inactivity Monitor using Array Based Detectors) project, we've developed an intelligent fall detector based on a low cost array of infrared detectors. A field trial and user research indicate that SIMBAD could significantly enhance the functionality and effectiveness of existing monitoring systems and community alarm systems.

title: Effects of an Intervention to Increase Bed Alarm Use to Prevent Falls in Hospitalized Patients
abstract: Bed alarm systems intended to prevent hospital falls have not been formally evaluated.  To investigate whether an intervention aimed at increasing bed alarm use decreases hospital falls and related events.  Pair matched, cluster randomized trial over 18 months. Nursing units were allocated by computer generated randomization on the basis of baseline fall rates. Patients and outcome assessors were blinded to unit assignment; outcome assessors may have become unblinded.  Education, training, and technical support to promote use of a standard bed alarm system (intervention units) bed alarms available but not formally promoted or supported (control units) MEASUREMENTS Pre post difference in change in falls per 1000 patient days (primary end point) number of patients who fell, fall related injuries, and number of patients restrained (secondary end points)  Prevalence of alarm use was 64.41 days per 1000 patient days on intervention units and 1.79 days per 1000 patient days on control units (P 0.004) There was no difference in change in fall rates per 1000 patient days (risk ratio, 1.09 [95% CI, 0.85 to 1.53] difference, 0.41 [CI, 1.05 to 2.47] which corresponds to a greater difference in falls in control vs. intervention units) or in the number of patients who fell, injurious fall rates, or the number of patients physically restrained on intervention units compared with control units.  The study was conducted at a single site and was slightly underpowered compared with the initial design.  An intervention designed to increase bed alarm use in an urban hospital increased alarm use but had no statistically or clinically significant effect on fall related events or physical restraint use.

title: Preventing falls and fall related injuries in hospitals.
abstract: Falls are a widespread concern in hospitals settings, with whole hospital rates of between 3 and 5 falls per 1000 bed days representing around a million inpatient falls occurring in the United States each year. Between 1% and 3% of falls in hospitals result in fracture, but even minor injuries can cause distress and delay rehabilitation. Risk factors most consistently found in the inpatient population include a history of falling, muscle weakness, agitation and confusion, urinary incontinence or frequency, sedative medication, and postural hypotension. Based on systematic reviews, recent research, and clinical and ethical considerations, the most appropriate approach to fall prevention in the hospital environment includes multifactorial interventions with multiprofessional input. There is also some evidence that delirium avoidance programs, reducing sedative and hypnotic medication, in depth patient education, and sustained exercise programs may reduce falls as single interventions. There is no convincing evidence that hip protectors, movement alarms, or low low beds reduce falls or injury in the hospital setting. International approaches to developing and maintaining a fall prevention program suggest that commitment of management and a range of clinical and support staff is crucial to success.

title: Characteristics and circumstances of falls in a hospital setting
abstract: To describe the epidemiology of hospital inpatient falls, including characteristics of patients who fall, circumstances of falls, and fall related injuries. Prospective descriptive study of inpatient falls. Data on patient characteristics, fall circumstances, and injury were collected through interviews with patients and/or nurses and review of adverse event reports and medical records. Fall rates and nurse staffing levels were compared by service. A 1,300 bed urban academic hospital over 13 weeks. All inpatient falls reported for medicine, cardiology, neurology, orthopedics, surgery, oncology, and women and infants services during the study period were included. Falls in the psychiatry service and falls during physical therapy sessions were excluded. A total of 183 patients fell during the study period. The average age of patients who fell was 63.4 years (range 17 to 96) Many falls were unassisted (79% and occurred in the patient's room (85% during the evening/overnight (59% and during ambulation (19% Half of the falls (50% were elimination related, which was more common in patients over 65 years old (83% vs 48% P<.001) Elimination related falls increased the risk of fall related injury (adjusted odds ratio, 2.4; 95% confidence interval 1.1 to 5.3) The medicine and neurology services had the highest fall rates (both were 6.12 falls per 1,000 patient days) and the highest patient to nurse ratios (6.5 and 5.3,  Falls in the hospital affect young as well as older patients, are often unassisted, and involve elimination related activities. Further studies are necessary to prevent hospital falls and reduce fall injury rates.

title: Falls in older people: epidemiology, risk factors and strategies for prevention.
abstract: Falls are a common and often devastating problem among older people, causing a tremendous amount of morbidity, mortality and use of health care services including premature nursing home admissions. Most of these falls are associated with one or more identifiable risk factors (e.g. weakness, unsteady gait, confusion and certain medications) and research has shown that attention to these risk factors can significantly reduce rates of falling. Considerable evidence now documents that the most effective (and cost effective) fall reduction programmes have involved systematic fall risk assessment and targeted interventions, exercise programmes and environmental inspection and hazard reduction programmes. These findings have been substantiated by careful meta analysis of large numbers of controlled clinical trials and by consensus panels of experts who have developed evidence based practice guidelines for fall prevention and management. Medical assessment of fall risks and provision of appropriate interventions are challenging because of the complex nature of falls. Optimal approaches involve interdisciplinary collaboration in assessment and interventions, particularly exercise, attention to co existing medical conditions and environmental inspection and hazard abatement.

title: Falls risk prediction tools for hospital inpatients. Time to put them to bed?
abstract: Accidental falls are the commonest safety incidents affecting hospital inpatients and care home residents [1, 2] The recent National Patient Safety Agency (NPSA) report, 'Slips Trips and Falls in Hospital' [2] identified over 200,000 reported falls incidents from acute, community and mental health trusts in England and Wales from 2004/2005 alone, (some 32% of all incidents in all age groups) though we know from this and other sources that such incidents are underreported  Such falls are associated with a range of adverse outcomes including injury, impaired confidence and function, increased length of stay, institutionalisation anxiety and guilt for staff and relatives, complaint and litigation. They should, therefore, be a major risk management priority for hospitals and care homes (where around 50% of residents fall at least once a year)  and have recently been made a main focus for examining older patients' care by the Healthcare Commission  There is a growing body of evidence on interventions to prevent falls and falls related injuries in hospital [1, 6, 7] One component of many research interventions, and a common feature of 'real life' falls policies in hospitals, is the use of falls risk prediction tools. By this, I do not mean 'checklists' of common risk factors to prompt specific action by staff, which might, in turn, reduce falls. Such factors might include environmental and equipment safety, medication, hypotension, visual impairment, muscle weakness or postural instability, cognitive impairment, restlessness or agitation, all of which, amongst others, have been targeted in successful falls intervention programmes  I have no argument with the use of such tools, which, in effect, prompt good comprehensive geriatric assessment and care planning. My concern is over scoring tools, which purport simplistically to classify patients as having a 'high' or 'low' risk of falling so that interventions can be targeted to 'high risk' patients. This approach can work well in other fields, for instance, with diagnostic screening tests such as troponin for acute coronary syndrome, or d dimer for suspected pulmonary embolism (both of which are good 'true negative' tests with high specificity) It is also possible for clinical prediction tools with continuous scoring to be used to calculate overall probability of an adverse event. Examples of these include the Kings Fund 'Patient at Risk of Readmission Scores' (PARR) or Critical Care Early Warning Scores, both of which correlate tightly with the probability of the adverse event, (i.e. hospital admission or cardiac arrest/ICU admission) [9, 10] Falls risk assessment tools in hospital have rarely been used in this probabilistic way, rather, they place patients categorically as either at 'high' or 'low' risk. Though most work has been done in hospitals, my comments on the use of such tools in hospitals could apply equally to their use in long term care or community settings. There have been a succession of systematic reviews on validation studies for hospital falls prediction tools in recent years [8, 11 13] and several more new validation studies are in press. In this issue of Age and Ageing, Vassallo et al.  report a prospective validation study comparing two tools (STRATIFY and Downton Score) with nurses' clinical judgement (largely based on wandering behaviour) on a cohort of 200 geriatric patients. Meanwhile, Ashburn et al.  looked at 122 consecutive patients discharged from a stroke ward, following up on them to record further falls at home over 12 months. Sixty three experienced one or more further falls. Before discharge, they collected a variety of structured clinical data, a score based on 'near falls' in hospital, and poor upper limb function on retrospective fitting predicted falls with 70% specificity and 60% sensitivity. In Vassallo et al. the single item of 'wandering' identified by nurses conferred better predictive accuracy than either of the formal scores, but significantly lower sensitivity (though this might not be the case for populations where wandering is infrequent) These papers raise some interesting questions around the practical utility in predicting and preventing falls, the 'trade off' between the various elements of predictive validity, their validity in other (quite different) populations and settings. A detailed exploration of these and allied issues is not possible here, but is explored in recent reviews. However, even as one of the authors of the most widely validated tool for use in hospital (STRATIFY)  still used in many hospitals [1, 2] I am happy to recant. I do not believe that STRATIFY, or any other tool, is good enough at its job.

title: Falls and consequent injuries in hospitalized patients: effects of an interdisciplinary falls prevention program
abstract: BackgroundPatient falls in hospitals are common and may lead to negative outcomes such as injuries, prolonged hospitalization and legal liability. Consequently, various hospital falls prevention programs have been implemented in the last decades. However, most of the programs had no sustained effects on falls reduction over extended periods of time.MethodsThis study used a serial survey design to examine in patient fall rates and consequent injuries before and after the implementation of an interdisciplinary falls prevention program (IFP) in a 300 bed urban public hospital. The population under study included adult patients, hospitalized in the departments of internal medicine, geriatrics, and surgery. Administrative patient data and fall incident report data from 1999 to 2003 were examined and summarized using frequencies, proportions, means and standard deviations and were analyzed accordingly. total of 34,972 hospitalized patients (mean age: 67.3, SD 19.3 years; female 53.6% mean length of stay: 11.9 13.2 days, mean nursing care time per day: 3.5 1.4 hours) were observed during the study period. Overall, a total of 3,842 falls affected 2,512 (7.2% of the hospitalized patients. From these falls, 2,552 (66.4% were without injuries, while 1,142 (29.7% falls resulted in minor injuries, and 148 (3.9% falls resulted in major injuries. The overall fall rate in the hospitals' patient population was 8.9 falls per 1,000 patient days. The fall rates fluctuated slightly from 9.1 falls in 1999 to 8.6 falls in 2003. After the implementation of the IFP, in 2001 a slight decrease to 7.8 falls per 1,000 patient days was observed (p 0.086) The annual proportion of minor and major injuries did not decrease after the implementation of the IFP. From 1999 to 2003, patient characteristics changed in terms of slight increases (female gender, age, consumed nursing care time) or decreases (length of hospital stay) as well as the prevalence of fall risk factors increased up to 46.8% in those patients who fell.ConclusionFollowing the implementation of an interdisciplinary falls prevention program, neither the frequencies of falls nor consequent injuries decreased substantially. Future studies need to incorporate strategies to maximize and evaluate ongoing adherence to interventions in hospital falls prevention programs.

title: Interventions for preventing falls in older people living in the community.
abstract: 30% of people over 65 years of age living in the community fall each year. This is an update of a Cochrane review first published in 2009.  To assess the effects of interventions designed to reduce the incidence of falls in older people living in the community.  We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (February 2012) CENTRAL (The Cochrane Library 2012, Issue 3) MEDLINE (1946 to March 2012) EMBASE (1947 to March 2012) CINAHL (1982 to February 2012) and online trial registers.  Randomised trials of interventions to reduce falls in community dwelling older people.  Two review authors independently assessed risk of bias and extracted data. We used a rate ratio (RaR) and 95% confidence interval (CI) to compare the rate of falls (e.g. falls per person year) between intervention and control groups. For risk of falling, we used a risk ratio (RR) and 95% CI based on the number of people falling (fallers) in each group. We pooled data where appropriate.  We included 159 trials with 79,193 participants. Most trials compared a fall prevention intervention with no intervention or an intervention not expected to reduce falls. The most common interventions tested were exercise as a single intervention (59 trials) and multifactorial programmes (40 trials) 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.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; seven trials; 951 participants and RR 0.78, 95% CI 0.64 to 0.94; six trials; 714 participants) For Tai Chi, the reduction in rate of falls bordered on statistical significance (RaR 0.72, 95% CI 0.52 to 1.00; five trials; 1563 participants) but Tai Chi did significantly reduce risk of falling (RR 0.71, 95% CI 0.57 to 0.87; six trials; 1625 participants).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, vitamin D did not reduce rate of falls (RaR 1.00, 95% CI 0.90 to 1.11; seven 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.Home safety assessment and modification interventions were effective in reducing rate of falls (RR 0.81, 95% CI 0.68 to 0.97; six trials; 4208 participants) and risk of falling (RR 0.88, 95% CI 0.80 to 0.96; seven trials; 4051 participants) These interventions were more effective in people at higher risk of falling, including those with severe visual impairment. Home safety interventions appear to be more effective when delivered by an occupational therapist.An 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) 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. Conversely, there was a significant increase in outside falls in intervention group participants who took part in little outside activity.Pacemakers reduced rate of falls in people with carotid sinus hypersensitivity (RaR 0.73, 95% CI 0.57 to 0.93; three trials; 349 participants) but not risk of falling. First eye cataract surgery in women reduced rate of falls (RaR 0.66, 95% CI 0.45 to 0.95; one trial; 306 participants) but second eye cataract surgery did not.Gradual withdrawal of psychotropic medication reduced rate of falls (RaR 0.34, 95% CI 0.16 to 0.73; one trial; 93 participants) but not risk of falling. A prescribing modification programme for primary care physicians significantly reduced risk of falling (RR 0.61, 95% CI 0.41 to 0.91; one trial; 659 participants).An anti slip shoe device reduced rate of falls in icy conditions (RaR 0.42, 95% CI 0.22 to 0.78; one trial; 109 participants) One trial (305 participants) comparing multifaceted podiatry including foot and ankle exercises with standard podiatry in people with disabling foot pain significantly reduced the rate of falls (RaR 0.64, 95% CI 0.45 to 0.91) but not the risk of falling.There is no evidence of effect for cognitive behavioural interventions on rate of falls (RaR 1.00, 95% CI 0.37 to 2.72; one trial; 120 participants) or risk of falling (RR 1.11, 95% CI 0.80 to 1.54; two trials; 350 participants).Trials testing interventions to increase knowledge/educate about fall prevention alone did not significantly reduce the rate of falls (RaR 0.33, 95% CI 0.09 to 1.20; one trial; 45 participants) or risk of falling (RR 0.88, 95% CI 0.75 to 1.03; four trials; 2555 participants).No conclusions can be drawn from the 47 trials reporting fall related fractures.Thirteen trials provided a comprehensive economic evaluation. Three of these indicated cost savings for their interventions during the trial period: home based exercise in over 80 year olds, home safety assessment and modification in those with a previous fall, and one multifactorial programme targeting eight specific risk factors.  Group and home based exercise programmes, and home safety interventions reduce rate of falls and risk of falling.Multifactorial assessment and intervention programmes reduce rate of falls but not risk of falling; Tai Chi reduces risk of falling.Overall, vitamin D supplementation does not appear to reduce falls but may be effective in people who have lower vitamin D levels before treatment.