Falls Prevention in Care Homes: What the Evidence Shows

Falls prevention in care homes generates a lot of confident claims and not much clarity. So it's worth stepping back to what the research actually says, including the parts that don't make for a tidy headline.

The FinCH trial: a 43% reduction, with a catch

The largest UK study of its kind, the Falls in Care Homes (FinCH) trial led by Professor Pip Logan's team at the University of Nottingham, tested a structured, multifactorial falls prevention programme (originally called Guide to Action Care Homes, now branded Action Falls) across care homes for older people. The trial found a 43% reduction in the rate of falls during months four to six of the programme, with no reduction in residents' activity levels or independence, an important finding in itself, since some falls-prevention approaches inadvertently reduce falls simply by reducing how much residents move.

Here's the part that doesn't get repeated as often: that effect wasn't fully sustained. Between months six and twelve, the benefit waned, and the trial team's own analysis pointed to a likely cause. Staff didn't always keep the programme embedded in day-to-day routine once the initial training period had passed, and awareness dropped off. The FinCH programme didn't stop working. The reinforcement needed to keep it embedded mostly didn't happen.

That's a useful finding for any care home evaluating falls programmes. It reframes the real question worth asking a provider. Whether the programme works is largely settled; the harder question is who keeps it working after week twelve.

What the biggest review yet says about exercise

The most rigorous evidence available comes from a 2025 Cochrane review pooling 104 trials and 68,964 care home residents (Dyer et al., 2025), the largest review of falls prevention in care facilities published to date.

Its headline finding: exercise reduces the rate of falls while residents are actively taking part, a 32% reduction, moderate-certainty evidence. That effect disappears once the programme stops, though, high-certainty evidence, no residual benefit once exercise ends. A falls prevention programme in a care home only works while it's running.

The review also found that multifactorial programmes tailored to each resident and combined with staff training cut the rate of falls by 39%, moderate-certainty evidence, based on 3,553 residents across 7 trials. Generic multifactorial programmes without that tailoring and staff engagement showed no measurable effect.

That distinction, tailored and sustained versus generic and one-off, is the reasoning behind how the Falls Shield Protocol is structured.

NICE's 2025 update: assessment over prediction

Falls guidance moved again in April 2025, when NICE published NG249, replacing the 2013 CG161 guideline. The update steers away from scoring tools that attempt to predict who will fall, in favour of a comprehensive, multifactorial assessment for residents who've already fallen in the past year or who meet defined risk criteria. It's a shift from prediction towards individualised clinical judgement, and it lines up with what FinCH and the Cochrane review both show: the evidence supports resident-tailored falls prevention over a blanket programme.

The common thread: sustainability

Put the three sources together and a clear pattern emerges. Structured, evidence-based falls programmes work, and the evidence for that isn't really in dispute anymore. The weak point the evidence keeps flagging is whether care homes can keep a programme running at the intensity it needs once the initial training and enthusiasm has passed.

That's the specific gap SteadyMotion Clinical's Falls Shield Protocol is designed around. FinCH's own data shows most programmes fade after month six without reinforcement; the Protocol is built as ongoing clinical oversight, not a one-off training day, to keep a falls programme embedded.

It's worth being clear about what this evidence does and doesn't mean for any individual resident. None of these studies guarantee a specific outcome for a specific person; falls risk always needs individual clinical assessment, not a blanket statistic. What the research does show is a strong, consistent direction: structured, sustained, individualised programmes are the ones that work.

Want to see how a structured falls programme could work for your residents?

SteadyMotion Clinical runs a free 30-minute Falls Prevention Seminar on-site for East London care homes, walking through this evidence in plain terms alongside a practical mobility risk checklist your staff can use immediately. Email hello@steadymotionclinical.co.uk to book a seminar or a Clinic Day.