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: 43% lower falls rate in months 4 to 6, 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 (the Guide to Action Care Homes programme, GtACH) across care homes for older people. The trial found a 43% lower rate of falls during months four to six of the programme.
The part that gets repeated less often: the effect wasn't fully sustained. Between months six and twelve, the benefit waned, and the trial team's own analysis pointed to two causes. Staff did not embed the programme in their usual routines, and the assessment tool was not completed regularly, partly because staff were restricted from writing in care records and there was no ongoing trainer support.
That's a useful finding for any care home evaluating falls programmes. It points to the question worth asking any provider: who keeps the programme working after week twelve?
What the 2025 Cochrane review says about exercise
The most rigorous evidence available comes from a 2025 Cochrane review pooling 104 trials and 68,964 participants in care homes and hospitals (Dyer et al., 2025).
Its headline finding on exercise: in the trials of active exercise (14 trials, 2,215 residents), the rate of falls was 32% lower while residents were taking part (moderate-certainty evidence). Once the exercise stopped, that benefit did not last (7 trials, 1,354 residents; high-certainty evidence). In other words, the benefit of exercise lasts only while the programme runs.
The review also found that multifactorial programmes tailored to each resident and combined with staff engagement lowered 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 clear effect.
That distinction, tailored and sustained versus generic and one-off, is the reasoning behind how the Falls Shield Protocol is structured.
These are published research findings, not guaranteed results of our service.
NICE's 2025 update: tailored to the individual
Falls guidance moved again in April 2025, when NICE published NG249, replacing the 2013 CG161 guideline. For care homes, it recommends that falls risk interventions are individually tailored following assessment. That 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 can lower the rate of falls, and the evidence for that is consistent. 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. In FinCH, the benefit faded after month six when the programme was not reinforced. The Protocol is built as ongoing clinical oversight, not a one-off training day, to help 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 have the strongest evidence behind them.
Want to see how a structured falls programme could work for your residents?
SteadyMotion Clinical runs a free 30-minute falls seminar on site for care homes, assisted living and retirement communities across London, walking through this evidence in plain terms for managers and staff. Email hello@steadymotionclinical.co.uk to book a seminar or a Clinic Day.
Sources
Logan PA, Horne JC, Allen F, et al. A multidomain decision support tool to prevent falls in older people: the FinCH cluster RCT. Health Technology Assessment 2022;26(9). NIHR HTA Programme.
Dyer SM, et al. Interventions for preventing falls in older people in care facilities. Cochrane Database of Systematic Reviews 2025, CD016064.
NICE. Falls: assessment and prevention in older people and in people 50 and over at higher risk (NG249). April 2025.
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