Cochrane

# Supplementary material 6 to:
Interventions for preventing falls in older people living in the community

Gillespie LD , Robertson MC , Gillespie WJ , Sherrington C , Gates S , Clemson L , Lamb SE
https://doi.org/10.1002/14651858.CD007146.pub3

Cochrane disclaims all liability and responsibility arising from any reliance placed on this supplementary material which has been supplied by the author(s). The above associated publication’s Author Licence will apply in respect of any supplemental materials published. How to cite the supplementary material is defined in the Cochrane policy.

# Analyses

## Analysis group 1 — Exercise vs control

Analysis or subgroup title | No. of studies | No. of participants | Statistical method | Effect size
1.1 Rate of falls | 34 |  | Rate Ratio (IV, Random, 95% CI) | Subtotals only
1.1.1 Group exercise: multiple categories of exercise vs control | 16 | 3622 | Rate Ratio (IV, Random, 95% CI) | 0.71 [0.63, 0.82]
1.1.2 Individual exercise at home: multiple categories of exercise vs control | 7 | 951 | Rate Ratio (IV, Random, 95% CI) | 0.68 [0.58, 0.80]
1.1.3 Individual exercise: LiFE (balance and strength training in daily life activities) vs control | 1 | 34 | Rate Ratio (IV, Random, 95% CI) | 0.21 [0.06, 0.71]
1.1.4 Group exercise: Tai Chi vs control | 5 | 1563 | Rate Ratio (IV, Random, 95% CI) | 0.72 [0.52, 1.00]
1.1.5 Group exercise: gait, balance or functional training vs control | 4 | 519 | Rate Ratio (IV, Random, 95% CI) | 0.72 [0.55, 0.94]
1.1.6 Individual exercise: balance training vs control | 1 | 128 | Rate Ratio (IV, Random, 95% CI) | 1.19 [0.77, 1.82]
1.1.7 Group exercise: strength/resistance training vs control | 1 | 64 | Rate Ratio (IV, Random, 95% CI) | 1.80 [0.84, 3.87]
1.1.8 Individual exercise at home: resistance training vs control | 1 | 222 | Rate Ratio (IV, Random, 95% CI) | 0.95 [0.77, 1.18]
1.2 Number of fallers | 40 |  | Risk Ratio (IV, Random, 95% CI) | Subtotals only
1.2.1 Group exercise: multiple categories of exercise vs control | 22 | 5333 | Risk Ratio (IV, Random, 95% CI) | 0.85 [0.76, 0.96]
1.2.2 Individual exercise at home: multiple categories of exercise vs control | 6 | 714 | Risk Ratio (IV, Random, 95% CI) | 0.78 [0.64, 0.94]
1.2.3 Individual exercise: LiFE (balance and strength training in daily life activities) vs control | 1 | 31 | Risk Ratio (IV, Random, 95% CI) | 0.73 [0.39, 1.37]
1.2.4 Group exercise: Tai Chi vs control | 6 | 1625 | Risk Ratio (IV, Random, 95% CI) | 0.71 [0.57, 0.87]
1.2.5 Group exercise: gait, balance or functional training vs control | 3 | 453 | Risk Ratio (IV, Random, 95% CI) | 0.81 [0.62, 1.07]
1.2.6 Group exercise: strength/resistance training vs control | 1 | 120 | Risk Ratio (IV, Random, 95% CI) | 0.77 [0.52, 1.14]
1.2.7 Individual exercise at home: resistance training vs control | 1 | 222 | Risk Ratio (IV, Random, 95% CI) | 0.97 [0.68, 1.38]
1.2.8 Individual exercise: general physical activity (walking) vs control | 1 | 196 | Risk Ratio (IV, Random, 95% CI) | 0.82 [0.53, 1.26]
1.3 Number of people sustaining a fracture | 6 | 810 | Risk Ratio (IV, Fixed, 95% CI) | 0.34 [0.18, 0.63]

## Analysis group 2 — Group exercise: multiple categories of exercise vs control: subgroup analysis by falls risk at baseline

Analysis or subgroup title | No. of studies | No. of participants | Statistical method | Effect size
2.1 Rate of falls | 16 |  | Rate Ratio (IV, Random, 95% CI) | Subtotals only
2.1.1 Selected for higher risk of falling | 9 | 1261 | Rate Ratio (IV, Random, 95% CI) | 0.70 [0.58, 0.85]
2.1.2 Not selected for higher risk of falling | 7 | 2361 | Rate Ratio (IV, Random, 95% CI) | 0.72 [0.58, 0.90]
2.2 Number of fallers | 22 |  | Risk Ratio (IV, Random, 95% CI) | Subtotals only
2.2.1 Selected for higher risk of falling | 12 | 1430 | Risk Ratio (IV, Random, 95% CI) | 0.87 [0.78, 0.97]
2.2.2 Not selected for higher risk of falling | 10 | 3903 | Risk Ratio (IV, Random, 95% CI) | 0.85 [0.68, 1.06]

## Analysis group 3 — Group exercise: Tai Chi vs control: subgroup analysis by falls risk at baseline

Analysis or subgroup title | No. of studies | No. of participants | Statistical method | Effect size
3.1 Rate of falls | 5 |  | Rate Ratio (IV, Random, 95% CI) | Subtotals only
3.1.1 Selected for higher risk of falling | 2 | 555 | Rate Ratio (IV, Random, 95% CI) | 0.95 [0.62, 1.46]
3.1.2 Not selected for higher risk of falling | 3 | 1008 | Rate Ratio (IV, Random, 95% CI) | 0.59 [0.45, 0.76]
3.2 Number of fallers | 6 |  | Risk Ratio (IV, Random, 95% CI) | Subtotals only
3.2.1 Selected for higher risk of falling | 2 | 555 | Risk Ratio (IV, Random, 95% CI) | 0.85 [0.71, 1.01]
3.2.2 Not selected for higher risk of falling | 4 | 1070 | Risk Ratio (IV, Random, 95% CI) | 0.58 [0.46, 0.74]

## Analysis group 4 — Exercise vs exercise

Analysis or subgroup title | No. of studies | No. of participants | Statistical method | Effect size
4.1 Rate of falls | 7 |  | Rate Ratio (IV, Fixed, 95% CI) | Subtotals only
4.1.1 Group exercise: higher intensity multiple components vs lower intensity multiple components | 1 | 227 | Rate Ratio (IV, Fixed, 95% CI) | 0.60 [0.47, 0.76]
4.1.2 Group exercise: resistance training 1x per week vs balance and tone | 1 | 103 | Rate Ratio (IV, Fixed, 95% CI) | 0.73 [0.44, 1.22]
4.1.3 Group exercise: resistance training 2x per week vs balance and tone | 1 | 101 | Rate Ratio (IV, Fixed, 95% CI) | 0.88 [0.67, 1.16]
4.1.4 Group exercise: balance training in workstations vs 'conventional' fall-prevention exercise class | 1 | 45 | Rate Ratio (IV, Fixed, 95% CI) | 0.81 [0.37, 1.78]
4.1.5 Group exercise: enhanced balance therapy vs conventional physiotherapy post hip fracture | 1 | 133 | Rate Ratio (IV, Fixed, 95% CI) | 1.00 [0.64, 1.57]
4.1.6 Group exercise: square stepping vs walking | 1 | 68 | Rate Ratio (IV, Fixed, 95% CI) | 0.70 [0.23, 2.13]
4.1.7 Group exercise: exercise class + "trail walking" vs exercise class + indoor walking | 1 | 58 | Rate Ratio (IV, Fixed, 95% CI) | 0.45 [0.14, 1.49]
4.1.8 Group exercise + home exercise vs home exercise | 1 | 68 | Rate Ratio (IV, Fixed, 95% CI) | 1.09 [0.74, 1.62]
4.2 Number of fallers | 4 |  | Risk Ratio (IV, Fixed, 95% CI) | Subtotals only
4.2.1 Group exercise: higher intensity multiple components vs lower intensity multiple components | 1 | 227 | Risk Ratio (IV, Fixed, 95% CI) | 0.54 [0.35, 0.83]
4.2.2 Group exercise: square stepping vs walking | 1 | 68 | Risk Ratio (IV, Fixed, 95% CI) | 0.64 [0.21, 1.95]
4.2.3 Group exercise: exercise class + "trail walking" vs exercise class + indoor walking | 1 | 58 | Risk Ratio (IV, Fixed, 95% CI) | 0.45 [0.18, 1.13]
4.2.4 Group exercise + home exercise vs home exercise: multiple components | 1 | 68 | Risk Ratio (IV, Fixed, 95% CI) | 1.11 [0.72, 1.70]

## Analysis group 5 — Medication provision: vitamin D (with or without calcium) vs control/placebo/calcium

Analysis or subgroup title | No. of studies | No. of participants | Statistical method | Effect size
5.1 Rate of falls | 7 | 9324 | Rate Ratio (IV, Random, 95% CI) | 1.00 [0.90, 1.11]
5.1.1 Vitamin D3 (by mouth) vs control or placebo | 2 | 2478 | Rate Ratio (IV, Random, 95% CI) | 1.14 [1.03, 1.27]
5.1.2 Vitamin D3 (by mouth) + calcium vs control or placebo | 3 | 6586 | Rate Ratio (IV, Random, 95% CI) | 0.96 [0.89, 1.04]
5.1.3 Vitamin D3 (by mouth) + calcium vs calcium | 1 | 137 | Rate Ratio (IV, Random, 95% CI) | 0.54 [0.30, 0.98]
5.1.4 Vitamin D2 (by injection) vs placebo | 1 | 123 | Rate Ratio (IV, Random, 95% CI) | 0.61 [0.32, 1.17]
5.2 Number of fallers | 13 | 26747 | Risk Ratio (IV, Random, 95% CI) | 0.96 [0.89, 1.03]
5.2.1 Vitamin D3 (by mouth) vs control or placebo | 3 | 4516 | Risk Ratio (IV, Random, 95% CI) | 1.08 [0.93, 1.26]
5.2.2 Vitamin D3 (by mouth) + calcium vs control or placebo | 3 | 6576 | Risk Ratio (IV, Random, 95% CI) | 0.98 [0.92, 1.03]
5.2.3 Vitamin D3 (by mouth) + calcium vs calcium | 2 | 379 | Risk Ratio (IV, Random, 95% CI) | 0.70 [0.53, 0.92]
5.2.4 Vitamin D2 (by mouth) + calcium vs placebo + calcium | 1 | 302 | Risk Ratio (IV, Random, 95% CI) | 0.66 [0.41, 1.05]
5.2.5 Vitamin D2 (by injection) vs placebo | 2 | 9563 | Risk Ratio (IV, Random, 95% CI) | 0.98 [0.92, 1.04]
5.2.6 Vitamin D (by mouth or by injection) with or without calcium vs control: studies with multiple arms combined | 2 | 5411 | Risk Ratio (IV, Random, 95% CI) | 0.73 [0.37, 1.44]
5.3 Number of people sustaining a fracture | 10 | 27070 | Risk Ratio (IV, Random, 95% CI) | 0.94 [0.82, 1.09]
5.3.1 Vitamin D3 (by mouth) vs control or placebo | 2 | 4942 | Risk Ratio (IV, Random, 95% CI) | 0.97 [0.63, 1.51]
5.3.2 Vitamin D3 (by mouth) + calcium vs control or placebo | 3 | 6898 | Risk Ratio (IV, Random, 95% CI) | 0.83 [0.59, 1.16]
5.3.3 Vitamin D3 (by mouth) + calcium vs calcium | 2 | 379 | Risk Ratio (IV, Random, 95% CI) | 0.54 [0.26, 1.15]
5.3.4 Vitamin D2 (by injection) vs placebo | 1 | 9440 | Risk Ratio (IV, Random, 95% CI) | 1.09 [0.94, 1.28]
5.3.5 Vitamin D (by mouth or by injection) with or without calcium vs control: studies with multiple arms combined | 2 | 5411 | Risk Ratio (IV, Random, 95% CI) | 0.90 [0.53, 1.53]

## Analysis group 6 — Vitamin D (with or without calcium) vs control: subgroup analysis by falls risk at baseline

Analysis or subgroup title | No. of studies | No. of participants | Statistical method | Effect size
6.1 Rate of falls | 7 |  | Rate Ratio (IV, Random, 95% CI) | Subtotals only
6.1.1 Selected for higher risk of falling | 3 | 5381 | Rate Ratio (IV, Random, 95% CI) | 1.02 [0.85, 1.23]
6.1.2 Not selected for higher risk of falling | 4 | 3943 | Rate Ratio (IV, Random, 95% CI) | 1.00 [0.86, 1.17]
6.2 Number of fallers | 13 |  | Risk Ratio (IV, Random, 95% CI) | Subtotals only
6.2.1 Selected for higher risk of falling | 6 | 11094 | Risk Ratio (IV, Random, 95% CI) | 0.93 [0.78, 1.11]
6.2.2 Not selected for higher risk of falling | 7 | 15653 | Risk Ratio (IV, Random, 95% CI) | 0.96 [0.90, 1.02]

## Analysis group 7 — Vitamin D (with or without calcium) vs control: subgroup analysis by vitamin D level at baseline

Analysis or subgroup title | No. of studies | No. of participants | Statistical method | Effect size
7.1 Rate of falls | 7 |  | Rate Ratio (IV, Random, 95% CI) | Subtotals only
7.1.1 Selected for lower vitamin D levels | 2 | 260 | Rate Ratio (IV, Random, 95% CI) | 0.57 [0.37, 0.89]
7.1.2 Not selected for lower vitamin D levels | 5 | 9064 | Rate Ratio (IV, Random, 95% CI) | 1.02 [0.93, 1.13]
7.2 Number of fallers | 13 |  | Risk Ratio (IV, Random, 95% CI) | Subtotals only
7.2.1 Selected for lower vitamin D levels | 4 | 804 | Risk Ratio (IV, Random, 95% CI) | 0.70 [0.56, 0.87]
7.2.2 Not selected for lower vitamin D levels | 9 | 25943 | Risk Ratio (IV, Random, 95% CI) | 1.00 [0.93, 1.07]

## Analysis group 8 — Medication provision: vitamin D 2000 IU/day vs vitamin D 800 IU/day

Analysis or subgroup title | No. of studies | No. of participants | Statistical method | Effect size
8.1 Rate of falls | 1 | 173 | Rate Ratio (IV, Fixed, 95% CI) | 1.30 [0.99, 1.71]
8.2 Number of people sustaining a fracture | 1 | 173 | Risk Ratio (IV, Fixed, 95% CI) | 0.51 [0.13, 1.98]

## Analysis group 9 — Medication provision: vitamin D analogue vs placebo

Analysis or subgroup title | No. of studies | No. of participants | Statistical method | Effect size
9.1 Rate of falls | 1 |  | Rate Ratio (IV, Fixed, 95% CI) | Subtotals only
9.1.1 Calcitriol vs placebo | 1 | 213 | Rate Ratio (IV, Fixed, 95% CI) | 0.64 [0.49, 0.82]
9.2 Number of fallers | 2 |  | Risk Ratio (IV, Fixed, 95% CI) | Subtotals only
9.2.1 Calcitriol vs placebo | 1 | 213 | Risk Ratio (IV, Fixed, 95% CI) | 0.54 [0.31, 0.93]
9.2.2 Alfacalcidol vs placebo | 1 | 378 | Risk Ratio (IV, Fixed, 95% CI) | 0.69 [0.41, 1.17]
9.3 Number of people sustaining a fracture | 1 |  | Risk Ratio (IV, Fixed, 95% CI) | Subtotals only
9.3.1 Calcitriol vs placebo | 1 | 246 | Risk Ratio (IV, Fixed, 95% CI) | 0.60 [0.28, 1.29]
9.4 Number of people developing hypercalcaemia | 2 | 624 | Risk Ratio (M-H, Fixed, 95% CI) | 2.49 [1.12, 5.50]

## Analysis group 10 — Medication provision: other medications vs control

Analysis or subgroup title | No. of studies | No. of participants | Statistical method | Effect size
10.1 Rate of falls | 1 |  | Rate Ratio (IV, Fixed, 95% CI) | Subtotals only
10.1.1 Hormone replacement therapy vs placebo | 1 | 212 | Rate Ratio (IV, Fixed, 95% CI) | 0.88 [0.65, 1.18]
10.1.2 Hormone replacement therapy + calcitriol vs placebo | 1 | 214 | Rate Ratio (IV, Fixed, 95% CI) | 0.75 [0.58, 0.97]
10.2 Number of fallers | 3 |  | Risk Ratio (IV, Fixed, 95% CI) | Subtotals only
10.2.1 Hormone replacement therapy vs control/placebo | 2 | 585 | Risk Ratio (IV, Fixed, 95% CI) | 0.94 [0.81, 1.08]
10.2.2 Hormone replacement therapy + calcitriol vs placebo | 1 | 214 | Risk Ratio (IV, Fixed, 95% CI) | 0.90 [0.72, 1.11]
10.2.3 Alendronate + vitamin D3 vs control | 1 | 515 | Risk Ratio (IV, Fixed, 95% CI) | 0.82 [0.59, 1.14]
10.3 Number of people sustaining a fracture | 1 |  | Risk Ratio (IV, Fixed, 95% CI) | Subtotals only
10.3.1 Calcium vs placebo | 1 | 1255 | Risk Ratio (IV, Fixed, 95% CI) | 0.90 [0.69, 1.16]
10.3.2 Vitamin K2 + vitamin D2 + calcium vs control (Alzheimer's disease) | 0 | 0 | Risk Ratio (IV, Fixed, 95% CI) | Not estimable

## Analysis group 11 — Medication withdrawal vs control

Analysis or subgroup title | No. of studies | No. of participants | Statistical method | Effect size
11.1 Rate of falls | 2 |  | Rate Ratio (IV, Fixed, 95% CI) | Subtotals only
11.1.1 Psychotropic medication withdrawal vs control | 1 | 93 | Rate Ratio (IV, Fixed, 95% CI) | 0.34 [0.16, 0.73]
11.1.2 Medication review and modification vs usual care | 1 | 186 | Rate Ratio (IV, Fixed, 95% CI) | 1.01 [0.81, 1.25]
11.2 Number of fallers | 4 |  | Risk Ratio (IV, Fixed, 95% CI) | Subtotals only
11.2.1 Psychotropic medication withdrawal vs control | 1 | 93 | Risk Ratio (IV, Fixed, 95% CI) | 0.61 [0.32, 1.17]
11.2.2 Medication review and modification vs usual care | 2 | 445 | Risk Ratio (IV, Fixed, 95% CI) | 1.03 [0.81, 1.31]
11.2.3 GP educational programme + medication review and modification vs control | 1 | 659 | Risk Ratio (IV, Fixed, 95% CI) | 0.61 [0.41, 0.91]

## Analysis group 12 — Surgery vs control

Analysis or subgroup title | No. of studies | No. of participants | Statistical method | Effect size
12.1 Rate of falls | 5 |  | Rate Ratio (IV, Fixed, 95% CI) | Subtotals only
12.1.1 Cardiac pacing vs control | 3 | 349 | Rate Ratio (IV, Fixed, 95% CI) | 0.73 [0.57, 0.93]
12.1.2 Cataract surgery (1st eye) vs control | 1 | 306 | Rate Ratio (IV, Fixed, 95% CI) | 0.66 [0.45, 0.95]
12.1.3 Cataract surgery (2nd eye) vs control | 1 | 239 | Rate Ratio (IV, Fixed, 95% CI) | 0.68 [0.39, 1.17]
12.2 Number of fallers | 4 |  | Risk Ratio (IV, Fixed, 95% CI) | Subtotals only
12.2.1 Cardiac pacing vs control | 2 | 178 | Risk Ratio (IV, Fixed, 95% CI) | 1.20 [0.92, 1.55]
12.2.2 Cataract surgery (1st eye) vs control | 1 | 306 | Risk Ratio (IV, Fixed, 95% CI) | 0.95 [0.68, 1.33]
12.2.3 Cataract surgery (2nd eye) vs control | 1 | 239 | Risk Ratio (IV, Fixed, 95% CI) | 1.06 [0.69, 1.63]
12.3 Number of people sustaining a fracture | 3 |  | Risk Ratio (IV, Fixed, 95% CI) | Subtotals only
12.3.1 Cardiac pacing vs control | 1 | 171 | Risk Ratio (IV, Fixed, 95% CI) | 0.78 [0.18, 3.39]
12.3.2 Cataract surgery (1st eye) vs control | 1 | 306 | Risk Ratio (IV, Fixed, 95% CI) | 0.33 [0.10, 1.05]
12.3.3 Cataract surgery (2nd eye) vs control | 1 | 239 | Risk Ratio (IV, Fixed, 95% CI) | 2.51 [0.50, 12.52]

## Analysis group 13 — Fluid or nutrition therapy vs control

Analysis or subgroup title | No. of studies | No. of participants | Statistical method | Effect size
13.1 Number of fallers | 3 |  | Risk Ratio (IV, Fixed, 95% CI) | Subtotals only
13.1.1 Nutritional supplementation vs control | 3 | 1902 | Risk Ratio (IV, Fixed, 95% CI) | 0.95 [0.83, 1.08]

## Analysis group 14 — Psychological interventions vs control

Analysis or subgroup title | No. of studies | No. of participants | Statistical method | Effect size
14.1 Rate of falls | 1 |  | Rate Ratio (IV, Fixed, 95% CI) | Subtotals only
14.1.1 Cognitive behavioural intervention vs control | 1 | 120 | Rate Ratio (IV, Fixed, 95% CI) | 1.00 [0.37, 2.72]
14.2 Number of fallers | 2 |  | Risk Ratio (IV, Fixed, 95% CI) | Subtotals only
14.2.1 Cognitive behavioural intervention vs control | 2 | 350 | Risk Ratio (IV, Fixed, 95% CI) | 1.11 [0.80, 1.54]

## Analysis group 15 — Environment/assistive technology interventions: home safety vs control

Analysis or subgroup title | No. of studies | No. of participants | Statistical method | Effect size
15.1 Rate of falls | 6 | 4208 | Rate Ratio (IV, Random, 95% CI) | 0.81 [0.68, 0.97]
15.2 Number of fallers | 7 | 4051 | Risk Ratio (IV, Fixed, 95% CI) | 0.88 [0.80, 0.96]
15.3 Number of participants sustaining a fracture | 1 | 360 | Risk Ratio (IV, Fixed, 95% CI) | 1.32 [0.30, 5.87]

## Analysis group 16 — Home safety intervention vs control: subgroup analysis by risk of falling at baseline

Analysis or subgroup title | No. of studies | No. of participants | Statistical method | Effect size
16.1 Rate of falls | 6 |  | Rate Ratio (IV, Random, 95% CI) | Subtotals only
16.1.1 Selected for higher risk of falling | 3 | 851 | Rate Ratio (IV, Random, 95% CI) | 0.62 [0.50, 0.77]
16.1.2 Not selected for higher risk of falling | 3 | 3357 | Rate Ratio (IV, Random, 95% CI) | 0.94 [0.84, 1.05]
16.2 Number of fallers | 7 |  | Risk Ratio (IV, Random, 95% CI) | Subtotals only
16.2.1 Selected for higher risk of falling | 3 | 684 | Risk Ratio (IV, Random, 95% CI) | 0.85 [0.75, 0.97]
16.2.2 Not selected for higher risk of falling | 4 | 3367 | Risk Ratio (IV, Random, 95% CI) | 0.90 [0.80, 1.00]

## Analysis group 17 — Home safety intervention vs control: subgroup analysis by delivery personnel

Analysis or subgroup title | No. of studies | No. of participants | Statistical method | Effect size
17.1 Rate of falls | 7 |  | Rate Ratio (IV, Random, 95% CI) | Subtotals only
17.1.1 Home safety intervention (OT) vs control | 4 | 1443 | Rate Ratio (IV, Random, 95% CI) | 0.69 [0.55, 0.86]
17.1.2 Home safety intervention (not OT) vs control | 4 | 3075 | Rate Ratio (IV, Random, 95% CI) | 0.91 [0.75, 1.11]
17.2 Number of fallers | 7 |  | Risk Ratio (IV, Random, 95% CI) | Subtotals only
17.2.1 Home safety intervention (OT) vs control | 5 | 1153 | Risk Ratio (IV, Random, 95% CI) | 0.79 [0.70, 0.91]
17.2.2 Home safety intervention (not OT) vs control | 3 | 2975 | Risk Ratio (IV, Random, 95% CI) | 0.94 [0.85, 1.05]

## Analysis group 18 — Environment/assistive technology interventions: vision improvement vs control

Analysis or subgroup title | No. of studies | No. of participants | Statistical method | Effect size
18.1 Rate of falls | 3 |  | Rate Ratio (IV, Fixed, 95% CI) | Subtotals only
18.1.1 Vision assessment and eye examination + intervention (with or without referral) vs control | 1 | 616 | Rate Ratio (IV, Fixed, 95% CI) | 1.57 [1.19, 2.06]
18.1.2 Visual acuity assessment and referral vs remainder | 1 | 1090 | Rate Ratio (IV, Fixed, 95% CI) | 0.91 [0.77, 1.09]
18.1.3 Single lens distance glasses vs usual glasses (multifocal) | 1 | 597 | Rate Ratio (IV, Fixed, 95% CI) | 0.92 [0.73, 1.17]
18.2 Number of fallers | 3 |  | Risk Ratio (IV, Fixed, 95% CI) | Subtotals only
18.2.1 Vision assessment and eye examination + intervention (with or without referral) vs control | 1 | 616 | Risk Ratio (IV, Fixed, 95% CI) | 1.54 [1.24, 1.91]
18.2.2 Visual acuity assessment and referral vs remainder | 1 | 1090 | Risk Ratio (IV, Fixed, 95% CI) | 0.89 [0.76, 1.04]
18.2.3 Single lens distance glasses vs usual glasses (multifocal) | 1 | 597 | Risk Ratio (IV, Fixed, 95% CI) | 0.97 [0.85, 1.11]
18.3 Number of people sustaining a fracture | 2 |  | Risk Ratio (IV, Fixed, 95% CI) | Subtotals only
18.3.1 Vision assessment and eye examination + intervention (with or without referral) vs control | 1 | 616 | Risk Ratio (IV, Fixed, 95% CI) | 1.73 [0.96, 3.12]
18.3.2 Single lens distance glasses vs usual glasses (multifocal) | 1 | 597 | Risk Ratio (IV, Fixed, 95% CI) | 1.58 [0.74, 3.40]

## Analysis group 19 — Environment/assistive technology interventions: footwear modification vs control

Analysis or subgroup title | No. of studies | No. of participants | Statistical method | Effect size
19.1 Rate of falls | 1 |  | Rate Ratio (IV, Fixed, 95% CI) | Subtotals only
19.1.1 Anti-slip shoe device for icy conditions vs control | 1 | 109 | Rate Ratio (IV, Fixed, 95% CI) | 0.42 [0.22, 0.78]
19.2 Number of fallers | 1 |  | Risk Ratio (IV, Fixed, 95% CI) | Subtotals only
19.2.1 Balance-enhancing insoles vs conventional insoles | 1 | 40 | Risk Ratio (IV, Fixed, 95% CI) | 0.56 [0.23, 1.38]

## Analysis group 20 — Knowledge/education interventions vs control

Analysis or subgroup title | No. of studies | No. of participants | Statistical method | Effect size
20.1 Rate of falls | 1 |  | Rate Ratio (IV, Fixed, 95% CI) | Subtotals only
20.1.1 Education interventions vs control | 1 | 45 | Rate Ratio (IV, Fixed, 95% CI) | 0.33 [0.09, 1.20]
20.2 Number of fallers | 4 |  | Risk Ratio (IV, Fixed, 95% CI) | Subtotals only
20.2.1 Education interventions vs control | 4 | 2555 | Risk Ratio (IV, Fixed, 95% CI) | 0.88 [0.75, 1.03]

## Analysis group 21 — Multiple interventions

Analysis or subgroup title | No. of studies | No. of participants | Statistical method | Effect size
21.1 Rate of falls | 14 |  | Rate Ratio (IV, Fixed, 95% CI) | Subtotals only
21.1.1 Exercise + home safety vs remainder | 1 | 1090 | Rate Ratio (IV, Fixed, 95% CI) | 0.77 [0.61, 0.98]
21.1.2 Exercise + vision assessment vs remainder | 1 | 1090 | Rate Ratio (IV, Fixed, 95% CI) | 0.72 [0.57, 0.91]
21.1.3 Exercise + home safety + vision assessment vs remainder | 1 | 1090 | Rate Ratio (IV, Fixed, 95% CI) | 0.71 [0.53, 0.96]
21.1.4 Home safety + vision assessment vs remainder | 1 | 1090 | Rate Ratio (IV, Fixed, 95% CI) | 0.89 [0.70, 1.12]
21.1.5 Exercise + home safety +education vs control | 1 | 285 | Rate Ratio (IV, Fixed, 95% CI) | 0.69 [0.50, 0.96]
21.1.6 Exercise + home safety + education vs education | 1 | 124 | Rate Ratio (IV, Fixed, 95% CI) | 0.93 [0.61, 1.44]
21.1.7 Exercise + home safety + education + clinical assessment vs education | 1 | 122 | Rate Ratio (IV, Fixed, 95% CI) | 0.89 [0.58, 1.37]
21.1.8 Exercise + home safety + multifactorial assessment and referral vs multifactorial assessment and referral | 1 | 19 | Rate Ratio (IV, Fixed, 95% CI) | 0.18 [0.02, 1.59]
21.1.9 Exercise + vitamin D vs no exercise/no vitamin D (severe visual impairment) | 1 | 391 | Rate Ratio (IV, Fixed, 95% CI) | 1.15 [0.82, 1.61]
21.1.10 Exercise + nutrition + calcium + vitamin D vs calcium + vitamin D | 1 | 20 | Rate Ratio (IV, Fixed, 95% CI) | 0.19 [0.05, 0.68]
21.1.11 Exercise + cognitive behavioural therapy vs control | 1 | 116 | Rate Ratio (IV, Fixed, 95% CI) | 0.38 [0.10, 1.47]
21.1.12 Exercise + "individualised fall prevention advice" vs control | 1 | 78 | Rate Ratio (IV, Fixed, 95% CI) | 0.89 [0.71, 1.10]
21.1.13 Centre-based rehabilitation (exercise + education) vs home-based rehabilitation (exercise + education) | 1 | 76 | Rate Ratio (IV, Fixed, 95% CI) | 0.46 [0.22, 0.97]
21.1.14 Physical training + education vs control | 1 | 33 | Rate Ratio (IV, Fixed, 95% CI) | 2.12 [0.59, 7.57]
21.1.15 Exercise + education vs education | 1 | 132 | Rate Ratio (IV, Fixed, 95% CI) | 0.90 [0.61, 1.33]
21.1.16 Exercise + education + risk assessment vs control | 1 | 453 | Rate Ratio (IV, Fixed, 95% CI) | 0.75 [0.52, 1.09]
21.1.17 Multifunctional training + whole body vibration vs light physical exercise | 1 | 97 | Rate Ratio (IV, Fixed, 95% CI) | 0.46 [0.27, 0.79]
21.1.18 Multifaceted podiatry including foot and ankle exercises vs routine podiatry care | 1 | 305 | Rate Ratio (IV, Fixed, 95% CI) | 0.64 [0.45, 0.91]
21.1.19 Multidisciplinary rehabilitation + home safety visit vs multidisciplinary rehabilitation (no home visit) | 1 | 95 | Rate Ratio (IV, Fixed, 95% CI) | 0.46 [0.21, 1.00]
21.2 Number of fallers | 13 |  | Risk Ratio (IV, Fixed, 95% CI) | Subtotals only
21.2.1 Exercise + home safety vs remainder | 1 | 1090 | Risk Ratio (IV, Fixed, 95% CI) | 0.76 [0.60, 0.97]
21.2.2 Exercise + vision assessment vs remainder | 1 | 1090 | Risk Ratio (IV, Fixed, 95% CI) | 0.73 [0.59, 0.91]
21.2.3 Exercise + home safety + vision assessment vs remainder | 1 | 1090 | Risk Ratio (IV, Fixed, 95% CI) | 0.67 [0.51, 0.88]
21.2.4 Home safety + vision assessment vs remainder | 1 | 1090 | Risk Ratio (IV, Fixed, 95% CI) | 0.81 [0.65, 1.01]
21.2.5 Exercise + home safety + education vs control | 1 | 310 | Risk Ratio (IV, Fixed, 95% CI) | 0.90 [0.74, 1.09]
21.2.6 Exercise + home safety + education vs education | 1 | 124 | Risk Ratio (IV, Fixed, 95% CI) | 0.87 [0.61, 1.24]
21.2.7 Exercise + home safety + education + clinical assessment vs education | 1 | 122 | Risk Ratio (IV, Fixed, 95% CI) | 0.83 [0.57, 1.20]
21.2.8 Exercise + vit D vs no exercise/no vit D (severe visual impairment) | 1 | 391 | Risk Ratio (IV, Fixed, 95% CI) | 0.99 [0.81, 1.20]
21.2.9 Exercise + cognitive behavioural therapy vs control | 1 | 116 | Risk Ratio (IV, Fixed, 95% CI) | 0.40 [0.11, 1.45]
21.2.10 Centre-based rehabilitation (exercise + education) vs home-based rehabilitation (exercise + education) | 1 | 73 | Risk Ratio (IV, Fixed, 95% CI) | 0.57 [0.35, 0.93]
21.2.11 Physical training + education vs control | 1 | 33 | Risk Ratio (IV, Fixed, 95% CI) | 1.39 [0.66, 2.93]
21.2.12 Exercise + education vs control | 1 | 103 | Risk Ratio (IV, Fixed, 95% CI) | 1.68 [0.16, 17.67]
21.2.13 Exercise + education vs education | 1 | 132 | Risk Ratio (IV, Fixed, 95% CI) | 0.84 [0.59, 1.20]
21.2.14 Exercise + education + risk assessment vs control | 1 | 453 | Risk Ratio (IV, Fixed, 95% CI) | 0.96 [0.82, 1.12]
21.2.15 Multifaceted podiatry including foot and ankle exercises vs routine podiatry care | 1 | 305 | Risk Ratio (IV, Fixed, 95% CI) | 0.85 [0.66, 1.10]
21.2.16 Home safety + medication review vs control | 1 | 294 | Risk Ratio (IV, Fixed, 95% CI) | 0.79 [0.46, 1.34]
21.2.17 Education + free access to geriatric clinic vs control | 1 | 815 | Risk Ratio (IV, Fixed, 95% CI) | 0.77 [0.63, 0.94]
21.2.18 Multidisciplinary rehabilitation + home safety visit vs multidisciplinary rehabilitation (no home visit) | 1 | 95 | Risk Ratio (IV, Fixed, 95% CI) | 0.51 [0.21, 1.24]
21.3 Number of people sustaining a fracture | 2 |  | Risk Ratio (IV, Fixed, 95% CI) | Subtotals only
21.3.1 Multifaceted podiatry including foot and ankle exercises vs routine podiatry care | 1 | 305 | Risk Ratio (IV, Fixed, 95% CI) | 0.14 [0.02, 1.05]
21.3.2 Multifunctional training + whole body vibration vs light physical exercise | 1 | 97 | Risk Ratio (IV, Fixed, 95% CI) | 0.46 [0.13, 1.64]

## Analysis group 22 — Multifactorial intervention vs control

Analysis or subgroup title | No. of studies | No. of participants | Statistical method | Effect size
22.1 Rate of falls | 19 | 9503 | Rate Ratio (IV, Random, 95% CI) | 0.76 [0.67, 0.86]
22.2 Number of fallers | 34 | 13617 | Risk Ratio (IV, Random, 95% CI) | 0.93 [0.86, 1.02]
22.3 Number of people sustaining a fracture | 11 | 3808 | Risk Ratio (IV, Random, 95% CI) | 0.84 [0.67, 1.05]

## Analysis group 23 — Multifactorial intervention vs control: subgroup analysis by falls risk at baseline

Analysis or subgroup title | No. of studies | No. of participants | Statistical method | Effect size
23.1 Rate of falls | 19 |  | Rate Ratio (IV, Random, 95% CI) | Subtotals only
23.1.1 Selected for higher risk of falling | 17 | 5954 | Rate Ratio (IV, Random, 95% CI) | 0.77 [0.66, 0.90]
23.1.2 Not selected for higher risk of falling | 2 | 3549 | Rate Ratio (IV, Random, 95% CI) | 0.57 [0.23, 1.38]
23.2 Number of fallers | 34 |  | Risk Ratio (IV, Random, 95% CI) | Subtotals only
23.2.1 Selected for higher risk of falling | 25 | 7536 | Risk Ratio (IV, Random, 95% CI) | 0.94 [0.85, 1.03]
23.2.2 Not selected for higher risk of falling | 9 | 6081 | Risk Ratio (IV, Random, 95% CI) | 0.92 [0.76, 1.11]

## Analysis group 24 — Multifactorial intervention vs control: subgroup analysis by intensity of intervention

Analysis or subgroup title | No. of studies | No. of participants | Statistical method | Effect size
24.1 Rate of falls | 19 |  | Rate Ratio (IV, Random, 95% CI) | Subtotals only
24.1.1 Assessment and active intervention | 11 | 6338 | Rate Ratio (IV, Random, 95% CI) | 0.74 [0.61, 0.89]
24.1.2 Assessment and referral or provision of information | 9 | 3376 | Rate Ratio (IV, Random, 95% CI) | 0.82 [0.71, 0.95]
24.2 Number of fallers | 34 |  | Risk Ratio (IV, Random, 95% CI) | Subtotals only
24.2.1 Assessment and active intervention | 16 | 7315 | Risk Ratio (IV, Random, 95% CI) | 0.87 [0.76, 0.98]
24.2.2 Assessment and referral or provision of information | 20 | 6662 | Risk Ratio (IV, Random, 95% CI) | 1.02 [0.93, 1.12]

## Analysis group 25 — Multifactorial intervention (setting 1) vs multifactorial intervention (setting 2)

Analysis or subgroup title | No. of studies | No. of participants | Statistical method | Effect size
25.1 Rate of falls | 1 |  | Rate Ratio (IV, Fixed, 95% CI) | Subtotals only
25.1.1 Community-based intervention vs hospital-based intervention | 1 | 349 | Rate Ratio (IV, Fixed, 95% CI) | 0.84 [0.49, 1.46]
25.2 Number of fallers | 2 |  | Risk Ratio (IV, Fixed, 95% CI) | Subtotals only
25.2.1 Community-based intervention vs hospital-based intervention | 1 | 349 | Risk Ratio (IV, Fixed, 95% CI) | 1.27 [0.78, 2.08]
25.2.2 Specialised Geriatric Service intervention vs family physician intervention | 1 | 234 | Risk Ratio (IV, Fixed, 95% CI) | 0.96 [0.72, 1.29]
25.3 Number of people sustaining a fracture | 1 |  | Risk Ratio (IV, Fixed, 95% CI) | Subtotals only
25.3.1 Community-based intervention vs hospital-based intervention | 1 | 219 | Risk Ratio (IV, Fixed, 95% CI) | 1.17 [0.20, 6.85]

## Figures and tables

Analysis 1.1: Rate of falls

Analysis 1.2: Number of fallers

Analysis 1.3: Number of people sustaining a fracture

Analysis 2.1: Rate of falls

Analysis 2.2: Number of fallers

Analysis 3.1: Rate of falls

Analysis 3.2: Number of fallers

Analysis 4.1: Rate of falls

Analysis 4.2: Number of fallers

Analysis 5.1: Rate of falls

Analysis 5.2: Number of fallers

Analysis 5.3: Number of people sustaining a fracture

Analysis 6.1: Rate of falls

Analysis 6.2: Number of fallers

Analysis 7.1: Rate of falls

Analysis 7.2: Number of fallers

Analysis 8.1: Rate of falls

Analysis 8.2: Number of people sustaining a fracture

Analysis 9.1: Rate of falls

Analysis 9.2: Number of fallers

Analysis 9.3: Number of people sustaining a fracture

Analysis 9.4: Number of people developing hypercalcaemia

Analysis 10.1: Rate of falls

Analysis 10.2: Number of fallers

Analysis 10.3: Number of people sustaining a fracture

Analysis 11.1: Rate of falls

Analysis 11.2: Number of fallers

Analysis 12.1: Rate of falls

Analysis 12.2: Number of fallers

Analysis 12.3: Number of people sustaining a fracture

Analysis 13.1: Number of fallers

Analysis 14.1: Rate of falls

Analysis 14.2: Number of fallers

Analysis 15.1: Rate of falls

Analysis 15.2: Number of fallers

Analysis 15.3: Number of participants sustaining a fracture

Analysis 16.1: Rate of falls

Analysis 16.2: Number of fallers

Analysis 17.1: Rate of falls

Analysis 17.2: Number of fallers

Analysis 18.1: Rate of falls

Analysis 18.2: Number of fallers

Analysis 18.3: Number of people sustaining a fracture

Analysis 19.1: Rate of falls

Analysis 19.2: Number of fallers

Analysis 20.1: Rate of falls

Analysis 20.2: Number of fallers

Analysis 21.1: Rate of falls

Analysis 21.2: Number of fallers

Analysis 21.3: Number of people sustaining a fracture

Analysis 22.1: Rate of falls

Analysis 22.2: Number of fallers

Analysis 22.3: Number of people sustaining a fracture

Analysis 23.1: Rate of falls

Analysis 23.2: Number of fallers

Analysis 24.1: Rate of falls

Analysis 24.2: Number of fallers

Analysis 25.1: Rate of falls

Analysis 25.2: Number of fallers

Analysis 25.3: Number of people sustaining a fracture