American Health & Medical Research Association
Practical guide

Home safety fixes cut falls 38% for higher-risk older adults, not everyone

Exercise prevents falls in older adults. A check-every-risk nurse program, vitamin D pills and hip protectors worn at home disappointed. This is a targeted plan, and what to do after a fall.

By the Health Research USA editorial team

Published Last updated October 2026

Written from the sources listed below; links checked October 2026. It touches on medicines, doses or health conditions and has not yet been reviewed by a licensed clinician, so use it to prepare for a conversation with yours. How we research and review

Sources15, listed below Reading time15 minutes

Where the evidence stands

  • Strong evidence 1. Exercise2. Home checkExercise prevents falls in older adults at higher riskProfessional home hazard fixes cut falls in higher-risk people
  • Promising but early Check-everything programs lower the overall rate of fallsHip protectors prevent hip fractures in nursing homes, if worn
  • Not enough evidence 6. Floor planAlarms prevent long lies on the floor
  • Evidence says no, or unsafe Home hazard fixes help people not chosen for riskCheck-everything programs cut serious fall injuriesVitamin D pills prevent falls in people living at homeHip protectors prevent hip fractures at home

Each use is rated separately, from the scorecard in this guide. Safety cautions are spelled out in the guide itself. How we grade

On this page
  1. First, find out whether you're at higher risk
  2. Checking every risk factor helped less than expected
  3. Exercise is still the best-proven step
  4. Home fixes cut falls 38% for higher-risk people, but not across the board
  5. Vitamin D pills and hip protectors have narrow uses
  6. Your fall-prevention plan
  7. If you fall: a plan for the floor
  8. Your body and your house are the best-tested tools
  9. What the evidence shows
  10. Questions readers ask
  11. The bottom line

Key takeaways

  • In a 2023 Cochrane review, home hazard fixes cut falls by 38% in people at higher risk, but people not chosen for their risk saw no drop at all56.
  • A trial of 5,451 adults 70 and older, in which everyone was checked for seven fall risks and nurses helped fix them, didn’t clearly reduce serious fall injuries23.
  • The U.S. Preventive Services Task Force gives exercise a “B” for older adults at higher risk, but says check-everything programs offer a small benefit best weighed case by case1.
  • Hip protectors had little or no effect for people living at home, though they cut hip fractures slightly in nursing homes9.
  • In a study of people over 90, 80% of those who fell couldn’t get up after at least one fall, and 30% lay on the floor for an hour or more, so plan for the floor before you need to11.

Picture an ideal fall-prevention program. You’re checked for seven common causes of falls. Then a trained nurse helps you pick which ones to fix and keeps working with you for 20 months or more2.

Researchers built that program and tested it in 5,451 adults aged 70 and older, at 86 primary care practices in 10 U.S. health systems23. The trial was called STRIDE. Each volunteer had been hurt in a fall, had fallen at least twice in the past year, or feared falling because of trouble walking or balancing2.

The results appeared in the New England Journal of Medicine in 2020. Serious fall injuries fell by only about 8% to 10%, a gap small enough to be chance3. The comparison group got a pamphlet and a nudge to talk with their doctors2.

That doesn’t mean falls can’t be prevented. It means the steps that work are more specific than “check everything.” Exercise has the strongest record. Home changes made with a professional cut falls sharply, but only in people already at higher risk. And two popular fixes, vitamin D pills and padded hip underwear at home, haven’t held up.

Below, we look at how the evidence sorts out, and what to do in the minutes after a fall.

First, find out whether you’re at higher risk

The CDC says an older adult falls every second of every day12. Each year about 3 million older adults are treated for a fall injury, and about 43,000 die from falls12. Our team’s article on rising fall deaths covers the trend.

About 37% of people who fall report an injury that needed treatment or kept them from usual activities for at least a day13. Women, people 85 and older, and American Indian and Alaska Native people are more likely to fall, the CDC notes15.

Your own history matters most. The Task Force suggests a practical test for higher risk: a past fall, or trouble with physical function and getting around1. The Cochrane reviewers point to similar markers, such as a recent fall that led to a hospital stay, or starting to need help with daily tasks6. As you’ll see, that sorting decides which steps are worth your time.

Checking every risk factor helped less than expected

STRIDE tested a multifactorial intervention, meaning a program that assesses many risks and then tailors fixes. Every volunteer was screened for the same seven: shaky walking or balance, home hazards, foot and shoe problems, poor vision, medicines that raise fall risk, blood pressure drops on standing, and thin bones or low vitamin D2.

In the intervention group, nurses trained as “falls care managers” helped each person work on one to three of those risks2. Self-reported fall injuries dropped by a significant 10%3. But the main goal, fewer serious injuries confirmed by records, wasn’t met23.

Why? In everyday clinics, the program worked less well than the team expected, said senior author Shalender Bhasin. Costs such as rides to appointments and follow-up care got in the way3. A later commentary added that nurses struggled with cramped clinics, staff turnover and uneven support from doctors, and that matching people with a suitable exercise program was hard because programs varied so much4.

The Task Force’s 2024 review reached a similar verdict. Across 20 trials with 22,115 people, multifactorial programs cut the rate of falls by about 16%1. They didn’t significantly reduce the number of people who fell, injurious falls, fractures or deaths1. People followed about 60% to 70% of the advice they got1.

So in June 2024, the Task Force gave these programs a “C,” meaning clinicians should decide case by case because the routine benefit is small1. The lesson isn’t that assessment is useless. A list of referrals only helps if you act on it.

Exercise is still the best-proven step

The Task Force’s June 2024 statement gives exercise a “B” for adults 65 and older living at home who are at higher risk of falling, in line with its 2018 advice1. Serious harms in the trials were rare, though one trial reported a wrist fracture and another a hip fracture linked to an exercise session1.

Our articles on balance training programs, the 10-second balance test and tai chi lay out the trial numbers, what kind of exercise works and how much. The short version: balance work that truly challenges you, a few sessions a week, kept up for good.

Home fixes cut falls 38% for higher-risk people, but not across the board

In March 2023, a team led by Lindy Clemson of the University of Sydney updated the Cochrane review of home and environment changes56. Cochrane is an independent network that pools trials. The review covered 22 trials of 8,463 people aged 60 and older in 10 countries5.

Fixing home hazards usually meant a professional visit, often by an occupational therapist, who checks in and around your home and recommends changes6. Typical changes included clearing clutter, adding handrails and non-slip strips on steps, removing slippery mats and brightening stair lighting6.

Who got home hazard fixes Falls per 1,000 people, without fixes Falls per 1,000, with fixes Certainty
People at higher risk of falling 1,847 About 1,145 (38% fewer) High56
Everyone combined 1,319 a year About 976 (26% fewer) Moderate5
People not chosen for their risk Not given No drop (rate ratio 1.05) High5

The 1,145 and 976 are our subtractions from the review’s estimates of 702 and 343 fewer falls5.

That bottom row is the surprise. In six trials with 3,780 people who weren’t selected for fall risk, home fixes did nothing measurable for falls5. Clemson noted that people tend not to notice the clutter in their own homes, and that a fall or new trouble with daily tasks signals deeper risk6.

The review found no drop in fractures or fall-related hospital stays, though that evidence was thin5. Changing glasses or teaching people about falls didn’t clearly help on its own5.

Where experts disagree. The Task Force rated home changes offered alone as having too little evidence to judge1. The Cochrane team found high-certainty benefit for people at higher risk5. The reviews pooled different studies, and the Cochrane result comes from sorting people by risk. Our reading: a professional home check makes the most sense after a fall or when daily tasks get harder.

Vitamin D pills and hip protectors have narrow uses

Vitamin d. The Task Force’s 2018 statement advised against vitamin D pills to prevent falls1. In December 2024 it posted a draft that would again recommend against vitamin D, with or without calcium, to prevent falls or fractures in postmenopausal women and men 60 and older who live at home8.

The draft’s evidence review covered 20 trials. For falls, the pills made no clear difference: about 5 fewer people fell per 1,000 who took them, a gap consistent with chance8.

As of October 2026, the Task Force lists the update among those it is finalizing, so the draft isn’t final yet7. Our article on supplements by life stage covers the draft’s harms. The CDC still suggests asking your doctor about vitamin D14.

Hip protectors. These are hard or soft pads, usually sewn into special underwear, meant to soften a blow to the hip. A 2014 Cochrane review of 19 trials with about 17,000 people sorted out where they help9:

  • Nursing homes and residential care: about 11 fewer hip fractures per 1,000 people offered protectors, a small benefit9.
  • People living at home: little or no effect, with about 2 more hip fractures per 1,000 people offered them, within the range of chance9.

Protectors didn’t change the number of falls, and up to 5% of wearers had side effects such as skin irritation9. The biggest problem was that people often stopped wearing them, especially over time9.

Your fall-prevention plan

This plan is our own, built from the sources above. Bring it to your next checkup.

Step Best fit What to do Evidence Source
1. Exercise Older adults, especially after a fall or with unsteady walking Join a balance-focused class or home program, a few sessions a week, and keep going Strong evidence 1
2. Home check People who’ve fallen or need help with daily tasks Ask your clinician for an occupational therapist’s home visit; fix clutter, rails, mats and stair lighting Strong evidence for higher-risk people 56
3. Medicines Anyone on several medicines Ask your doctor or pharmacist to review all of them, including over-the-counter ones, for dizziness or sleepiness Recommended by the CDC; tested alone, results unclear 114
4. Eyes and feet Everyone Eye exam yearly; ask about distance-only glasses for walking outdoors; low-heeled, nonskid shoes, never socks on stairs Recommended by the CDC and NIA 1014
5. Bones Older adults, especially women, who have about 70% of hip fractures Ask about osteoporosis screening and treatment Recommended by the CDC 14
6. Floor plan Anyone who lives alone or spends hours alone Keep a charged phone on you, set a daily check-in, and learn how to get up Not enough evidence, but long lies are linked to serious harm 1011

Rows 3 and 4 are covered in depth in our article on hidden causes of poor balance, and our mobility article covers canes and walkers. Don’t stop or change any medicine on your own.

If you fall: a plan for the floor

In a Cambridge, England, study published in 2008, Jane Fleming and Carol Brayne tracked 110 people over 90 for a year11. Of the 66 who fell, 80% couldn’t get up after at least one fall, and 30% lay on the floor for an hour or more11.

Lying on the floor that long, often called a “long lie,” was strongly linked to serious injury, hospital admission and moving into long-term care11. Most of the falls, 82%, happened when the person was alone11.

Many of these people already had a call alarm. In most long lies, it was never pressed11. They described alarms as beside the point, a threat to their independence or awkward to use11. The authors called for teaching older people how to get up from the floor11.

The National Institute on Aging (NIA) suggests these steps10:

  1. Pause. Stay still and take a few deep breaths. Getting up too fast, or the wrong way, can make an injury worse.
  2. Check yourself. If you’re hurt, or can’t get up on your own, call for help or 911.
  3. Roll and rest. If you can get up safely, roll onto your side and rest so your body and blood pressure can adjust.
  4. Crawl to support. Get onto your hands and knees and crawl to a sturdy chair.
  5. Rise in stages. With your hands on the chair seat, slide one foot forward until it’s flat on the floor. From that kneeling position, rise slowly and turn to sit in the chair.
  6. If you can’t get up, get as comfortable as you can and wait for help.

Prepare now. NIA advises keeping a charged cordless or cell phone with you at all times and arranging a daily check-in with a family member or friend10. A button you wear on a necklace or bracelet, or a smartwatch with the same feature, can call for help10. Choose one you’ll wear in the bathroom and at night.

Afterward, tell your doctor about any fall, even one that didn’t hurt10. A fall can reveal a new health problem or a fixable medicine or vision issue10. And the CDC says an older adult who falls should be checked by a health care provider for signs of a brain injury15.

Your body and your house are the best-tested tools

Natural health trusts the body to adapt and asks what’s causing a problem. Fall research rewards both instincts. The best-proven steps use your own muscles, your balance and the rooms you live in. A pill, by contrast, hasn’t delivered: vitamin D didn’t prevent falls in trials of people living at home18.

The same honesty applies to medical programs. STRIDE was carefully designed, and it fell short too23. Judge every fix, from a supplement to a care program, by what it did in trials.

Self-reliance includes a plan for the floor. A neighbor who checks in each morning is an old idea that fits the research on long lies1011.

What the evidence shows

Claim Evidence level What it rests on
Exercise prevents falls in older adults at higher risk Strong evidence Task Force grade B, 20241
Professional home hazard fixes cut falls in higher-risk people Strong evidence 38% fewer falls, high certainty5
Home hazard fixes help people not chosen for risk Evidence says no, or unsafe No drop, high certainty5
Check-everything programs lower the overall rate of falls Promising but early About 16% fewer falls across 20 trials, with mixed results and no drop in injuries1
Check-everything programs cut serious fall injuries Evidence says no, or unsafe No clear drop in STRIDE or the Task Force review123
Vitamin D pills prevent falls in people living at home Evidence says no, or unsafe 2024 draft grade D; pooled trials showed no clear effect8
Hip protectors prevent hip fractures at home Evidence says no, or unsafe Little or no effect, moderate certainty9
Hip protectors prevent hip fractures in nursing homes, if worn Promising but early A small, borderline benefit; many people stop wearing them9
Alarms prevent long lies on the floor Not enough evidence Unused in most long lies in one study11

Questions readers ask

Can I just use a home safety checklist?

A checklist is a start, but the falls benefit in the Cochrane review came mostly from professional assessments aimed at people at higher risk56. If you’ve fallen or are starting to need help with daily tasks, ask for an occupational therapist’s visit6.

Should I keep taking vitamin D?

The draft is about preventing falls and fractures in people living at home8. It isn’t a reason to stop something your clinician prescribed for a deficiency or bone disease, so talk with your clinician before changing anything14.

Is a medical alert button worth it?

It can be, if you wear it. NIA lists wearable alarms and smartwatches as options10. In the study of people over 90, alarms went unused in most long lies, so pair any device with a daily check-in and a charged phone in your pocket1011.

The bottom line

Fall prevention works best when it’s matched to the person. Exercise is the best-proven step. A professional home check pays off after a fall or when daily tasks get harder, but did nothing for people who weren’t chosen for their risk. Big programs that check everything, vitamin D pills for people who live at home, and hip pads outside nursing homes have disappointed in trials.

Plan for the floor too. Keep a phone on you, set a daily check-in, learn how to get up in stages, and tell your doctor about every fall. Call for help or 911 if you’re hurt or can’t get up, call 911 for any head injury danger sign, and if you take a blood thinner, make sure you’re checked after any blow to the head.

About this article

This article was researched using U.S. Preventive Services Task Force statements, Cochrane reviews, a large randomized trial and its published reports, a cohort study in The BMJ, and CDC and National Institute on Aging guidance, all listed below. It was reviewed in October 2026. It is general education and not medical, legal or financial advice.

Sources

  1. U.S. Preventive Services Task Force. “Falls Prevention in Community-Dwelling Older Adults: Interventions.” Final recommendation statement, June 4, 2024. uspreventiveservicestaskforce.org
  2. National Institutes of Health. “Individually tailored falls prevention plan found no better than usual care in reducing serious injury” (on Bhasin S, et al., New England Journal of Medicine, 2020;383:129-140). News release, July 9, 2020. nih.gov
  3. University of Texas Medical Branch, Sealy Center on Aging. “Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE).” News release, July 10, 2020. utmb.edu)
  4. Hung WW. “Fall Injury Among Community-Dwelling Older Adults: Effect of a Multifactorial Intervention and a Home Hazard Removal Program.” Journal of Clinical Outcomes Management, 2022;29(3):102-105 (MDedge). doi.org
  5. Clemson L, Stark S, Pighills AC, Fairhall NJ, Lamb SE, Ali J, Sherrington C. “Environmental interventions for preventing falls in older people living in the community.” Cochrane Database of Systematic Reviews, 2023, Issue 3, CD013258 (abstract, PEDro database). search.pedro.org.au
  6. University of Sydney. “How to reduce falls among older people at home.” News release, March 10, 2023. sydney.edu.au
  7. U.S. Preventive Services Task Force. “Recommendations in Progress” (lists the vitamin D falls and fractures update under “Finalizing the Recommendation Statement”). USPSTF, accessed October 2026. uspreventiveservicestaskforce.org
  8. HealthDay. “USPSTF Recommends Against Vitamin D Supplementation for Fracture, Fall Prevention” (on the Task Force’s draft recommendation). December 17, 2024. healthday.com
  9. Santesso N, Carrasco-Labra A, Brignardello-Petersen R. “Hip protectors for preventing hip fractures in older people.” Cochrane Database of Systematic Reviews, 2014, Issue 3, CD001255 (Cochrane summary). cochrane.org
  10. National Institute on Aging. “Falls and Fractures in Older Adults: Causes and Prevention.” NIH, content reviewed September 12, 2022. nia.nih.gov
  11. Fleming J, Brayne C. “Inability to get up after falling, subsequent time on floor, and summoning help: prospective cohort study in people over 90.” BMJ, 2008;337:a2227. pubmed.ncbi.nlm.nih.gov
  12. Centers for Disease Control and Prevention, STEADI. “Patient & Caregiver Resources.” Updated September 4, 2026. cdc.gov
  13. Centers for Disease Control and Prevention. “Facts About Older Adult Falls.” Updated September 4, 2026. cdc.gov
  14. Centers for Disease Control and Prevention. “Preventing Falls and Hip Fractures.” Reviewed January 27, 2026. cdc.gov
  15. Centers for Disease Control and Prevention. “Information for Caregivers.” Still Going Strong, updated August 4, 2025. cdc.gov