Latest Cochrane Evidence Shows Exercise, Dairy-Rich Diet and Vitamin D Can Help Reduce Falls in Aged Care Homes
The latest Cochrane Review update on Falls Prevention highlights the benefits of exercise, a dairy-rich diet, increased Vitamin D and individually tailored programs for aged care residents.
Falls remain one of the most serious health risks facing older people living in residential aged care in Australia and around the globe. But the latest update to Cochrane’s landmark Interventions for preventing falls in older people in care facilities review has found that tailored exercise programs, vitamin D supplements and dairy-rich diets can help prevent them.
“We know that falls are one of the most serious and common health risks facing older people, particularly in residential care settings,” explains lead author and Flinders University Senior Research Fellow Dr Suzanne Dyer.
“Here in Australia, falls in older people lead to broken bones, a loss of independence and over 144,000 hospitalisations each year. They also cause 6,000 deaths, making this research critical for better understanding prevention and support for older people in aged care facilities.”
This comprehensive review was first published in 2010 and revised in 2012 and 2018. For the first time, it has been split into separate reports for different settings: one focused on aged care facilities, and another on hospitals due to follow in the months ahead.
“This review update builds on the 2018 review which was widely used by clinicians, policy makers and families to support aged care residents and inform falls prevention programs and policies. This latest update informed the Australian National Falls Prevention Guidelines which were just published in June,” says Dr Dyer.
So what’s changed?
“In total, the latest update analyses evidence from over 100 clinical trials involving nearly 69,000 residents in 25 countries. It includes many new and larger well-conducted, high-quality trials. We've also incorporated new methods to capture more detailed qualitative information about different strategies, highlighting what works and what doesn't. And critically, we know more about just how critical it is that facility staff be consistently engaged and supported to understand and implement these practical steps to prevent falls in aged care facilities.”
“We looked at a wide range of interventions and strategies ranging from staff training and medication reviews to assistive technology and changes in care delivery. However, the strongest evidence centres on tailored exercise programs, vitamin D supplements, better nutrition, and personalised falls prevention based on individual falls risks as among the most effective measures to reduce falls in care homes.”
Here’s a snapshot of the key findings:
Ongoing exercise in aged care
Ongoing, tailored exercise programs are a must for falls prevention
Among the most consistent findings was the value of ongoing, tailored exercise. Programs that were moderate or low intensity and delivered in a group, by physios or trained staff, can reduce the number of falls residents experience. And for residents who can walk, they should have the opportunity to exercise for at least an hour a week. Importantly, residents with dementia who are able to participate can also benefit from these programs.
“We found that measures like ongoing tailored exercise programs can significantly cut the risk of falls in aged care homes,” says Dr Dyer. The key word, she stresses, is “ongoing.” Short bursts of activity are not enough.
“You can’t go in and do a six-week program or a two-month program, and then a few months down the track, expect it still to be reducing falls. It doesn’t work that way, and the effect disappears.”
Yet in practice, many homes still provide only brief, seated group sessions usually lasting 20 or 30 minutes, once or twice a week that are not intense or regular enough to make a difference.
“About one in three adults worldwide currently don’t get the recommended amount of weekly exercise — at least 150 minutes of moderate activity or 75 minutes of vigorous activity,” explains Dr Rik Dawson, review co-author and President of the Australian Physiotherapy Association, highlighting the scale of inactivity. “Unfortunately trends are moving in the wrong direction: insufficient physical activity rose from around 26% in 2010 to 31% in 2022. The figures are even worse when it comes to aged care, where residents spend up to 85% of their waking time sedentary and have been shown to engage in less than five minutes of moderate to vigorous physical activity a day.”
“However the latest global evidence clearly shows exercise is an effective and essential component of falls prevention.”
Australian trials of strength and balance exercise programs such as SUNBEAM, which reported a 55% reduction in falls with physiotherapist-led training, and the TOP-UP study, which demonstrated benefits via telehealth, have found that evidence-based programs are feasible and effective.
The challenge now is to embed them as part of routine care.
2. Improving diet, dairy intake and nutrition
Aged care facility menus should have at least 3.5 servings of dairy foods – milk, yoghurt, cheese – daily
The review also shines a spotlight on the role of diet. In aged care, malnutrition has been found to be alarmingly common with a recent Monash University study finding around 40% of residents are malnourished, and 6% severely so. This not only undermines health and quality of life but costs the system an estimated $9 billion each year.
Menus that provide sufficient protein and calcium are critical, and dairy foods stand out as a simple, effective intervention.
“The evidence tells us that menus should have at least 3.5 servings of dairy foods – milk, yoghurt, cheese – daily,” says Dr Dyer. “Involving a dietician in designing menus to make sure this happens can reduce the number of falls and hip fractures.”
This evidence echoes the findings of the 2021 Royal Commission into Aged Care Quality and Safety, which identified poor nutrition as a major failing across the sector. Some homes were spending as little as $6 per resident per day on food. Although reforms have increased spending to $12–$14.50, research highlights that more attention must be given to nutritional quality, not just quantity.
Encouragingly, a large Australian trial involving more than 7,000 residents across 60 aged care homes showed that increasing daily dairy servings from about 2 to 3.5 servings led to significant health improvements – a 33% reduction in fractures and 46% reduction in hip fractures – and cost around 66 cents per resident per day to implement.
3. Vitamin D supplementation
Many aged care residents don’t spend enough time outdoors and are vitamin D deficient.
As in previous versions of this review, vitamin D supplementation was found to be a simple but effective measure. Because residents in aged care spend little time outdoors, deficiency is widespread, leaving muscles and bones weaker and more prone to injury.
“Many older Australians in care have low vitamin D levels, which can affect muscle strength,” explains Dr Dyer. “The latest evidence found the addition of vitamin D supplements proved helpful in reducing the overall number of falls. Daily or weekly dosing improves muscle function, helping prevent both falls and fractures.”
While vitamin D has long been on clinicians’ radar, the updated review reinforces that supplementation should be considered routine in care settings.
4. Individual and tailored assessments
Each aged care resident should have a comprehensive care plan developed on admission, which includes falls risk assessment and preventive strategies
The review also took a closer look at multifactorial programs, which combine several strategies based on a resident’s risk profile. In 2018, it wasn’t clear if these approaches worked to reduce falls. But by incorporating new methods and detailed analysis, it is now clear that when these programs are provided by tailoring carefully to individual needs and actively involving care staff, they are more effective, reducing both fall rates and the number of residents who fall.
“Under Australia’s Aged Care Quality Standards, all residents should have a comprehensive care plan developed on admission, which includes falls risk assessment and preventive strategies,” explains Dr Dawson.
“In practice though, facilities do complete a falls risk tool at entry, such as the Peninsula Fall Risk Assessment Tool, but implementation of exercise-based interventions is inconsistent, for example. Research and audits show that while the assessment is performed, interventions such as strength and balance exercise are not reliably offered unless aged care providers are prepared to fund these services out of their profits. Allied Health and consumer peak bodies are calling for targeted funding for Allied Health so that fall prevention programs can be better resourced.”
Recent Australian research supports this approach.
“The University of Sydney’s TOP-UP trial, published in the Medical Journal of Australia this month, showed that even residents with dementia can safely take part in telephysio, leading to fewer falls, better mobility and quality of life, and lower costs,” Dr Dawson adds. “For families, this means there’s a proven solution available now – just as aged care providers face new obligations under national standards.”
“Families can play a vital role in falls prevention by asking physios about tailored exercises, encouraging safe movements like sit-to-stands from a chair, supporting balance practice, or even offering yoghurt and cheese as snacks during visits. These simple steps can help to lower fall risks in aged care facilities.”
Looking ahead: translating evidence into action
“Tailored exercise programs, vitamin D supplements, better nutrition and involving the care staff in providing falls prevention approaches can make a real difference,” concludes Dr Dyer.
“With the right mix of strategies, it’s possible to reduce risks and help older people in care stay safer and more independent. We look forward to sharing our next review to help prevent falls in hospital settings in the months ahead.”
With Australia’s population ageing rapidly — and the number of people over 80 expected to triple by 2050 — the findings of this global review highlight practical, evidence-based measures that can improve health and independence for older people now and into the future.
