Falls are a common problem affecting older people, with a third of those aged 65 and over, and half of those aged over 85, falling each year [
1]. The consequences of falls are disability, reduced quality of life and financial costs to individuals and society [
2]. The UK National Health Service (NHS) is reported to spend around £1.7 billion each year on falls [
3]. As a consequence there has been a wealth of research undertaken to establish how best to prevent falls with interventions including exercise, home safety modifications and education [
4]. These interventions have been categorised into one of the following three combinations: [
5]
a)
Single interventions e.g. exercise;
b)
Multifactorial interventions where two or more individually tailored interventions are provided following a risk assessment e.g. one person may receive exercise and home hazard modification whereas another may receive home hazard and medication modifications; and,
c)
Multiple component interventions, where participants receive a fixed combination of two or more interventions e.g. exercise and Vitamin D.
There is increasing evidence from meta-analyses for the effectiveness of single interventions, such as exercise, at reducing the rate of falls in community-dwelling [
4] and mixed populations [
6]. Home modifications have also been found to be effective at reducing fall risk [
7]. Whilst combining interventions that are effective on their own might therefore seem intuitive, the evidence for combined interventions (multifactorial and multiple component as described above) is less clear. Multifactorial interventions, which require an individually tailored approach, have been shown in a meta-analysis to reduce the rate of falls [
4] but there remains uncertainty in relation to reducing the number of those that fall [
8]. Indeed, this is supported by a recently updated Cochrane review, including more than 13,000 participants which observed no benefit in a reduction in the number that fell [
4]. These two reviews and meta-analyses [
4,
8] reported high levels of heterogeneity (I-squared between 60% and 69%) in the meta-analyses relating to number of people that fall, although this variation was not explained by baseline fall risk and intensity of interventions. That said, multifactorial interventions are the recommended approach for falls prevention in the UK [
9] whereas multiple component interventions on the other hand, which do not necessitate an individual assessment, and might therefore be an alternative approach, have not been extensively evaluated. Whilst Gillespie and colleagues included multiple component interventions as part of their review, their synthesis was narrative with each study reported separately due to the variety of combined interventions undertaken [
4]. Of the included studies that were effective, all but one included exercise but the omission of any summary data across the studies as a whole leaves an unclear picture as to the effectiveness of multiple component fall prevention programmes.
The aim of this review was to establish the effectiveness of multiple component interventions, as defined by Lamb et al. [
5] targeting older people, on (a) number of people that fell, (b) fall rates, and (c) number that sustained a fall-related injury, including an exploration of between-trial variability.