The personalised falls programme probably works no better than good advice
What happened
A Cochrane review published on 21 September 2026 has looked again at one of the standard approaches to preventing falls in older people, and found it works less well than many assume. The approach is called a multifactorial programme. The idea sounds sensible: assess each person individually, work out their particular risks — perhaps their eyesight, their medicines, their balance, the state of their stairs — and then put together a personalised plan for that one person. The review was led by the University of Exeter. Its co-leads were Dr Lianne Wood, the Bateman Family Chair in Peripheral Neuropathy at the University of Exeter Medical School, and Dr Cynthia Swarnalatha, also at Exeter Medical School. Professor Sarah Lamb, the Mireille Gillings Professor of Health Innovation at Exeter, was also involved. The team compared personalised programmes against several alternatives: simple falls education and advice, exercise programmes, usual medical care, and packages of several measures offered to everyone rather than tailored to the individual. Against education and advice, the conclusion was blunt. Personalised programmes "probably make no difference to how often people fall".
Why this matters
Falls are not a small problem. Around one in three people over 65 falls each year, and the review notes 684,000 reported cases worldwide. A fall is rarely just a fall. It can mean a broken wrist or hip, weeks in hospital, a loss of confidence that shrinks someone's world to one room, and sometimes a move out of their own home. Most older people who have had one fall will tell you the fear of the next one changes how they live. So this matters because personalised assessments cost money and time. They need trained staff, home visits and follow-up appointments. If a cheaper approach does the same job, that is a large amount of NHS time that could go somewhere more useful. It also matters for families. If you have been waiting months for a falls assessment for a parent, it is worth knowing that the things that help most are things you can start this week, without waiting for anyone.
What the evidence actually says
The findings are more nuanced than the headline, and the detail is where the useful part sits. Against falls education and advice, personalised programmes probably make no difference to how often people fall or their risk of falling. Against exercise programmes, the picture is unclear. The evidence was not strong enough to say which is better. Against usual medical care, personalised programmes did show a small benefit in the number of falls and the risk of falling — but the review is clear that the effect was substantially smaller than what exercise or good education achieve. Packages of several measures offered to everyone, rather than tailored, showed little to no benefit over standard care. So the message is not 'nothing works'. It is almost the opposite. The review points firmly at exercise to build strength, and at good education that actually persuades people to take up exercise, as the things that make the difference. That is a useful correction to a common instinct. A personalised plan feels more thorough, and feeling thorough is not the same as working. A plan that identifies eight risk factors is no use if the person does not then do the one thing — get stronger — that changes the odds. One honest caveat: Cochrane rates its confidence in each finding, and the phrase "probably make no difference" is doing real work. It means the evidence is reasonably good but not certain. This is a correction to how services are prioritised, not proof that individual assessments are worthless for everybody.
Practical advice
The review's own conclusion points at exercise and at education that leads to exercise. Here is what that looks like in practice. Strength and balance work is the main event. Not gentle walking alone — that is good for you, but it is not the same thing. Standing on one leg while the kettle boils, rising from a chair without using your hands, heel-to-toe walking along a hallway. The NHS has free strength and balance exercises you can follow at home. Do it often and keep doing it. Strength built over six weeks is lost again if you stop. A little, most days, beats a lot for a month. Get your eyes tested. Free for over-60s in the UK. New glasses, especially varifocals, can temporarily make stairs harder, so take particular care in the first weeks. Ask a pharmacist to review your medicines. Some medicines, and especially several taken together, can cause dizziness or drops in blood pressure on standing. This is one of the most overlooked causes of falls, and a pharmacist can review it without a GP appointment. Sort the obvious hazards, then stop worrying about them. Good lighting on stairs, a handrail, trailing wires out of the way, well-fitting slippers with backs. This is worth an afternoon, not an obsession. Do not hide a fall. Many older people do not mention one because they fear losing independence. Telling a GP after the first fall is how you avoid the second.
What to know
A Cochrane review led by the University of Exeter, published on 21 September 2026, found that personalised falls prevention programmes probably make no difference compared with simply giving people good education and advice. Against usual care they helped a little, but far less than exercise or education do. The practical message is encouraging rather than discouraging. The most effective things are the ones you can begin without an appointment: build strength and balance, keep at it, get your eyes checked, and have your medicines reviewed. If you are waiting for a falls assessment, do not wait to start. Sources: University of Exeter, 'Personalised programmes to prevent falls may make no difference: Cochrane review', 21 September 2026, https://news.exeter.ac.uk/faculty-of-health-and-life-sciences/personalised-programmes-to-prevent-falls-may-make-no-difference-cochrane-review/; Cochrane Library, 'Multifactorial and multiple component interventions for preventing falls in older people living in the community', https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012221.pub2/full; NHS, 'Falls', https://www.nhs.uk/conditions/falls/ This article is for general information and does not replace advice from a doctor, pharmacist or other qualified healthcare professional.
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