IMPORTANCE: Falls result in substantial burden for patients and health care systems, and given the aging of the population worldwide, the incidence of falls continues to rise. OBJECTIVE: To assess the potential effectiveness of interventions for preventing falls. DATA SOURCES: Medline, Embase, Cochrane Central Register of Controlled Trials, and Ageline databases from inception until April 2017. Reference lists of included studies were scanned. STUDY SELECTION: Randomized clinical trials (RCTs) of fall-prevention interventions for participants aged 65 years and older. DATA EXTRACTION AND SYNTHESIS: Pairs of reviewers independently screened the studies, abstracted data, and appraised risk of bias. Pairwise meta-analysis and network meta-analysis were conducted. MAIN OUTCOMES AND MEASURES: Injurious falls and fall-related hospitalizations. RESULTS: A total of 283 RCTs (159,910 participants; mean age, 78.1 years; 74% women) were included after screening of 10,650 titles and abstracts and 1,210 full-text articles. Network meta-analysis (including 54 RCTs, 41,596 participants, 39 interventions plus usual care) suggested that the following interventions, when compared with usual care, were associated with reductions in injurious falls: exercise (odds ratio (OR) 0.51 (95% CI 0.33 to 0.79); absolute risk difference (ARD) -0.67 (95% CI -1.10 to -0.24)); combined exercise and vision assessment and treatment (OR 0.17 (95% CI 0.07 to 0.38); ARD -1.79 (95% CI -2.63 to -0.96)); combined exercise, vision assessment and treatment, and environmental assessment and modification (OR 0.30 (95% CI 0.13 to 0.70); ARD -1.19 (95% CI -2.04 to -0.35)); and combined clinic-level quality improvement strategies (eg, case management), multifactorial assessment and treatment (eg, comprehensive geriatric assessment), calcium supplementation, and vitamin D supplementation (OR 0.12 (95% CI 0.03 to 0.55); ARD -2.08 (95% CI -3.56 to -0.60)). Pairwise meta-analyses for fall-related hospitalizations (2 RCTs; 516 participants) showed no significant association between combined clinic- and patient-level quality improvement strategies and multifactorial assessment and treatment relative to usual care (OR 0.78 (95% CI 0.33 to 1.81)). CONCLUSIONS AND RELEVANCE: Exercise alone and various combinations of interventions were associated with lower risk of injurious falls compared with usual care. Choice of fall-prevention intervention may depend on patient and caregiver values and preferences.

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