Exercise interventions are among the most effective non-pharmacological approaches for fall prevention. Regular exercise, especially activities that improve balance and strength, can help reduce falls by up to 43%. Balance exercises focus on standing on one leg, standing heel-to-toe, and walking with the head tipped forward and back. Strength exercises target major muscle groups using resistance bands, weights, or body weight. Older adults should aim for both aerobic activity and exercises to improve balance and strength at least 2-3 times per week. Tai Chi and yoga are also beneficial exercise programs that have been shown to reduce falls by up to 55% when practiced regularly.

Home hazard modifications involve removing or addressing environmental risks in the home that could contribute to falls. Some key modifications include improving lighting, especially on stairways; removing loose rugs and cables; installing grab bars near the toilet and in the shower or tub; and using non-slip mats in the bathroom. Stairways should have handrails on both sides that are easy to grasp. Furniture should be arranged to provide clear pathways and easy mobility through each room. Clutter and obstacles that could serve as tripping hazards should be stored away or removed. Outdoor modifications like installing handrails on porches or steps can also help reduce fall risks.

Vision screenings are important to identify impairments like cataracts or glaucoma that may increase fall risks if left unaddressed. Regular eye exams can detect changes in vision that may benefit from corrective lenses or treatment. General vision assessments are also valuable to screen for issues like peripheral vision loss or impairment of depth perception and light sensitivity. Low-vision aids or rehabilitation can assist those with long-term visual impairment. Proper lighting, clear pathways, and removal of low-contrast clutter can accommodate visual deficits.

Foot and footwear assessments identify problems like improperly fitting shoes, foot deformities, or risks of foot ulcers that can contribute to instability and falls. Proper fitting, well-cushioned, slip-resistant shoes with low heels are recommended. Orthotics or other inserts may help accommodate foot issues. Regular foot care including nail trimming and moisturizing can improve foot health. Shoes should be replaced when worn out, and different shoes may be needed for various indoor and outdoor activities.

Medication management can play an important role in fall prevention. A comprehensive review of all prescription and over-the-counter medications is recommended at least annually. Health providers should evaluate potential side effects or interactions that may impair balance, coordination, alertness, or cognition. Adjustments or alternatives may be appropriate to minimize fall risks from medications when clinically feasible.

Patient education provides fall prevention information and strategies to empower older adults and their caregivers in identifying and addressing individual risks. Topics covered may include recommended exercise programs, home hazard assessments, vision and foot safety, safe mobility aids, awareness of fall-risk increasing conditions/situations, asking for assistance when appropriate, and developing a fall response plan. Educational programs can be delivered individually or in group settings and may include videos, handouts, and demonstrations of key techniques and recommendations to optimize learning and adoption of safer behaviors.

Multifactorial interventions that combine two or more of the above approaches, tailored to an individual’s needs and risks, have been shown to reduce falls by up to 39% in community-dwelling older adults. A comprehensive assessment followed by a coordinated prevention strategy is most effective for sustaining safer behaviors over the long-term. Follow-up evaluations allow ongoing adjustments based on changing needs and risks as part of active fall prevention care.

Non-pharmacological interventions provide versatile, multimodal options for individuals and health systems to holistically address intrinsic and extrinsic factors contributing to falls. Regular exercise, home modifications, vision/foot screening, medication management, patient education, and multifactorial programs can all help empower older adults to safely age in place by substantially reducing their risk of fall injuries. An integrated model combining clinical and community supports optimizes adoption and adherence to crucial fall prevention strategies.