Falls are common in elderly people living in institutions, and they often cause serious injuries such as hip fracture.1 2 The clinical and economic costs of such injuries are high,3 and numerous guidelines have been developed to reduce falls and related injuries. A variety of approaches have been used in different countries and it is not known whether these have been effective. Current literature suggests that some interventions may be effective, based on lower levels of evidence, and these have been combined into multifactorial interventions in many studies.4 In this week's BMJ a systematic review by Oliver and colleagues evaluates interventions to prevent falls and fractures in people living in hospitals and care homes.5

It is important to review the effectiveness of interventions in these settings as most studies of falls have been conducted in the community.6 People in institutional settings have different risk profiles to those living in the community because their activity …