References to studies identified [posted as supplied by author] w1. Dyer CAE, Taylor GJ, Reed M, et al. Falls prevention in residential care homes: a

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1 References to studies identified [posted as supplied by author] w1. Dyer CAE, Taylor GJ, Reed M, et al. Falls prevention in residential care homes: a randomised controlled trial. Age Ageing 2004;33: w2. Shaw FE, Bond J, Richardson D, et al. Multifactorial intervention after a fall in older people with cognitive impairment and dementia presenting to the accident and emergency department: a randomised controlled trial. BMJ 2003;326: w3. Jensen J, Lundin-Olsson L, Nyberg L, Gustafson Y. Fall and injury prevention in older people living in residential care facilities. Annals Intern Med 2002;136: w4. Jensen J, Nyberg L, Gustafson Y, Lundin-Olsson L. Fall and injury prevention in residential care effects in residents with higher and lower levels of cognition. J Am Geriatr Soc 2003;51(5):6w6-33. w5. Donald IP, Pitt K, Armstrong E, Shuttleworth H. Preventing falls on an elderly care rehabilitation ward. Clin Rehabil 2000;14: w6. Mayo NE, Gloutney L, Levy AR. A randomised trial of identification bracelets to prevent falls among patients in a rehabilitation hospital. Arch Phys Med Rehabil 1994;75(12): w7. Haines TP, Bennell KL, Osborne RH, Hill KD. Effectiveness of targeted falls prevention programmes in a subacute setting. A randomised controlled trial. BMJ 2004;328: w8. Fonda D, Cook J, Sandler V. Reducing Serious Fall Related Injuries in Hospital. (Australian Medical Journal 2006 In Press) w9. Reuben DB, Borok GM, Wolde-Tsadik G, et al. A randomized trial of comprehensive geriatric assessment in the care of hospitalized patients. NEJM 1995;332(20): w10. Healey F, Monro A. Cockram A, et al. Using targeted risk factor reduction to prevent falls in older hospital inpatients. A randomised controlled trial. Age Ageing 2004;33: w11 Mitchell A, Jones N. Striving to prevent falls in an acute care setting - action to enhance quality. J Clin Nurs 1996;5(4): w12 Hoffman SB, Powell-Cope G, MacClellan L, Bero K. BedSAFE - a bed safety project for frail older adults. J Geront Nurs 2003;29(11): w13 Savage T, Matheis-Kraft C. Fall occurrence in a geriatric psychiatry setting before and after a fall prevention program. J Geront Nurs 2001;w6,10: w14 Vassallo M, Vignaraja R, Sharma JC, et al. The effect of changing practice on fall prevention in a rehabilitative hospital: the hospital injury prevention study. J Am Geriatr Soc 2004;52: w15 Barry E, Carey D, Laffoy M. Preventing accidental falls among older people in long stay units. Irish Med Jl 2001;94, 6: w16 Kilpack V, Boehm J, Smith N, Mudge B. Using research-based interventions to decrease patient falls. Applied Nurs Res 1991;4(2):50-6. w17 Brandis S. A collaborative occupational therapy and nursing approach to falls prevention in hospital inpatients. Journal Qual Clin Pract 1999;19: w18 Oliver D, Martin F, Seed P. Preventing patient falls. Age Ageing 2002;31(1):75-6. w19 Kerse N, Butler M, Robinson E, Todd M. Fall prevention in residential care: a cluster randomised, controlled trial. J Am Geriatr Soc 2004;52: w20 Rubenstein LZ, Robbins AS, Josephson KR, et al. The value of assessing falls in an elderly population; a randomised clinical trial. Ann Intern Med 1990;113:

2 w21 Becker C, Kron M, Lindeman U et al. Effectiveness of a multifaceted intervention on falls in nursing home residents. J Am Geriatr Soc 2003;1(3): w22 McMurdo ME, Millar AM, Daly F. A Randomised Controlled Trial of Fall Prevention Strategies in Old Peoples Homes. Gerontology 2000;46(2): w23 Schnelle JF, MacRae PG, Giacobassi K, et al. Exercise with physically restrained nursing home residents. Maximising the benefits of restraint reduction. J Am Geriatr Soc 1996;44: w24 Kannus P, Parkkari J, Niemi S, et al. Prevention of hip fractures in elderly people with use of a hip protector. NEJM 2000;343: w25 O'Halloran PD, Cran GW, Beringer TRO, et al. A cluster randomised controlled trial to evaluate a policy of making hip protectors available to residents of nursing homes. Age Ageing 2004;33: w26 Cameron ID, Venman J, Kurrle SE, et al. Hip protectors in aged-care facilities: a randomized trial of individual higher-risk residents. Age Ageing 2001;30: w27 Jantti PO, Aho HJ, Maki-Jokela PL, Heikinheimo RJ. Hip Protectors and hip fractures. Age Ageing 1998;w6,6: w28 Van Schoor NM, Smit JH, Twisk JWR, et al. Prevention of hip fractures by external hip protectors. A randomized controlled trial. JAMA 2003;289: w29 Lauritzen JB, Petersen MM, Lund B. Effect of external hip protectors on hip fractures. Lancet 1993;341: w30 Meyer G, Warnke A, Bender R, Muhlhauser I. Effect on hip fractures of increased use of hip protectors in nursing homes: cluster randomized controlled trial. BMJ 2003;326:76-8. w31 Chan DK, Hillier G, Coore M, et al. Effectiveness and acceptability of a newly designed hip protector. Arch Gerontol Geriatr 2000;30: w32 Woo J, Sum C, Yiu HH, et al. Efficacy of a specially designed hip protector for hip fracture prevention and compliance with use in elderly Hong Kong Chinese. Clin Rehab 2003;17(2): w33 Ekman A, Mallmin H, Michanelsson K, Ljunghall S. External hip protectors to prevent osteoporotic fractures. Lancet 1997;350: w34 Villar TMA, Hill P, Inskip H, et al. Will elderly rest home residents wear hip protectors? Age Ageing 1998;w6: w35 Tinetti ME, Inouye SK, Gill TM, Doucette JT. Shared risk factors for falls, incontinence, and functional dependence. JAMA 1995;w63: w36 Capezuti E, Evans L, Strumpf N, Maislin G. Physical restraint use and falls in nursing home residents. J Am Geriatr Soc 1996;44:6w w37 Capezuti E, Strumpf NE, Evans L, Maislin G. Outcomes of night time physical restraint removal for severely impaired nursing home residents. Am. J Alz Dis 1999;14(3): w38 Ejaz F, Jones JA, Rose MS. Falls among nursing home residents. An examination of incident reports before and after restraint reduction programs. J Am Geriatr Soc 1994;42: w39 Hanger HC, Ball MC, Wood LA. An analysis of falls in hospital. Can we do without bedrails? J Am Geriatr Soc 1999;47: w40 Kelly KE, Phillips CL, Cain KC et al. Evaluation of a non intrusive monitor to reduce falls in nursing home patients. J Am Med Dir Assoc. 2002;3(6): w41 Mulrow CD, Gerety MB, Kanten D, et al. A randomized trial of physical rehabilitation for very frail nursing home residents. JAMA 1994;w61(7):

3 w42 Bischoff HA, Stahelin HB, Dick W, et al. Effects of vitamin D and calcium supplementation on falls: a randomized controlled trial. J Bone Min Res 2003;18: w43 Chapuy M, Arlot M, Dubouef F, et al. Vitamin D3 and calcium to prevent hip fractures in elderly women. NEJM 1992;3w6 (23): w44 Haumschild M, Karfonta TL, Haumschild MS, Phillips SE. Clinical and economic outcomes of a fall focused pharmaceutical intervention program. Am J Health Sys Pharm 2003;60:

4 Table A Key Features of Included Studies and Interventions Employed [posted as supplied by author] Paper (ref) Category Setting, Population Design Mayo w6 Multifaceted USA. Hospital rehab ward, subjects with RS Hospital (MH) or more risk factors for falls/fractures >80 Haines w7 MH Australia. 3 subacute wards, metropolitan 24 2 RS, RA, MC, NI, ED, EX, HP hospital. All admissions, n -626 Reuben w9 MH Several USA acute hospitals. > RA, MC, NI, EX, EN, MR Comprehensive Geriatric Assessment Healey w10 MH UK. 8 general hospital wards for older Paired 18 1 RS, RA, MC, NI, ED, EX, EN, people. Mean age 81 Cluster MR,RR Fonda w8 MH Australia. Subacute hospital. All admissions Before and Mean Age 80 After Mitchell w11 MH Australia. Acute and subacute medical Before and ward. Mean age 76 pre-intervention, 72, After post Hoffman w12 MH USA. Care homes. All residents Before and After Savage w13 MH Canada. 2 psychiatric wards. Mean age 77. Before and Most patients with advanced dementia After Vassallo w14 MH UK. 3 geriatric wards in 3 hospitals. All Open patients Cluster Barry w15 MH Ireland. Hospital rehab unit. Mean age 81 Before and After ua lit y Sc or e D e m en tia * In te rv en tio ns 17 2 RS, RA, NI, ED, EN, RR 13 0 RA, MC, NI, ED, EX, EN, MR 12 2 RA, NI, ED, EN, MR, RR 11 3 RS, RA, NI, ED, EX, EN 10 2 RS, RA, MC, NI, ED, EN, RR 10 0 RS, RA, MC, NI, ED, EX, EN, MR, RR, HP Kilpack w16 MH USA. Adult medical and surgical tertiary care units Brandis w17 MH Australia. Hospital inpatients Before and After Retrospecti ve Observation al Cohort 5 0 RS, RA, MC, NI, ED, EN 5 0 RS, NI, ED, HP Oliver w18 MH UK. Urban teaching hospital elderly care Before and 2 2 RS, RA, MC, NI, ED, EN, MR wards. Mean age 80 After Kerse w19 Multifaceted New Zealand. 14 residential care homes of Stratified 25 2 RS, RA, ED, EN Care Home (MCH) various types. Randomisation within matched pairs Cluster Rubenstein w20 MCH US. 1 residential care home RA, MC, NI, EN, MR Becker w21 MCH Germany. 6 care homes. Mean age 84 Cluster 23 2 RA, MC, ED, EX, EN, HP Jensen w3,w4 MCH Sweden. 9 residential homes. Comparison Cluster 22 1, 3 RA, NI, ED, EX, EN, MR, RR, H of high (MMSE 19) vs low (MMSE <19) cognition Schnelle w23 MCH USA. 4 nursing homes. Mean age 87 in both groups. Predefined conditions around incontinence, immobility to select patients 21 3 NI, EX for randomisation Dyer w1 MCH UK. 20 care homes. Excluded specialist care homes for mentally ill and patients with Cluster 19 2 RA, NI, ED, EX, EN, MR

5 *Dementia: Percentage of population with dementia 0 = unknown, 1 =<40%, 2= 40-69%, 3 = 70%. Quality Score = Downs and Black Quality Score, Studies within each category are listed in descending order of Downs and Black Quality Score. Jensen reported an initial and then a subgroup analysis for patients with higher Vs lower levels of cognition. Hence Jensen MMSE 19 and Jensen MMSE <19 reported as two separate papers. Donald reported a 2 x 2 factorial design with environmental changes and exercise as the variables, hence Donald is treated as Donald (exercise) and Donald (environmental change). & Interventions: RS = Risk stratification or labelling, RA = Risk assessment, MC = Medical/CVS review, NI = Nursing int, ED = Education, EX = Exercise/Physiotherapy, EN = Equipment/Environmental, MR = Medication review, RR = Restraint review or removal, HP = Hip protector

6 Table B Outcome Data (Falls, Fallers and Fractures) for All Included Studies [posted as supplied by author] Study Category No. of Falls Falls/Person Year Fallers Total subjects % of subjects falling No. of fractures Fractures/ 1000 Person Years I C I C I C I C I C I C Mayo w6 Multifaceted w6/65 21/ Hospital (MH) Haines w7 MH /310 71/ Reuben w9 MH 160/ / Healey w10 MH Fonda w9 MH Mitchell w11 MH MH Hoffman w1 2 Savage w13 MH /23 9/ MH /w65 111/ Vassallo w1 4 Barry w15 MH /172 39/ Kilpack w16 MH Brandis w17 MH 258 w Oliver w18 MH Kerse w19 Multifaceted / / Care Home (MCH) MCH /79 68/ Rubenstei n w20 Becker w21 MCH / / Jensen w4 MCH /112 43/ (MMSE 19) Jensen w4 MCH /69 62/ (MMSE <19) MCH /92 29/ Schnelle w2 3 Dyer w1 MCH /102 51/ MCH /52 22/ McMurdo w 22 Shaw w2 MCH 96/ /

7 Kannus w24 O Halloran w25 Hip Protectors, Single Intervention, Care Home (HP) HP HP Cameron w 26 Jantti w27 HP w Van Schoor w28 HP 7w HP Lauritzen w 29 Meyer w30 HP /459 w64/ Woo w32 HP Ekman w33 HP Villar w34 HP 8/101 1/ Chan w31 HP Tinetti w35 Physical restraint removal (PRR) w /w65 92/ PRR 100/203 49/ Capezuti w3 6 PRR 5/51 1/ Capezuti w3 7 Hanger w39 PRR Ejaz w38 PRR Kelly w40 Fall Alarm w6 Donald w5 Exercise /30 6/ Mulrow w41 Exercise /97 38/ Donald w /28 1/ Environment al Change Bischoff w42 Vitamin D /62 18/ Chapuy w43 Calcium and Vitamin D

8 Medication 16/200 30/ Haumschil d w44 review and withdrawal n.b. Where columns are blank this indicates that these outcome data could not be extracted or calculated for that paper

9 Table C Effect of Intervention Relative to Control for All Included Studies [posted as supplied by author] Fallers - Relative Paper Category Falls - Rate Ratio (95% CI) Risk (95% CI) Fractures -Rate Ratio (95% CI) Mayo w6 Multifaceted Hospital (MH) 1.15 (0.72 to 1.84) 1.36 (0.86 to 2.16) Haines w7 MH 0.69 (0.54 to 0.88) 0.78 (0.56 to 1.06) 0.98 (0.14 to 6.94) Reuben w9 MH 1.18 (0.93 to 1.49) 1.14 (0.88 to 1.47) Healey w10 MH 0.59 (0.25,1.37) Fonda w8 MH 0.62 (0.52 to 0.72) Mitchell w11 MH 0.56 (0.33 to 0.94) Hoffman w12 MH 0.93 (0.73 to 1.19) Savage w13 MH 0.09 (0.01 to 0.70) 0.11 (0.02 to 0.81) Vassallo w14 MH 1.07 (0.25 to 4.65) 0.70 (0.15 to 3.20) Barry w15 MH 0.72 (0.50 to 1.02) 0.84 (0.56 to 1.25) 0.11 (0.01 to 0.91) Kilpack w16 MH 0.94 (0.72 to 1.21) Brandis w17 MH 0.93 (0.78 to 1.10) 0.36 (0.10 to 1.37) Oliver w18 MH 1.24 (1.07 to 1.45) Kerse w19 Multifaceted Care Home (MCH) 1.78 ( ) 1.29 (0.92 to 1.81) Rubenstein w20 MCH 0.91 (0.78 to 1.05) 0.97 (0.84 to 1.11) 1.44 (0.46 to 4,52) Becker w21 MCH 0.55 (0.35 to 0.84) 0.71 (0.43 to 1.17) 0.92 (0.13 to 2.73) Jensen w4 MCH 0.61 (0.40 to 0.93) 0.69 (0.42 to 1.12) 1.11 (0.12 to 9.91) ( 19) Jensen w4 MCH 1.05 (0.73 to 1.51) 0.88 (0.59 to 1.33) (< 19) Schnelle w23 MCH 0.62 (0.38 to 1.00) 0.62 (0.37 to 1.06) 2.14 (0.39 to 11.70) Dyer w1 MCH 0.54 (0.42 to 0.70) 1.01 (0.73 to 1.40) 0.99 (0.19 to 5.09) McMurdo w22 MCH 0.78 (0.49 to 1.25) 0.66 (0.38 to 1.16) 0.26 (0.02 to 3.07) Shaw w2 MCH 0.92 (0.81 to 1.05) 0.55 (0.21 to 1.48) Kannus w24 Hip Protectors, Single Intervention, 0.46 (0.16 to 1.32) Care Home (HP) O Halloran w25 HP 1.05 (0.74 to 1.49) Cameron w26 HP 1.02 ( ) 1.17 (0.42 to 3.22) Jantti w27 HP 1.25 (1.01 to 1.54) 0.14 (0.02 to 1.16) Van Schoor w28 HP 0.75 (0.69 to 0.83) 1.00 (0.53 to 1.90) Lauritzen w29 HP 1.12 (0.60 to 2.10) 0.44 (0.16 to 1.17) Meyer w30 HP 0.66 (0.57 to 0.76) 0.91 (0.76 to 1.09) 0.49 (0.26 to 0.93) Woo w32 HP 0.w6 (0.06 to 1.19) Ekman w33 HP 0.81 (0.43 to 1.52) 0.34 (0.02 to 4.75) Villar w34 HP 3.17 (0.41 to 24.52) Chan w31 HP 1.47 (1.15 to 1.87) Tinetti w35 Physical Restraint Removal (PRR) 0.22 (0.19 to 0.26) 0.56 (0.47 to 0.66) 0.12 (0.04 to 0.31) Capezuti w36 PRR 1.20 (0.93 to 1.55) Capezuti w37 PRR 1.08 (0.14 to 8.34) Hanger w39 PRR (Bedrail) 1.16 (1.01 to 1.34)

10 Ejaz w38 PRR 0.79 (0.62 to 1.01) Kelly w40 Fall Alarm 0.09 (0.01 to 0.68) Donald w5 Exercise 0.54 (0.16 to 1.84) 0.6 (0.06 to 1.20) Mulrow w41 Exercise 1.32 (0.94 to 1.84) 1.16 (0.83 to 1.61) Donald w5 Environmental Change (1.89 to 6.50 (0.86 to 49.30) ) Bischoff w42 Vitamin D 0.44 (0.6 to 0.71) 0.75 (0.41 to 1.37) Chapuy w43 Calcium and Vitamin D 0.66 (0.50 to 0.86) Haumschild w44 Medication Review and Withdrawal 0.53 (0.30 to 0.95)