Background Falls in older adults cost Australia’s health systems over 2.4 billion each year and can have devastating personal consequences, with 140,000 older Australians hospitalised for a fall and 5000 Australians dying from a fall each year. There is strong evidence from over 250 randomised controlled trials to support fall prevention interventions including exercise for the general community and targeted multifactorial assessments for higher risk people. Australia’s Fall Prevention Guidelines have not been updated since 2009.

Objective We were commissioned by the Australian Commission for Safety and Quality in Health Care to update the Australian Fall Prevention Guidelines.

Methods We updated the Cochrane review (Cameron et al 2018) on fall prevention in care facilities and hospitals to inform guidance for these settings (without screening abstracts/trial records). We used Cochrane reviews (e.g., Sherrington et al 2019) and the World Falls Guidelines (Montero-Odasso M et al. Age Ageing. 2022) to inform guidance for community settings. We used a modified GRADE approach to assess the certainty of evidence and strength of recommendations.

Results For fall prevention in hospital we recommend tailored education, personalised multifactorial interventions after assessment, post-operative geriatric orthopaedic care after hip fracture and home safety interventions after discharge. For fall prevention in residential aged care settings we recommend personalised multifactorial interventions after assessment, tailored supervised exercise, menu assessment by dietitians, daily or weekly Vitamin D, bone protective medicines, and hip protectors. For fall prevention in community settings we recommend exercise for all, home safety interventions and personalised multifactorial interventions after assessment for higher risk people, and single interventions should be provided for older people at increased risk of falls with particular risk factors affecting vision, feet, cardiac function, Vitamin D levels and bone health.

Conclusion Implementation and scale-up of these evidence-based recommendations could help address Australia’s rising costs and consequences from falls but is not currently planned, a missed opportunity.