Aims:
To examine how frailty has been considered and incorporated into the design, implementation and analysis of existing hospital-based falls prevention intervention trials through a secondary analysis of a Cochrane systematic review.
Methods:
A secondary analysis was conducted of randomised controlled trials included in the 2018 Cochrane systematic review “Interventions for preventing falls in older people in care facilities and hospitals’’ and its 2026 update of trials in hospital settings. Only trials conducted in hospital settings were included. Full-text screening was undertaken to identify studies that mentioned frailty using predefined keywords. Further data were extracted on the measurement of frailty, the assessment tools used, how frailty was incorporated into the intervention design, intervention tailoring to frailty level, and subgroup analyses of participants with frailty.
Results:
A total of 56 hospital-based falls prevention trials were included. Frailty was mentioned in 22 studies; however, only seven measured frailty using a validated assessment tool. Only two studies operationalised frailty in the intervention design. Several studies assessed physical function and/or mobility, but these measures were rarely framed within a frailty construct. No trials tailored falls prevention interventions according to frailty severity, and only few examined the differential effects of an intervention between participants with and without frailty.
Conclusions:
Despite strong evidence linking frailty to falls risk, frailty is inconsistently measured and rarely integrated into hospital-based falls prevention interventions. Future research should prioritise systematic frailty assessments and develop interventions tailored to frailty to enable more holistic and effective falls prevention in hospital settings.