Which interventions are most effective at preventing falls in the elderly?Systematic review with meta-analysis.Forty trials met inclusion criteria. Four types of intervention to prevent falls were identified. Risks most commonly assessed in multifactorial programmes were drugs, vision, orthostatic blood pressure and environmental hazards. Multifactorial risk assessment and management programmes significantly reduced the risk of falling and the monthly rate of falling compared with usual care (risk of falling: adjusted risk ratio 0.82, 95% CI 0.72 to 0.94; monthly rate of falling: adjusted incidence rate ratio 0.63, 95% CI 0.49 to 0.83). Exercise significantly reduced the risk of falling, but not the monthly rate of falling (risk of falling: adjusted risk ratio 0.86, 95% CI 0.75 to 0.99; monthly rate of falling: adjusted incidence rate ratio 0.86, 95% CI 0.73 to 1.01). Removing environmental hazards and education had no significant effect on the risk of falling or the monthly rate of falling.Multifactorial risk assessment and management significantly reduce the risk of falls and the number of falls per month in the elderly. Exercise can also reduce the risk of falling in the elderly.