Effectiveness of Home Hazard Assessment and Environmental Modification on Fall-Related Outcomes in Older Adults: A Systematic Review and Meta-analysis

Falls are a major public and environmental health concern among older adults, frequently associated with hazardous home environments, thereby undermining the achievement of SDG 3 by increasing morbidity, injuries, and healthcare burden. Although home hazard assessment and environmental modification are widely recommended for fall prevention and creating age-friendly homes, evidence regarding their effectiveness remains inconsistent. This systematic review and meta-analysis aimed to evaluate the effects of home hazard assessment and environmental modification on fall-related outcomes among community-dwelling older adults. A systematic search was conducted in five databases (Cochrane Library, PubMed, Scopus, ProQuest, and Web of Science) from July to August 2025. Randomised controlled trials involving adults aged more than 60 years were included. Outcomes assessed were fall incidence, fall-related injury events, and medically attended falls. Risk of bias was evaluated using the RoB 2 tool. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using fixed- and random-effects models as appropriate. Ten randomized controlled trials involving 3,191 participants were included. Home hazard assessment and modification significantly reduced fall incidence (OR = 0.69; 95% CI: 0.59–0.79) and medically attended fall events (OR = 0.59; 95% CI: 0.37–0.93). However, a modest increase in reported fall-related injury events was observed (OR = 1.19; 95% CI: 1.01–1.41), likely reflecting improved surveillance and reporting. Home hazard assessment and environmental modification effectively reduce falls and fall-related healthcare utilization among community-dwelling older adults and should be integrated into community-based fall prevention strategies and age-friendly housing policies.