Background: Inpatient falls in the elderly are costly health care complications. Multifactorial falls interventions appear to be the most effective in preventing falls, however the majority of studies on multifactorial falls interventions have been conducted in residential aged care settings and rehabilitation units. Aim: To evaluate the effectiveness of multifactorial falls interventions for people over 65 years, in the acute hospital setting. Methods: A systematic search of literature in four electronic databases, published in the English language from 2015 to 2020 was conducted. Whittemore and Knafl's framework guided the review. Findings: The initial search identified 244 papers, nine met the inclusion criteria. Three themes associated with multifactorial falls interventions for people over 65 years in the acute hospital setting emerged from the analysis; (i) Information and education, (ii) Nursing team leadership and the falls team, and (iii) Framework for change. Discussion: Multifactorial falls interventions are effective in the acute hospital setting, particularly those that include a whole team approach, and are supported by strong nurse leadership at executive and ward level. Conclusion: Several gaps were identified in the literature that may inform future practice, education and research. First, collaboration and co-design with the patient and bedside nurse in the planning, development, and evaluation of falls prevention projects was identified as an important omission. Second, individualised care for the cognitively impaired patient should be the focus of future research.