Background <p>This study evaluated the effectiveness of a Falls Reduction for Elderly Emergency Department (FREED) intervention in reducing recurrent falls among older adults presenting to the emergency department (ED) after a fall at 6 months.</p> Methods <p>This randomized controlled trial conducted in an ED in Bangkok, Thailand, included patients aged ≥ 60 years who had experienced a fall in the previous 7 days. The patients were randomized to receive the FREED intervention or usual care, including a systematic fall risk assessment, medication review, vitamin D supplementation, physical therapy referrals, and home environment assessment. The primary outcomes analysis included the intention-to-treat (ITT) and per-protocol (PP) analyses.</p> Results <p>After excluding 1,026 ineligible individuals, 216 patients (median age: 75 [interquartile range: 69–81] years were enrolled, 108 in the FREED intervention and 108 in the usual care arm. Six-month follow-up data were available for 97% of the participants. The intergroup difference in repeated falls (primary result) was not significant (intervention group: 20.4%, control group: 25.0%; the observed absolute risk reduction of 4.6% was not statistically significant (95% confidence interval: -15.8% to 6.5%, <i>p</i> = 0.42). At 6 months, activities of daily living (ADL) scores decreased very slightly in both groups, with no between-group differences.</p> Conclusion <p>The FREED intervention was feasible and acceptable among older ED patients who had fallen but did not significantly reduce repeated falls at 6 months. Fall prevention in the ED can be challenging, and multicenter studies with longer follow-up periods are required to further explore the impact of ED-initiated fall prevention interventions.</p> Clinical trial number <p>TCTR20180522002.</p> Trial registration <p>The trial was registered in the Thai Clinical Trial Register on 22 May 2018.</p>