Falls often have severe financial and environmental consequences, not only for those who fall, but also for their families and society at large. Identifying fall risk in older adults can be of great use in preventing or reducing falls and fall risk, and preventative measures that are then introduced can help reduce the incidence and severity of falls in older adults. The overall aim of our systematic review was to provide an analysis of existing mechanisms and measures for evaluating fall risk in older adults. The 43 included FRATs produced a total of 493 FRAT items which, when linked to the ICF, resulted in a total of 952 ICF codes. The ICF domain with the most used codes was body function, with 381 of the 952 codes used (40%), followed by activities and participation with 273 codes (28%), body structure with 238 codes (25%) and, lastly, environmental and personal factors with only 60 codes (7%). This review highlights the fact that current FRATs focus on the body, neglecting environmental and personal factors and, to a lesser extent, activities and participation. This over-reliance on the body as the point of failure in fall risk assessment clearly highlights the need for gathering qualitative data, such as from focus group discussions with older adults, to capture the perspectives and views of the older adults themselves about the factors that increase their risk of falling and comparing these perspectives to the data gathered from published FRATs as described in this review.

Falls are common events with serious consequences for older people. With an ageing population and increasing health-care costs, information and communication technologies (ICT) will have a potential role in future health-care delivery. However, research on technology acceptance in health care for older people is limited and its application to falls prevention is unknown. The aims of this study were to explore and describe the perceptions of community-dwelling Australian and Irish older people about their current use of technology, and the potential use of technology for falls prevention. Qualitative data were collected from three focus groups conducted in and around Limerick in Ireland, and three in the Sydney area, Australia. A total of 35 older people participated. Data were analysed using thematic analysis. Four themes emerged from the data: (a) perceptions of vulnerability to falls, (b) preferences for exercise interventions, (c) participation in and ownership of technology, and (d) perceptions about applications of technology for falls prevention. As the use of technology is an instrumental activity of daily living, health professionals need to assess the capacity of older people to adopt these technologies, and provide falls prevention interventions to accommodate the technology skills of older people. Some participants were reluctant to embrace technology and barriers to the effective use of technology to assist in preventing falls may conflict with future health service trends.

Falls prevention strategies can only be effective in reducing falls amongst older people if they are adopted and enacted in their daily lives. There is limited evidence identifying what older people in residential aged care (RAC) homes understand about falls and falls prevention, or what may limit or enable their adoption of strategies. This study was conducted in two countries and explored older people's knowledge and awareness of falls and their preferences, opportunities and motivation to undertake falls prevention strategies. A cross-sectional survey was administered to participants (N = 70) aged 65 years and over, living in six RAC homes in Perth, Australia and six RAC homes in Swansea, Wales, United Kingdom. Participants had limited knowledge about intrinsic falls risk factors and strategies to address these and frequently expressed self-blame regarding falling. Almost all (N = 67, 95.7%) participants felt highly motivated to maintain their current functional mobility and independence in everyday tasks. Key preferences for receiving falls prevention messages favoured a positive approach promoting wellness and independence (N = 41, 58.6%) via pictorial posters or brochures (N = 37, 52.9%) and small group discussions preferably with demonstrations (N = 18, 25.7%). Findings from this study may assist organisations and staff to more effectively engage with older people living in RAC about falls prevention and design targeted resources to address the motivations and preferences of this population.

Women experience a rapid rise in the incidence of wrist fracture after age 50. Accordingly, this study aimed to (1) determine the internal and environmental fall-related circumstances resulting in a wrist fracture, and (2) examine the relationship of functional status to these circumstances. Women aged 50 to 94 years reported on the nature of the injury (n = 99) and underwent testing for physical activity status, balance, strength, and mobility (n = 72). The majority of falls causing wrist fracture occurred outdoors, during winter months, as a result of a slip or trip while walking. Half of these falls resulted in other injuries including head, neck, and spine injuries. Faster walking speed, lower grip strength, and higher balance confidence were significantly associated with outdoor versus indoor falls and slips and trips versus other causes. This study provides insights into potential screening and preventive measures for fall-related wrist fractures in women.

Translation of falls prevention evidence into practice is problematic. Understanding older adults’ views about falls prevention information could enhance delivery of falls prevention, resulting in better engagement and uptake of recommended activities. The aim of this study was to examine the views and preferences of community-dwelling older adults about seeking and receiving falls prevention information. A community forum using a modified World Café approach was conducted. Participants discussed five topic areas in small groups, under the guidance of table facilitators. Perspectives were captured on paper. Thematic analysis was conducted to identify factors that influence participants’ engagement and uptake of information. Seventy-three older adults participated in the forum covering wide-ranging preferences around falls prevention information. Personal experience was considered the key influence on an older adult's decision to initiate seeking information. While health professionals were often approached, alternative sources such as public libraries, peer educators and seniors’ organisations were also favoured as credible sources of information. Older adults proposed falls prevention information should be delivered with a positive tone, coupled with highly valued qualities of respect, empathy and time to listen to foster motivation to engage in recommended activities. Consumer-focused practical strategies were proposed to potentially improve future design, communication and dissemination of falls prevention information. This improvement could enhance engagement of messages and subsequent uptake of falls prevention recommended strategies.

Fear of falling (FoF) is a common condition in older age. However, there is a paucity of research on its prevalence, impact and treatment in older people with dementia. People with dementia have an increased risk of falls which present a significant threat to their independence, as well as having a significant economic impact on health and social services. This review outlines the key issues in relation to FoF, current guidelines and assessment tools and their use for people with dementia. Further research needs to be completed in both addressing the specific assessment barriers that people with dementia may face regarding the use of current FoF tools, with further exploration surrounding the individual's experience of FoF and how this may be impacting upon their quality of life and functionality. Until a well-validated method has been developed, clinicians need to utilize available tools as guidelines, seek the assistance of proxies at all stages of the care journey, and use clinical judgement to assess FoF in patients with dementia.

Parkinson's disease (PD) is a common and costly condition affecting a predominantly older population. Physical rehabilitation has been shown to enhance motor performance and functional mobility in the short-term. However, there is limited information available about how best to design and deliver an ambulatory rehabilitation (AR) programme for this patient group. This article reviews the current evidence, aiming to provide guidance about best-practice service provision. We highlight the benefits of group therapy and techniques aimed at reducing falls. Further research is required to determine the optimal dose and intensity of AR necessary to provide sustained benefits in people with different stages of PD.

Objectives: The aim of this study was to assess whether a multicomponent cognitive behavioral group intervention is preferable to usual care in terms of (healthcare) costs and effects on fear of falling and activity avoidance.

Methods: This economic evaluation was embedded in a randomized controlled trial among 540 community-living adults in the Netherlands, aged 70 years and older who reported fear of falling and fear-induced activity avoidance. The participants allocated to the intervention group received a multicomponent cognitive behavioral group intervention consisting of eight weekly sessions and a booster session. The sessions were aimed at instilling realistic views of falls, reducing fall risk, and increasing activity and safe behavior. Participants in the control group received usual care. Cost outcome measures were healthcare costs, and patient and family costs. Clinical outcomes were fear of falling and activity avoidance. All outcomes were assessed at baseline and at 2, 8, and 14 months by means of registration forms, self-administered questionnaires, and interviews by telephone.

Results: Participants were randomly allocated to intervention (n = 280) and control groups (n = 260). Costs for the intervention program were on average €276 per person. Total costs per person were comparable (€4,925 in intervention group and €4,828 in control group). Furthermore, favorable effects of the program were observed for fear of falling and activity avoidance.

Conclusions: This study showed that the intervention program is preferable to usual care in terms of costs and effects. The program had comparable costs and significantly reduced fear of falling and associated activity avoidance among older community-living persons.

Falls and fall-related injury are common and become more prevalent with increasing age. Risk factors for falling are numerous, synergistic and complex, and require multidisciplinary assessment. The evidence base for intervention strategies continues to improve, but is often limited by the methodological difficulties that are inherent in falls research. The most effective intervention is a multifactorial approach that targets identified risk factors. Multicomponent exercise, either in a group or individually, is one of the most effective components of intervention. Other successful components include home hazard modification and psychotropic medication withdrawal. Primary prevention does not appear to be cost effective, but secondary prevention far outweighs the cost of falls and fall-related injury.

Background: Globally, falls in older people are a leading cause of injury-related mortality and morbidity. Cognitive impairment is a well-known risk factor for falls in this population group. While there is now a large body of evidence to support effective interventions for falls reduction across care settings, very little is known about interventions in the vulnerable, but increasing population of cognitively impaired community-dwelling older people. Therefore, the purpose of this systematic review is to investigate interventions designed to reduce falls in community-dwelling, cognitively impaired older adults.

Methods: A literature search of databases was conducted to identify original research published in English, which met predefined inclusion and exclusion criteria for effective (non-pharmacological) falls prevention interventions in cognitively impaired community-dwelling people over 65 years of age. Data from the selected papers were extracted into data extraction tables and analyzed according to study characteristics, measures, results, and quality.

Results: The review identified 11 studies providing data from 1,928 participants. Interventions included exercise, health assessment and management of risk, multi-component and cognitive behavioral programs, and hip protectors as falls risk reduction strategies. Seven of the selected studies showed an intervention effect in decreasing falls risk; however, only two of these showed a significant improvement in physical performance measures specifically in a cognitively impaired group.

Conclusions: The diversity of interventions, study designs, populations, and quality of the studies, which met inclusion criteria, resulted in conflicting evidence and inconclusive results for falls prevention interventions in this highly complex population.

Background: Cognitively impaired older people fall twice as often as their cognitively intact counterparts. There is, however, limited information on factors that increase the risk of falls in this population. This study aimed to determine whether a group of cognitively impaired older people (CIG) perform worse than a matched group of cognitively intact older people (NCIG) on a profile of physical performance and mobility tests.

Methods: One hundred and thirty-eight cognitively impaired and 276 age and gender matched cognitively intact community-dwelling older adults (>60 years) took part in the study. Participants completed a detailed physical performance battery from which composite fall risk scores were derived. Falls were measured prospectively for 12 months with monthly falls diaries, telephone calls, and by regularly contacting participants’ “person responsible.”

Results: The CIG performed worse than the NCIG in tests of reaction time, muscle strength (grip and quadriceps), balance (sway on floor, sway on foam, controlled leaning balance and near tandem standing ability), and mobility (sit to stand, timed up and go (TUG) and steps required to turn 180 degrees). The CIG had significantly higher composite fall risk scores than the NCIG and fell significantly more during follow-up (Multiple falls (2+): CIG 43%; NCIG 21%).

Conclusions: Fall risk in the CIG was significantly increased due to multiple physical impairments. Physical profiles provide a means of quantifying the extent of impairment in older people with cognitive impairment and potential direction for targeting interventions for reducing fall risk.

Background: The feasibility, test-retest reliability, and accuracy of different fall recording methods have not been studied in older persons with dementia.

Methods: This was a prospective observational study, nested within a randomized controlled trial on motor training, in which 110 participants were monitored for falls over 12 months. Seven methods of fall recording were compared: face-to-face interviews; phone interviews: weekly for three months, monthly for 9 months, a final interview after 12 months; prospective calendar method; interviews with a proxy and the general practitioner (GP). Summing the count of falls and removing duplicate reporting of the same fall was found to provide the best approximation of the actual number of falls and was chosen as the criterion-standard.

Results: The combination of calendar method and phone interviews showed the highest accuracy (74% of falls, 93% of fallers). As a single measure, weekly phone calls were superior to calendars or proxy-report. Monthly phone calls recorded only half the falls that were picked up by weekly calls (p = 0.002) and were inferior to the calendars (p<0.001) and proxy-report (p = 0.015). GPs knew of only 14% of falls and 19% of fallers. In addition, 49% of subjects who documented a fall prospectively did not recall a fall after 12 months.

Conclusion: The combination of fall calendars with regular telephone interviews can be recommended for persons with mild to moderate stage dementia. If feasible, recall periods should be as short as one week; additional information by care-givers increases accuracy of reports. Retrospective recall of falling with long recall periods is not recommended.

The prevalence of falls and associated injuries increases with age and dependency. The highest occurs among individuals living in long-term care institutions. Preventing falls results in reduced physical and psychological morbidity as well as having cost-saving implications. This review explores both uni- and multifactorial approaches to reducing fall rates and risk in individuals in long-term care, as well as highlighting the differences in this group from community-dwelling individuals.

PubMed lists over 6,000 references (700 reviews) on unintentional falls in older adults. This article traces key methodological milestones in the application of epidemiologic methods since the earliest publications in the late 1940s. Within the context of advances in case definition, sampling, measurement, research design, and statistical analysis, the article reviews estimates of frequency of occurrence, risk factor associations, morbidity and mortality consequences, demonstration of the multiple risk factor theory of falls using fall prevention interventions, and the challenges of fall risk prediction models. Methodological explanations are provided for observed heterogeneities, and the case is presented for moving beyond undifferentiated lists of risk factors by focusing on balance and gait as the factors through which the mechanistic effects of distal risk factors can be understood. Moreover, the case is made to advance our statistical analyses by looking at interactions among intrinsic risk factors and between intrinsic, extrinsic, and environmental factors.