Summary

Across the globe, falls among older people can have grave consequences for individuals and for the healthcare and aged-care systems more broadly. The synergy between intrinsic and situational risk factors adds complexity to the identification and management of falls, as does the public health response at primary, secondary, and tertiary levels of prevention. Falls among people age 65 years and over are recognized as a geriatric syndrome and as a marker of frailty, with increasing rates among those experiencing other chronic conditions, such as Parkinson’s disease, stroke, and dementia.

Prevention or management of falls requires a combination of strategies as single or multicomponent interventions. Multimodal exercise, combining balance and functional exercise, environmental adaptation, medication reduction and withdrawal, cataract surgery, single-lens glasses, vitamin D supplementation, management of foot problems and footwear, and cardiac pacing have a degree of evidence to support their implementation. Multicomponent programs, such as i-FOCIS and PDSAFE, have important benefits for specific population groups.

Importantly, over the past few decades, falls prevention has shifted from a biomedical approach to a holistic biopsychosocial model. This model aids promotion of a whole-of-community approach through building healthy public policy, creating supportive environments, and strengthening personal skills and community action. The biopsychosocial approach also focuses attention on understanding local contexts, ensuring that falls prevention interventional research can be adapted and fit-for-purpose for low-, middle- and high-income countries.

The uptake of falls prevention evidence into practice and policy still faces challenges and new frontiers. Supporting the adoption, implementation, and sustainability of interventions is complex at the individual level, the service provider level, and the healthcare system level. Practice-change frameworks and models are useful, such as those utilized in the Stopping Elderly Accidents, Deaths and Injuries (USA), iSOLVE (Australia), and STRIDE (USA) trials.

Falls prevention is complex, yet solutions can be relatively simple. Working together with older people, health professionals and community health leaders can champion ways of bringing falls prevention activities to scale. Research collaboration between stakeholders is a crucial mechanism for drawing together unique perspectives to address ongoing gaps and concerns.