Meeting the challenge of falls prevention at the population level: a community-based intervention with older people in Australia

Older people form a large and growing segment of our population,experience disproportionately more illness and require moreuse of health services than any other group. This differentialis largely due to falls, which are the leading cause of injuryfor those aged 65 plus. The North Coast ‘Stay On YourFeet’ programme is a 4-year multi-strategic, community-basedintervention to address this problem among 80000 older residents.This paper presents key results of the first 18 months of theprogramme. It demonstrates potential achievements of this typeof intervention and examines some barriers. Programme effectwas measured quasi-experimentally by monitoring indicators ofawareness, knowledge, attitudes and risk factors via a telephonesurvey with random cohorts in intervention and control areas.After allowing for baseline covariates, the intervention wassignificantly associated with: raised awareness both of theproblem of falling and its preventability; improved knowledgeof the risk factors for falling; and a higher self-rated riskof falling. As expected, there is as yet no population changein falls rate. Initial changes shown in risk factors for fallingraise interesting challenges. A reduction in physical activitymay indicate that older people, now more aware of risk, arebeing advised to restrict their activities. An increase in proportionof older people taking medications which may cause unsteadinessalso presents a challenge. However, a concomitant decrease inreported dizziness may indicate that medications are now bettermanaged. This evaluation shows that in 18 months, a well-fundedand managed community-based falls prevention programme can achievechanges in awareness, knowledge and attitudes but that continuedintervention is required to substantially change behaviouralrisk factor profiles and the likelihood of an older person falling.