Psychosocial risk factors associated with falls among Chinese community‐dwelling older adults in Hong Kong

This study examined the relationship between psychosocial factors and falls among community‐dwelling older adults in the Hong Kong Special Administrative Region of China. The study included 1573 adults aged 60 or above who lived at home and who were applying for long‐term care services. These participants were part of a large cross‐sectional survey carried out between 2003 and 2004 in which they completed the Hong Kong Chinese version of the Resident Assessment Instrument‐Home Care (RAI‐HC) assessment. Of those persons who were surveyed, 516 (32.8%, 95% CI 30.5% to 35.2%) had fallen in the previous 90 days. Bivariate analyses showed that five psychosocial factors (depressive symptoms, fear of falling, a decline in social activities, the number of hours of informal care support during weekdays and living alone) were significantly associated with falls (P < 0.05). Logistic regression analysis showed living alone (odds ratio (OR) = 0.62; 95% CI 0.44 to 0.86) was the only psychosocial factor significantly associated with falls, after adjusting for the known significant factors related to falls. It was also found that more elders who lived with others had environmental hazards than those who lived alone (71.0% vs 29.0%, χ2 = 4.80, P = 0.028). These findings suggested that living with others may not be as safe as we assume. Interventions to increase awareness of home safety and to seek co‐operation with family members in falls prevention are recommended. Fall preventive strategies should be educated to family members who are living with frail older adults. On the other hand, Chinese older adults who live alone often receive support from relatives or friends. Social support seems to be crucial to prevent them from falls and this measure is recommended to be continued in the community.     

The causes of falls: views of older people with visual impairment

BackgroundSight impairment increases with age and, compared with the general older population, older people with sight impairment are more likely to fall. There is a growing body of evidence on the views and perceptions of older people about falls, but little is published on the views of older people with sight impairment.ObjectiveTo explore what older people with sight impairment believe to be the causes of falls.DesignA qualitative design was used, incorporating focus groups and interviews in which participants discussed falls and falls prevention. Framework analysis was employed to identify themes arising from participants'' discussions of the causes of falls.Setting and participantsFifty‐four community dwelling men and women with sight impairment, aged 65 and over, were recruited from across Greater Manchester, UK.ResultsFive types of factors were identified that were believed to cause falls: (i) health issues and changes in balance caused by ageing; (ii) cognitive and behavioural factors; (iii) the impact of sight impairment on getting around the home; (iv) the impact of sight impairment on negotiating the environment away from home; and (v) unexplained falls.Discussion and conclusionsOlder people with sight impairment reported many researched risk factors previously identified by older people without sight impairment but also described many perceived risks unique to people with sight impairment. There are few interventions to prevent falls aimed at older people with sight impairment, and the results of this study allow further tailoring of such interventions based on views of older people with sight impairment.     

Associations between falls and general health,nutrition, dental health and medication use in Swedish home‐dwelling people aged 75 years and over

The vast majority of elderly people in Sweden live in private homes in their communities for as long as possible. Poor health and a high risk of falls are very common among this group. This cross‐sectional study investigates the association between falls and general health, appetite, dental health, and the use of multiple medications among home‐dwelling men and women aged ≥75 years. Data were collected between October 2008 and March 2009 using a postal questionnaire. A total of 1243 people participated in the questionnaire survey (74% response rate), of which 1193 were included in the analysis. The majority of participants were women (n = 738, 62%). Falls in the previous 12‐month period were reported by 434 (36%) participants. Most fallers (n = 276, 64%) were women. The majority of the fallers lived in a flat (n = 250, 58%). Poor health (aOR: 1.61; CI: 1.34–1.95), poor dental health (aOR: 1.22; CI: 1.07–1.39) and the use of four or more types of medication daily (aOR: 1.13; CI: 1.03–1.25) were significantly associated with falls in all participants. Poor dental health was found irrespectively of living in a flat (aOR: 1.23; CI: 1.04–1.46) or living in a house (aOR: 1.28; CI: 1.02–1.61), and both were significantly associated with falls. The use of more than four different types of medication daily (aOR: 1.25; CI: 1.11–1.41) was associated with falls for those living in a flat. The results highlight that falls are associated with poor general health, poor dental health and the use of four or more types of medication daily. Health professionals should provide health promotion education and investigate dental health and risk factors for oral disease. Likewise, medical and clinical practices of physicians and community care nurses should include assessing the risk of falling, and treatment that predisposes falls.     

Low‐income homebound older adults receiving home‐delivered meals: Physical and mental health conditions,incidence of falls and hospitalisations

Significant differences in health across racial/ethnic and socioeconomic groups in the US signal increasing numbers of low‐income homebound older adults in a rapidly ageing society. The purpose of this study was to examine physical and psychiatric conditions and their association with incidence of self‐reported falls and hospitalisations among largely low‐income and racial/ethnic minority adults age 50+ (N = 2,224), clients from a home‐delivered meals programme in Central Texas. Data came from comprehensive, in‐home assessments done in 2017 by these older adults’ case managers. We used bivariate analyses to compare those with and without incidence of self‐reported past‐year falls and those with and without a hospitalisation episode with respect to their sociodemographic and clinical characteristics. We used multivariable logistic regression analysis to examine sociodemographic and clinical correlates of any incidence of falls and negative binomial regression analysis to examine these correlates of the number of hospitalisations in the preceding 12 months. The rates of chronic physical illnesses, including cardiovascular disease, diabetes, gastrointestinal disease, lung disease and renal failure, were extremely high. The 41% of reported falls among the study sample was also higher than the rate among US older adults in general. More diagnosed physical illnesses, depression, chewing/swallowing problems, chronic/severe pain, activities and instrumental activities of daily living (ADL/IADL) impairments and ambulation assistive device use were associated with greater odds of falling. The rate of past‐year hospitalisation was 26%, and more diagnosed physical illnesses, ADL/IADL impairments, ambulation assistive device use and any fall incidence were positively associated with the number of hospitalisations. These findings indicate the need for fall prevention programmes for frail homebound older adults as well as health and social care services that help older adults better manage physical/mental health problems and reduce preventable health crises and hospitalisations.     

Understanding help‐seeking in older people with urinary incontinence: an interview study

The prevalence of urinary incontinence (UI) increases with age and can negatively affect quality of life. However, relatively few older people with UI seek treatment. The aim of this study was to explore the views of older people with UI on the process of seeking help. Older people with UI were recruited to the study from three continence services in the north of England: a geriatrician‐led hospital outpatient clinic (n = 18), a community‐based nurse‐led service (n = 22) and a consultant gynaecologist‐led service specialising in surgical treatment (n = 10). Participants took part in semi‐structured interviews, which were transcribed and underwent thematic content analysis. Three main themes emerged: Being brushed aside, in which participants expressed the feeling that general practitioners did not prioritise or recognise their concerns; Putting up with it, in which participants delayed seeking help for their UI due to various reasons including embarrassment, the development of coping mechanisms, perceiving UI as a normal part of the ageing process, or being unaware that help was available; and Something has to be done, in which help‐seeking was prompted by the recognition that their UI was a serious problem, whether as a result of experiencing UI in public, the remark of a relative, the belief that they had a serious illness or the detection of UI during comprehensive geriatric assessment. Greater awareness that UI is a treatable condition and not a normal part of ageing is needed in the population and among health professionals. Comprehensive geriatric assessment appeared an important trigger for referral and treatment in our participants. Screening questions by healthcare professionals could be a means to identify, assess and treat older people with UI.     

Self‐directed community services for older Australians: a stepped capacity‐building approach

Consumer‐directed care (CDC) is increasingly widespread among aged care service options in Organisation for Economic Co‐operation and Development (OECD) countries. However, the evidence base regarding the programmatic and contextual factors that affect the outcome of CDC interventions is surprisingly small. This paper reports on a self‐directed care approach for older Australians with complex care needs. A multi‐methods longitudinal comparative cohort study was employed comprising 4 survey tools and 56 semi‐structured interviews. Participation rates were around 20%. A total of 185 (98 in the intervention and 87 in the control group) older people and carers were recruited at baseline. Eleven months later, 109 participants (59 in the intervention and 50 in the control group) completed the repeat measure. Attrition rates were around 40%. Data collection occurred between July 2010 and April 2012. The data suggest that intervention group participants were likely to be more satisfied with the way they were treated (P = 0.013), their care options (P = 0.014), the ‘say’ they had in their care (P < 0.001), the information they received regarding their care (P = 0.012), what they were achieving in life (P = 0.031), that the services changed their view on what could be achieved in life (P = 0.020) and with their standard of living (P = 0.008). The evaluation suggests that while only a very small segment of older people is interested in a voucher or cash option, a substantially larger group would like to have greater say over and more direct access to their care, without, however, assuming administrative and financial responsibilities. The paper concludes that a stepped capacity‐building approach to CDC may improve the acceptability of CDC to older people and generate synergies that improve older people's care outcomes.     

Perspectives of older adults regarding barriers and enablers to engaging in fall prevention activities after hospital discharge

Older adults recently discharged from hospital are at high risk of functional decline and falls. A tailored fall prevention education provided at hospital discharge aimed to improve the capacity of older adults to engage in falls prevention activities. What remains unknown are the factors affecting behaviour change after hospital discharge. This study identified the perceived barriers and enablers of older adults to engagement in fall prevention activities during the 6‐month period post‐discharge. An exploratory approach using interpretative phenomenological analysis focused on the lived experience of a purposive sample (n = 30) of participants. All were recruited as a part of an RCT (n = 390) that delivered a tailored fall prevention education program at three hospital rehabilitation wards in Perth, Australia. Data were collected at 6‐month post‐discharge using semi‐structured telephone surveys. Personal stories confirmed that some older adults have difficulty recovering functional ability after hospital discharge. Reduced physical capability, such as experiences of fatigue, chronic pain and feeling unsteady when walking were barriers for participants to safely return to their normal daily activities. Participants who received the tailored fall education program reported positive effects on knowledge and motivation to engage in fall prevention. Participants who had opportunities to access therapy or social supports described more positive experiences of recovery compared to individuals who persevered without assistance. A lack of physical and social support was associated with apprehension and fear toward adverse events such as falls, injuries, and hospital readmission. The lived experience of participants following hospital discharge strongly suggested that they required more supports from both healthcare professionals and caregivers to ensure that their needs were met. Further research that evaluates how to assist this population to engage in programs that will mitigate the high risk of falls and hospital readmissions is required.     

Driving forces for home‐based reablement; a qualitative study of older adults’ experiences

As a result of the ageing population worldwide, there has been a growing international interest in a new intervention termed ‘reablement’. Reablement is an early and time‐limited home‐based intervention with emphasis on intensive, goal‐oriented and interdisciplinary rehabilitation for older adults in need of rehabilitation or at risk of functional decline. The aim of this qualitative study was to describe how older adults experienced participation in reablement. Eight older adults participated in semi‐structured interviews. A qualitative content analysis was used as the analysis strategy. Four main themes emerged from the participants’ experiences of participating in reablement: ‘My willpower is needed’, ‘Being with my stuff and my people’, ‘The home‐trainers are essential’, and ‘Training is physical exercises, not everyday activities’. The first three themes in particular reflected the participants’ driving forces in the reablement process. Driving forces are intrinsic motivation in interaction with extrinsic motivation. Intrinsic motivation was based on the person's willpower and responsibility, and extrinsic motivation was expressed to be strengthened by being in one's home environment with ‘own’ people, as well as by the co‐operation with the reablement team. The reablement team encouraged and supported the older adults to regain confidence in performing everyday activities as well as participating in the society. Our findings have practical significance for politicians, healthcare providers and healthcare professionals by contributing to an understanding of how intrinsic and extrinsic motivation influence reablement. Some persons need apparently more extrinsic motivational support also after the time‐limited reablement period is completed. The municipal health and care services need to consider individualised follow‐up programmes after the intensive reablement period in order to maintain the achieved skills to perform everyday activities and participate in society.     

Older people's views of advice about falls prevention: a qualitative study

The aim of this study was to gain an understanding of older people's perceptions of falls prevention advice, and how best to design communications that will encourage older people to take action to prevent falls. Focus groups and interviews were carried out with 66 people aged 61-94 years recruited from a variety of settings, using falls prevention messages to stimulate discussion. Thematic analysis revealed that participants interpreted 'falls prevention' principally as meaning hazard reduction, use of aids and restriction of activity. Only one participant was aware that falls risk could be reduced by carrying out exercises to improve strength and balance. Falls prevention advice was typically regarded as useful in principle but not personally relevant or appropriate. Advice about falling was often depicted as common sense, only necessary for older or more disabled individuals, and potentially patronizing and distressing. Our findings suggest that older people do not reject falls prevention advice because of ignorance of their risk of falling, but because they see it as a potential threat to their identity and autonomy. Messages that focus on the positive benefits of improving balance may be more acceptable and effective than advice on falls prevention.     

Men's perspectives on fall risk and fall prevention following participation in a group‐based programme conducted at Men's Sheds,Australia

Research on older men's views regarding fall prevention is limited. The purpose of this qualitative study was to explore the experiences and perspectives of older men regarding fall risk and prevention so that fall prevention programmes can better engage older men. Eleven men who had taken part in a group‐based fall prevention programme called Stepping On conducted at Men's Sheds in Sydney, Australia, participated in semi‐structured interviews during June and July 2015 which were audio‐recorded and transcribed. Data were coded and analysed using constant comparative methods. Over‐arching theoretical categories were developed into a conceptual framework linking programme context and content with effects of programme participation on men. Men's Sheds facilitated participation in the programme by being inclusive, male‐friendly places, where Stepping On was programmed into regular activities and was conducted in an enjoyable, supportive atmosphere. Programme content challenged participants to think differently about themselves and their personal fall risk, and provided practical options to address fall risk. Two major themes were identified: adjusting the mindset where men adopted a more cautious mindset paying greater attention to potential fall risks, being careful, concentrating and slowing down; and changing the ways where men acted purposefully on environmental hazards at home and incorporated fall prevention exercises into their routine schedules. Practitioners can engage and support older men to address falls by better understanding men's perspectives on personal fall risk and motivations for action.     

Risk factors,incidence, consequences and prevention strategies for falls and fall‐injury within older indigenous populations: a systematic review

Objective : To examine the risk factors, incidence, consequences and existing prevention strategies for falls and fall‐related injury in older indigenous people. Methods : Relevant literature was identified through searching 14 electronic databases, a range of institutional websites, online search engines and government databases, using search terms pertaining to indigenous status, injury and ageing. Results : Thirteen studies from Australia, the United States, Central America and Canada were identified. Few studies reported on fall rates but two reported that around 30% of indigenous people aged 45 years and above experienced at least one fall during the past year. The most common hospitalised fall injuries among older indigenous people were hip fracture and head injury. Risk factors significantly associated with falls within indigenous populations included poor mobility, a history of stroke, epilepsy, head injury, poor hearing and urinary incontinence. No formally evaluated, indigenous‐specific fall prevention interventions were identified. Conclusion : Falls are a significant and growing health issue for older indigenous people worldwide that can lead to severe health consequences and even death. No fully‐evaluated, indigenous‐specific fall prevention programs were identified. Implications for Public Health : Research into fall patterns and fall‐related injury among indigenous people is necessary for the development of appropriate fall prevention interventions.     

Thoughts on effective falls prevention intervention on a population basis

The prevention of accidental injury associated with falls in older people is a public health target in many countries. Older people make up a large and increasing percentage of the population. As people grow older, they are at increasing risk of falling and suffering injury from falling. Falls are not an inevitable result of ageing, but they are the most serious and frequent home accident among older people. Falls are a major reason for admission to hospital and residential care setting, even when no serious injury has occurred. Falls are therefore costly for society as well as causing considerable suffering, morbidity and mortality. Unless concerted action is taken, the number of falls and injuries is likely to increase even further over the next 25–30 years. A number of strategies and interventions targeted at individuals has been shown to work, but population-based strategies have not been well evaluated. Review of the literature confirms that fall prevention programmes can be effective in reducing the numbers of older people who fall and the rate at which people fall. Targeted strategies aimed at behaviour change and risk modification for those living in the community appear to be most promising. Multidisciplinary multi-factorial intervention programmes that include risk-factor assessment, screening, and appropriate intervention have been shown to be effective. New integrated falls services will help to provide both effective interventions and long-term support to regain mobility, independence and confidence. Health and social care statutory agencies need to work together to prioritise fall prevention as part of their overall strategy for promoting healthy ageing. Coherent multi-disciplinary programmes can be developed at the national level, but these should be implemented with national data collection mechanisms to evaluate interventions. The evidence is still scant for wider population-based approaches to falls prevention. This paper will consider some of the evidence on effectiveness of falls interventions delivered on a population basis.     

Community care staff attitudes towards delivering a falls prevention exercise intervention to community care clients

Millions of older people world-wide receive community care services in their home to assist them to live independently. These services often include personal care, domestic assistance and social support which are delivered by non-university trained staff, and are frequently long term. Older people receiving community care services fall 50% more often than individuals of similar age not receiving services. Yet, few ongoing community care services include exercise programs to reduce falls in this population. We conducted an earlier study to examine the feasibility of community care staff delivering a falls prevention program. A critical finding was that while some of the assessment and support staff responsible for service delivery delivered the falls prevention exercise program to one or two clients, others delivered to none. Therefore, the aim of this qualitative sub-study was to understand reasons for this variation. Semi-structured interviews were conducted with 25 participating support staff and assessors from 10 community care organisations. Staff who had successfully delivered the intervention to their clients perceived themselves as capable and that it would benefit their clients. Older clients who were positive, motivated and wanted to improve were perceived to be more likely to participate. Staff who had worked at their organisation for at least 5 years were also more likely to deliver the program compared to those that had only worked up to 2 years. Staff that did not deliver the intervention to anyone were more risk averse, did not feel confident enough to deliver the program and perceived their clients as not suitable due to age and frailty. Experienced staff who are confident and have positive ageing attitudes are most likely to deliver falls prevention programs in a home care organisation.     

A sustainable programme to prevent falls and near falls in community dwelling older people: results of a randomised trial

STUDY OBJECTIVE: In the causative mechanism of falls among older community dwellers, slips and trips have been found to be significant precursors. The purpose of the two year trial was to assess the effectiveness of multi-component interventions targeting major risk factors for falls in reducing the incidence of slips, trips and falls among the well, older community. DESIGN: Four groups with approximately equal numbers of participants were randomly allocated to interventions. The prevention strategies included education and awareness raising of falls risk factors, exercise sessions to improve strength and balance, home safety advice to modify environmental hazards, and medical assessment to optimise health. The interventions combined the strategies in an add on approach. The first intervention group receiving the information session only was regarded as the control. The outcome of interest was the occurrence of a slip, trip or fall, monitored prospectively using a daily calendar diary. PARTICIPANTS AND SETTING: Two hundred and fifty two members of the National Seniors Association in the Brisbane district agreed to participate. National Seniors clubs provide a forum for active, community dwelling Australians aged 50 and over to participate in policy, personal development and recreation. MAIN RESULTS: Using Cox's proportional hazards regression model, adjusted hazard ratios comparing intervention groups with the control ranged from 0.35 (95% CI 0.17, 0.73) to 0.48 (0.25, 0.91) for slips; 0.29 (0.16, 0.51) to 0.45 (0.27, 0.74) for trips; and 0.60 (0.36, 1.01) to 0.82 (0.51, 1.31) for falls. While calendar monitoring recorded outcome, it was also assessed as a prevention strategy by comparing the intervention groups with a hypothetical nonintervened group. At one year after intervention, reductions in the probability of slips, trips and falls (61 (95% CI 54, 66)%; 56 (49, 63)%; 29 (22, 36)% respectively) were demonstrated. CONCLUSIONS: This study makes an important contribution to the priority community health issue of falls prevention by showing that effective, sustainable, low cost programmes can be introduced through community-based organisations to reduce the incidence of slips, trips and falls in well older people.     

The cost-effectiveness of falls prevention interventions for older community-dwelling Australians

Objective: To evaluate the cost‐effectiveness of strategies designed to prevent falls among older people. Methods: A decision analytic Markov model of interventions designed to prevent falls was developed. Incremental cost‐effectiveness ratios (ICERs) using quality adjusted life year (QALYs) as the measure, were calculated for those interventions aimed at the general population (home exercise, group exercise, tai chi, multiple and multi‐factorial interventions); high‐risk populations (group exercise, home hazard assessment/modification and multi‐factorial interventions); and specific populations (cardiac pacing, expedited cataract surgery and psychotropic medication withdrawal). Uncertainty was explored using univariate and probabilistic sensitivity analysis. Conclusion: In the general population, compared with no intervention the ICERs were tai chi ($44,205), group‐based exercise ($70,834), multiple interventions ($72,306), home exercise ($93,432), multifactorial interventions with only referral ($125,868) and multifactorial interventions with an active component ($165,841). The interventions were ranked by cost in order to exclude dominated interventions (more costly, less effective) and extendedly dominated interventions (where an intervention is more costly and less effective than a combination of two other interventions). Tai chi remained the only cost‐effective intervention for the general population. Implications: Interventions designed to prevent falls in older adults living in the community can be cost‐effective. However, there is uncertainty around some of the model parameters which require further investigation.     

Self‐reported health,healthcare service use and health‐related needs: A comparison of older and younger homeless people

The number of older homeless people with a limited life expectancy is increasing. European studies on their health‐related characteristics are lacking. This study compared self‐reported health, healthcare service use and health‐related needs of older and younger homeless people in the Netherlands. It is part of a cohort study that followed 513 homeless people in the four major Dutch cities for a period of 2.5 years, starting from the moment they registered at the social relief system in 2011. Using cross‐sectional data from 378 participants who completed 2.5‐year follow‐up, we analysed differences in self‐reported health, healthcare service use, and health‐related needs between homeless adults aged ≥50 years (N = 97) and <50 years (N = 281) by means of logistic regression. Results show that statistically significantly more older than younger homeless people reported cardiovascular diseases (23.7% versus 10.3%), visual problems (26.8% versus 14.6%), limited social support from family (33.0% versus 19.6%) and friends or acquaintances (27.8% versus 14.6%), and medical hospital care use in the past year (50.5% versus 34.5%). Older homeless people statistically significantly less often reported cannabis (12.4% versus 45.2%) and excessive alcohol (16.5% versus 27.0%) use in the past month and dental (20.6% versus 46.6%) and mental (16.5% versus 25.6%) healthcare use in the past year. In both age groups, few people reported unmet health‐related needs. In conclusion, compared to younger homeless adults, older homeless adults report fewer substance use problems, but a similar number of dental and mental problems, and more physical and social problems. The multiple health problems experienced by both age groups are not always expressed as needs or addressed by healthcare services. Older homeless people seem to use more medical hospital care and less non‐acute, preventive healthcare than younger homeless people. This vulnerable group might benefit from shelter‐based or community outreach programmes that proactively provide multidisciplinary healthcare services.     

First Nation Elders’ perspectives on healthy ageing in NSW,Australia

Objectives : Healthy ageing has been unattainable for many of Australia’s First Nation people, driven by an earlier onset of chronic disease when compared to the general Australian population. Our objective was to examine the perspectives of Australian First Nation people about healthy ageing. Methods : We used a conversational method to gather knowledge from older First Nation people from established communities in New South Wales, Australia. Discussions were audio recorded and transcribed and analysed using an Indigenous research standpoint methodology. Eight yarning circles were held in six locations with 76 participants aged 45 years and over. Results : Key issues around healthy ageing were identified; particularly, what the impact of chronic disease means to individuals. Study participants reported that healthy ageing is essential to continue to share knowledge of their history and culture. Conclusion : This article highlights the need for culturally appropriate healthy ageing programs addressing issues related to chronic disease among First Nation communities. Implications for public health : Research into what constitutes healthy ageing for older First Nation people is necessary for the development of culturally appropriate chronic disease interventions.     

Community Peer-Led Falls Prevention Presentations: What Do the Experts Suggest?

Falls among older adults are a major problem. Despite considerable progress in falls prevention research, older adults often show low motivation to engage in recommended preventive strategies. Peer-led falls prevention education for older adults may have potential for bridging the research evidence-practice gap, thereby promoting the uptake of falls prevention strategies. We evaluated peer educators’ presentations of falls prevention education to community-dwelling older adults in regard to established criteria that were consistent with adult learning principles, the framework of health behaviour change, falls prevention guidelines, and recommendations for providing falls prevention information. We conducted a within-stage mixed model study using purposive and snowball sampling techniques to recruit 10 experts to evaluate video recordings of the delivery of three peer-led falls prevention presentations. Each expert viewed three videos and rated them using a questionnaire containing both open-ended and closed items. There was a good level of expert agreement across the questionnaire domains. Though the experts rated some aspects of the presentations highly, they thought that the presentations were mainly didactic in delivery, not consistently personally relevant to the older adult audience, and did not encourage older adults to engage in the preventive strategies that were presented. Based on the experts’ findings, we developed five key themes and recommendations for the effective delivery of peer-led falls prevention presentations. These included recommending that peer educators share falls prevention messages in a more interactive and experiential manner and that uptake of strategies should be facilitated by encouraging the older adults to develop a personalised action plan. Findings suggest that if peer-led falls prevention presentations capitalise on older adults’ capability, opportunity, and motivation, the older adults may be more receptive to take up falls prevention messages.     

Young people's perspectives on the use of reverse discourse in web-based sexual-health interventions

Web-based sexual-health promotion efforts often utilise reverse discourse – the acknowledgement and rejection of shame associated with stigmatised terms – both to challenge judgments about ‘risky’ behaviours (e.g., casual sex) and to appeal to young people. This study examines the use of reverse discourse in Internet-based sexual-health promotion and analyses young people's perspectives on this approach. During in-depth interviews and focus groups with young people (aged 15–24), participants shared their perspectives on written (e.g., clinical language; colloquial language) and visual (e.g., generic, stock images; sexualised images) depictions of sexual-health topics on the websites. More explicit styles elicited negative responses from young people in terms of perceived appeal, trust and quality of websites. Negative social mores were associated with some of the more explicit portrayals of young people's sexual lives on the websites, revealing how reverse discourse re-stigmatises young people by re-emphasising young people's sexual activity as inherently risky or immoral. Reverse discourse was perceived to have negative effects on the saliency and credibility of online sexual-health information. We discuss the theoretical basis for the operationalisation of reverse discourse in this context, and discuss the importance of considering sociotechnical aspects of Internet-based sexual-health interventions.