Professional Documents
Culture Documents
Contents
Chapter I Magnitude of falls – A worldwide overview 1 1. Falls 1 2. Magnitude of falls worldwide 1 3.
Population ageing 3 4. Main risk factors for falls 4 5. Main protective factors 6 6. Costs of falls 6 7. References
7
Chapter II Active ageing: A Framework for the Global Strategy for the prevention of falls in older age 10 1. What is
'Active Ageing'? 10 2. References 12
Chapter III Determinants of Active Ageing as they relate to falls in older age 13 1. Cross-cutting
determinants: Culture and gender 13 2. Determinants related to health and social services 14 3. Behavioural
determinants 15 4. Determinants related to personal factors 16 5. Determinants related to the physical
environment 18 6. Determinants related to the social environment 18 7. Economic determinants 19 8.
References 19
Chapter IV Challenges for prevention of falls in older age 20 1. Changing behaviour to prevent falls 20 2.
References 25
Chapter V Examples of effective policies and interventions 26 1 Policy 26 2. Prevention 29 3. Practice –
Interventions 32 4. Concluding remarks 33 5. References 33
Chapter VI WHO falls prevention model within the Active Ageing framework 35 1. The need 35 2. The
foundation 37 3. Three pillars of the WHO Falls Prevention Model 39 4. The way forward 47
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Acknowledgements
This global report is the product of the conclusions reached and recommenda- tions made at the WHO Technical Meeting on
Falls Prevention in Older Age which took place in victoria, Canada in February 2007. The report includes international and
regional perspectives on falls prevention issues and strategies and is based on a series of background papers that were prepared
by worldwide recognized ex- perts. The papers are available at: http://www.who.int/ageing/projects/falls_pre-
vention_older_age/en/index.html
The report was developed by the Department of Ageing and Life Course (ALC) under the direction of Dr Alexandre Kalache and
the coordination of Dr Dongbo Fu who was closely assisted by Ms Sachiyo Yoshida. ALC would like to thank three institutions
for their financial and technical support: the Division of Aging and Seniors, Public Health Agency of Canada; the Department of
Healthy Children, Women and Seniors, British Columbia Ministry of Health and the British Columbia injury Prevention and
Research Unit.
The contribution and input of the following experts are gratefully acknowledged: Dr W. Al-Faisal (Syria), Ms Lynn Beattie
(U.S.A), Dr Hua Fu (China), Dr K. James (Jamaica), Dr S. Kalula (South Africa), Dr B. Krishnaswamy (india), Dr Nabil Kronfol
(Lebanon), Dr P. Marin (Chile), Dr ian Pike (Canada), Dr Debra J. Rose (U.S.A.), Dr vicky Scott (Canada), Dr Judy Stevens
(U.S.A), Prof. Chris Todd (the United Kingdom), Dr G. Usha ( india ) and Dr Wojtek J. Chodzko-Zajko (U.S.A.).
Editing, layout and printing of the report was managed by Mrs Carla Salas-Rojas (ALC).
WHO GLOBAL REPORT ON FALLS PREvENTiON iN OLDER AGE
3. Population ageing
"Population ageing is a triumph of human- ity but also a challenge to society" (34). Worldwide, the
number of persons over 60 years is growing faster than any other age group. The number of this age
group was estimated to be 688 million in 2006, projected to grow to almost two billions by 2050. By that
time, the population of older people will be much larger than that of children under the age of 14 years for
the first time in human history. Moreover, the oldest segment of population, aged 80 and over,
particularly prone to falls and its consequences is the fastest growing within older population expected to
represent 20% of the older population by 2050 (35).
Figure 2 illustrates the population pyramid in 2005 and 2025. It highlights the growing proportion of
older population in parallel
with a decreasing proportion of younger population. The triangular population pyra- mid of 2005 will be
replaced with a more cylinder-like structure in 2025.
a) impact of population ageing on falls.
Falls prevention is a challenge to popula- tion ageing. The numbers of falls increase in magnitude as the
numbers of older adults increase in many nations throughout the world. Falls exponentially increase with
age-related biological change, therefore a pronounced number of persons over the age of 80 years will
trigger substantial increase of falls and fall injury at an alarming rate. In fact, incidence of some fall
injuries, such as fractures and spinal cord injury, have mark- edly increased by 131% during the last three
decades (36). If preventive measures are not taken in immediate future, the numbers of injuries caused by
falls is projected to be 100% higher in the year 2030 (36).
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dimensions: This applies to many developing countries
biological, behavioural, envi- where currently
close to 70% of the elderly
ronmental and socioeconomic factors. population lives, and
where population ageing is occurring rapidly. “Unlike the developed world that became richer before
getting older, developing countries are getting older before becoming richer” (37). This is reflected in the
fact that health in
Figure 3 encapsulates the risk factors and the interaction of them on falls and fall- related injuries. As the
exposure to risk factors increases, the greater becomes the risk of falling and being injured.
older age is neglected in some developing countries. Falls prevention is one of the
a) Biological risk factors
issues that have not been given a sufficient attention. For instance, there is a lack of epidemiological data
in many regions of the developing world.
Biological factors embrace characteristics of individuals that are pertaining to the human body. For
instance, age, gender and race are non-modifiable biological factors. These are also associated with
changes due
4. Main risk factors for falls
to ageing such as the decline of physical, cognitive and affective capacities, and the
Falls occur as a result of a complex interac-
co-morbidity associated with chronic ill-
tion of risk factors. The main risk factors
nesses.
reflect the multitude of health determi- nants that directly or indirectly affect well-being. Those are
categorized into four
Figure 2. Global population pyramid in 2005 and 2025
Age group
80+
Males
Females
70-74
2025
60-64
2005
50-54
40-44
30-34
20-24
10-14
0-4
400000 300000 200000
100000 0
100000 200000
300000 400000 Population in thousands
Source : UN, 2004 (35)
WHO GLOBAL REPORT ON FALLS PREvENTiON iN OLDER AGE
Figure 3. Risk factor model for falls in older age
Behavioural risk factors
-Multiple medication use -Excess alcohol intake -Lack of excercise -Inappropriate footware
Environmental risk factors
-Poor building design
Falls and
Biological risk factors -Age, gender and race -Slippery floors and stairs -Looser rugs -Insufficient lighting -Cracked or uneven
sidewalks
The interaction of biological factors with behavioural and environmental risks increases the risk of
falling. For example, the loss of muscle strength leads to a loss of function and to a higher level of frailty,
which intensifies the risk of falling due to some environmental hazards (see Chapter 3 for further
information).
b) Behavioural risk factors
Behavioural risk factors include those concerning human actions, emotions or daily choices. They are
potentially modifi- able. For example, risky behaviour such as the intake of multiple medications, excess
alcohol use, and sedentary behaviour can be modified through strategic interventions for behavioural
change (see Chapter 3 and 4 for further information).
fall-related injuries
-Chronic illnesses (e. g. Parkinson, Arthritis, Osteoporosis) -Physical, cognitive and affective capacities decline
Socioeconomic risk factors -Low income and education levels -Inadequate housing -Lack of social interactions -Limited access
to health and social services -Lack of community resources
Gender
determinants Economic
Health and social services
determinants Social
Active Ageing
Behavioural determinants
Personal
environment Physical
determinants
Culture
Source: Active Ageing: A Policy Framework, WHO, 2002 (http://www.who.int/ageing/publications/active/en/index.html)
WHO GLOBAL REPORT ON FALLS PREvENTiON iN OLDER AGE
Figure 2. Maintaining functional capacity over the life course
Early life
Adult life
Older age Growth and
Maintaining highest
Maintaining independence development
possible level of function
andpreventing disability
in Range individuals
of function
Disability threshold*
Rehabilitation and ensuring the quality of life
Age
Source: Active Ageing: A Policy Framework, WHO, 2002
Source: Active Ageing: A Policy Framework, WHO, 2002
3. Behavioural determinants
a) Physical activity
Regular participation in moderate physical activity is integral to good health and maintain- ing
independence, contributing to lowering risk of falls and fall-related injuries.
Regular participation in moderate physi- cal activity is integral to good health and maintaining
independence. It prevents onset of multiple pathologies and func- tional capacity decline. Moderate physi-
cal activities and exercise also lowers risk of falls and fall-related injuries in older age through controlling
weight as well as contributing to healthy bones, muscles, and joints (4). Exercise can improve balance,
mobility and reaction time. It can increases bone mineral density of postmenopausal women and
individuals aged 70 years and over (5).
Moreover, it should be noticed that partici- pation in vigorous physical activities – for instance intensive
running in older age may increase the risk of falls. Promoting appropriate physical activities or exercises
to improve strength, balance, and flexibility is one of the most feasible and cost-effec- tive strategies to
prevent falls among older adults in the community. Activities such as outdoor walking or mall walking
indoors is the most feasible and accessible way of exercising that improves strength, balance and
flexibility leading to a reduction on the risk of falling. Other kind of effective physi- cal activities and
exercises are mentioned in Chapter 5.
b) Healthy eating
Eating a balanced diet rich in calcium may decrease the risk injuries resulting from falls in older people.
Eating a healthy balanced diet is central to healthy ageing. Adequate intake of protein, calcium, essential
vitamins and water are essential for optimum health. If deficien- cies do exist, it is reasonable to expect
that weakness, poor fall recovery and increase risk of injuries will ensure. Growing evi- dence supports
dietary calcium and vita- min D intake improves bone mass among persons with low bone density and
that it reduces the risk of osteoporosis and falling (6). No dairy and fish consumption were as- sociated
with a higher risk of falling. Older persons with low dietary intake of calcium and vitamin D may be at
risk for falls and therefore fractures resulting from them (7).
Use of excessive alcohol has been shown to be a risk factor of falls. Consumption of 14 or more drinks
per week is associated with an increased risk of falls in older adults (7).
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c) Use of medicines
Older people tend to take more drugs than younger people. Also as people age, they develop altered
mechanisms for absorbing and metabolizing drugs. If older persons don't take medications as directed by
health professionals, their risk of falling can be affected in several ways. Effects of uncon- trolled medical
conditions and of medica- tion because of non-adherence can provoke or generate altering alertness,
judgement, and coordination; dizziness; altering the balance mechanism and the ability to recognize and
adapt to obstacles; and in- creased stiffness or weakness (7).
When prescribing new drugs to these older patients health professionals should fully ascertain other drugs
being taken, includ- ing self-prescribed medicines.
d) Risk-taking behaviours
The ordinary choices people make and the actions they take may increase their chance of falling.
Some risk-taking behaviours increase the risk of falling in older age. Those behav- iours include climbing
ladders, standing on unsteady chairs or bending while perform- ing activities of daily living, rushing with
little attention to the environment or not using mobility devices prescribed to them such as a cane or
walker (8).
Wearing poor fitting shoes is also a risk taking behaviour. Walking in socks without shoes or in slippers
without a sole increases the risk of slipping indoor. Appropriate shoes are particularly important –
avoiding high heels, thin and hard soles, or slippers of unsuitable size and that do not stick closely to the
feet.
4. Determinants related to personal factors
a) Attitudes
People's attitudes influence their behaviours. Attitudes affect how people interpret and cope with falls in
older age.
Older people's attitudes greatly influence whether they will avoid fall-related risk- taking behaviours
when they participate in activities of daily living. If older people perceive falls as a normal consequence
of ageing expressed as "seniors will always fall" their attitudes may halt preventive measures.
Attitudes of policy-makers determine to a large extent the amount of resources allocated to falls
prevention and develop- ment and enforcement of related policies. Awareness and attitudes of health
profes- sionals to falls are essential to increased in- centive in providing appropriate services for
preventing and managing falls in older age.
WHO GLOBAL REPORT ON FALLS PREvENTiON iN OLDER AGE
Professionals who design public transporta- tions, such as buses and subway systems, often do not make
them age-friendly, neglecting the risk of falls for older people. For example, in some developing coun-
tries, buses are designed with not enough seats and rails and the steps to climb into them are too high. As
a consequence, older people incur the risk of falling because they have to stand or do not have the
strength to climb into the buses in the first place and cannot properly hold on for support. Moreover, the
steps on the public buses are often too high to older people and they might fall when getting into the bus.
b) Fear of falling
Fear of falling is frequently reported by older persons. Older people are usually un- der the fear of falling
again, being hurt or hospitalized, not being able to get up after a fall, social embarrassment, loss of inde-
pendence, and having to move from their homes. Fear can positively motivate some seniors to take
precautions against falls and can lead to gait adaptations that increase stability. For others, fear can lead to
a de- cline in overall quality of life and increase the risk of falls through a reduction in the activities
needed to maintain self-esteem, confidence, strength and balance. In addi- tion, fear can lead to
maladaptive changes in balance control that may increase the risk of falling. People who are fearful of
falling also tend to lack confidence in their ability to prevent or manage falls, which increases the risk of
falling again (7).
c) Coping with falls
The ability of coping with falls of both older people and health professionals can lower the risk and
consequences of falling.
Falls are particularly difficult to manage in PHC settings because health professionals lack enough
knowledge and skills. Building coping skills of health professionals to pre- vent and manage falls needs to
be empha- sized. For example, health professionals are recommended to teach patients at risk of falling
how to get up from the floor; unfor- tunately clinical experience suggests that this is rarely done (9).
Physical and mental management of falls by older people and their family members is also important.
Therefore, training older people at high risk to avoid falling needs to be encouraged.
d) Ethnicity and race
Although the relationship between falls and ethnicity and race remains widely open for research,
Caucasians living in the USA have higher risk of falling. In addition, for both men and women, the rate of
hospitaliza- tion for fall-related injuries is some two to four times higher among the Whites than
Hispanics and Asians/Pacific Islanders, and about 20% higher than African-Americans (10). It is also
clear differences observed between Singaporeans of Chinese, Malay and Indian ethnic origins, and
between native Japanese older community dwellers and Japanese-Americans and Caucasians. Native
Japanese people have much lower rates of falls than Japanese-Americans and Caucasians.
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7. Economic determinants
Older people with lower economic status, especially those who are female, live alone or in rural areas
face an increased risk of falls.
Studies have shown that there is a rela- tionship between socioeconomic status and falls. Lower income is
associated with increased risk of falling (12). Older people, especially those who are female, live alone or
in rural areas with unreliable and insuffi- cient incomes face an increased risk of falls. Poor environment
in which they live, their poor diet and the fact of not being able to access health care services even when
they have acute or chronic illness exacerbates the risk of falling.
The negative cycle of poverty and falls in older age is particularly evident in rural areas and in developing
countries. The fall- related burden to health system will keep increasing unless resources and money are
allocated in order to provide proper PHC and opportunities to older people for social participation. It is
never too late to break this vicious cycle.
8. References
1. Stevens JA et al. (2006). The costs of fatal
and non-fatal falls among older adults. Injury Prevention, 12(5):290-295. 2. Hendrie D et al. (2003). Injury in Western
Australia: The Health System Cost of Falls in Older Adults in Western Australia. Perth, Western Australia. Western Australian
Government. 3. Ebrahim S, Kalache A (1996). Epidemiology in Old Age. London, Blackwell BMJ Books. 4. Gardner MM,
Robertson MG, Campbell AJ
(2000). Exercise in preventing falls and fall related injuries in older people: A review of randomised controlled trials. British
Journal of Sports Medicine, 34:7-17. 5. Day M et al. (2002). Randomised factorial
trial of falls prevention among older people living in their own homes. BMJ, doi:10.1136/ bmj.325.7356.128. 6. Tuck SP, Francis
RM (2002). Osteoporosis. Postgraduate Medical Journal, 78:526-532. 7. Division of Aging and Seniors (2005). Report
on senior's fall in Canada. Ontario. Public Health Agency of Canada. 8. Gallagher EH, Brunt H (1996). Head over
heels: A clinical trial to reduce falls among the elderly. Canadian Journal on Aging, 15:84-96. 9. Simpson JM, Salkin S (1993).
Are elderly
people at risk of falling taught how to get up again? Age Ageing, 22: 294-296. 10. Ellis AA, Trent RB (2001). Hospitalized
fall injuries and race in California. Injury Prevention, 7:316-320. 11. Rubenstein LZ (2006). Falls in older people: epidemiology,
risk factors and strategies for prevention. Age and Ageing, 35-S2:ii37-ii41. 12. Reyes CA et al. (2004). Risk factors for falling
in older Mexican Americans. Ethnicity & Disease, 14:417-422.
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2. References
1. Yardley L et al. Recommendations for
promoting the engagement of older people in preventive health care. Manchester, ProFaNE, Workpackage 4
(http://www.profane.eu.org/ directory/display_resource.php?resource_ id=1121, accessed 27 August 2007). 2. Yardley L et al.
(2007). Recommendations for promoting the engagement of older people in activities to prevent falls. Quality and Safety in
Health Care, 16(3):230-234. 3. Yardley L, Todd C. (2005). Encouraging
positive attitudes to falls in later life. London, Help the Aged. 4. Yardley L et al. (2006). Older people's views
of advice about falls prevention: a qualitative study. Health Education Research, 21:508-517. 5. Yardley L et al. (2006). Older
people's views of falls-prevention interventions in six European countries. The Gerontologist, 46:650-660. 6. Simpson JM,
Darwin C, Marsh N (2003). What are older people prepared to do to avoid falling? A qualitative study in London. British Journal
of Community Nursing, 8:152-159. 7. Chang JT et al. (2004). Interventions for the
prevention of falls in older adults: systematic review and meta-analysis of randomised clinical trials. British Medical Journal,
328:680-683. 8. Kannus P et al. (2005). Prevention of falls and consequent injuries in elderly people. Lancet, 366:1885-1893. 9.
Skelton D, Todd C (2004). What are the main
risk factors for falls amongst older people and what are the most effective interventions to prevent these falls? Copenhagen,
WHO Regional Office for Europe, Health Evidence Network report, (http://www.euro.who.int/ document/E82552.pdf, accessed
27 August 2007).
10. World Health Organization (2003). Adherence
to long-term therapies: evidence for action. Geneva. 11. Bandura A (1997). Self-efficacy: the exercise of
control. New York, WH Freeman. 12. King AC et al. (2000). Personal and
environmental factors associated with physical inactivity among different racial-ethnic groups of US middle-aged and older-aged
women. Health Psychology, 19:354-364. 13. King AC, Rejeski WJ, Buchner DM (1998).
Physical activity interventions targeting older adults: A critical review and recommendations. American Journal of Preventive
Medicine, 15:316-333. 14. Ory M et al. (2003). Challenging aging
stereotypes: strategies for creating a more active society. American Journal of Preventive Medicine, 25:164-171. 15.
Commonwealth Department of Health and
Aged Care (2001). National Falls Prevention for Older People Initiative "Step out with confidence". Canberra, Commonwealth of
Australia. 16. McInnes E, Askie L (2004). Evidence review
on older people's views and experiences of falls prevention strategies. Worldviews on Evidence- Based Nursing, 1:20-37. 17.
Yardley L et al. (2007). Attitudes and beliefs that predict older people’s intention to undertake strength and balance training.
Journals of Gerontology Series B, Psychological Sciences and Social Sciences, 62B:119-125.
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Components of successful multifactorial interventions include: staff training and guidance, changes in
medication, resident education, environmental assessment and modification, supply and repair of aids, ex-
ercise, and use of hip protectors (12, 17, 10).
A single intervention shown to be effective in residential settings is the use of vitamin D and calcium
supplements. Other single strategies that show promise include:
• gait training and advice on appropriate use of assistive devices;
• review and modification of medications, particularly psychotropics;
• nutritional review and supplementation;
• staff education programmes;
• exercise programmes;
• environmental modification;
• post-fall problem-solving sessions; and
• the use of hip protectors (12, 17).
There is no evidence to support the ef- fectiveness of interventions to reduce falls among residents with
cognitive impair- ments (17).
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3. c) Acute care settings2:
Practice – Interventions
No evidence exists to support the effec-
Practice settings are where falls preven- tiveness of
multifactorial interventions in
tion evidence is translated into feasible, acute care settings
(14). The use of physical
affordable and sustainable interventions. or pharmaceutical
restraints commonly
Practitioners are well placed to link the used with the
intention of reducing falls
application of evidence to organizational is shown not to be
effective. Conversely,
policies and to identify gaps that need to there is moderate
evidence to support an
be addressed before successful adoption is increased risk of
injury from a fall with
possible. An effective tool for enacting the the use of
restraints (12). Alternatives to
translation of evidence into practice is the restrains (lower
bed, mats on floor, train-
development of a clinical practice guide- ing on exercise
and safe transfers) have
line. An example of an effective guideline moderate
evidence for their effectiveness
is produced by the Registered Nursing (12). Other
interventions that have been
Association of Ontario (RNAO), Canada. tested but lack
strong supporting evidence include: hospital discharge risk assessment and planning, exercise
programmes, envi- ronmental modifications, use of bed alarms and the use of identification bracelets (18,
19). Some evidence exists to support facilitated home assessments for those at high risk for falling when
discharged from hospital (10).
In less developed countries the translation of falls prevention evidence to practice is made difficult by
competing demands for urgent health-care issues and shortages of health-care providers. In addition,
before effective adoption of evidence to prac- tice, more studies are necessary to better understand the
unique contributors to falls among older people in less developed countries, including the influence of
diet,
2 Acute care setting: refers to hospitals or rehabilitation units
hazardous environments, the lack of acces- sible safety equipment and transportation, and the role of
inadequate health services.
The RNAO Prevention of Falls and Fall injuries in the Older Adult Best Practice Guideline
The RNAO Prevention of Falls and Fall injuries in the Older Adult Best Practice Guideline was designed
for long-term and acute-care nurses to enhance their skills and abilities for risk assessment and
prevention. The purpose of this guideline is to increase all nurses’ confidence, knowledge, skills and
abilities in the identification of adults within health- care facilities at risk of falling and to define
interventions for the prevention of falling (20).
WHO GLOBAL REPORT ON FALLS PREvENTiON iN OLDER AGE
Injury outcomes among older persons in less developed versus more developed countries also need to be
explored, par- ticularly given that hip fractures are being described as an “orthopedic epidemic” in less
developed countries [Baker et al;1992: cited in (21)].
4. Concluding remarks
Given recent rapid population ageing worldwide, without concerted action by policy-makers, researchers
and practitio- ners, the economic and societal burden of falls will increase by epidemic proportions in all
parts of the world over the next few decades. The complex and multifactorial nature of falls in older age
demands a pro- active and systematic approach to preven- tion. Healthy public policies and proven
prevention strategies that are tailored to target populations are essential for the successful integration of
fall-prevention evidence into practice for effective fall-risk identification and reduction.
5. References
1. Scott VJ, Peck S, Kendall P (2004). Prevention
of falls and injuries among the elderly: a special report from the office of the provincial health officer. Victoria, British
Colombia, Provincial Health Office, B.C. Ministry of Health. 2. British Columbia Injury Research and
Prevention Unit (BCIRPU) (2006). Vancouver, British Columbia, (http://www.injuryresearch. bc.ca/, accessed 27 August 2007).
3. Herman M, Gallagher E, Scott VJ (2006). The
evolution of seniors' falls prevention in British Columbia. Victoria, British Columbia, B.C. Ministry of Health,
(http://www.health.gov. bc.ca/library/publications/year/2006/falls_ report.pdf, accessed 27 August 2007). 4. National Council on
Aging (NCOA) Center
for healthy aging model health programs for communities (2007). Washington, DC, Center for Health Aging (http://
healthyagingprograms.org/content. asp?sectionid=69, accessed 27 August 2007). 5. Fall Prevention Center of Excellence. Falls
Free
(2007). Washington, DC, Center for Healthy Aging (http://www.stopfalls.org/, accessed 27 August 2007).
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6. Prevention of Falls Network Europe, ProFaNE
(2007). Manchester, GB, ProFaNE (http://www. profane.eu.org/, accessed 27 August 2007). 7. Scott VJ et al. Canadian Falls
Prevention
Curriculum©, Vancouver, British Columbia. B.C. Injury Research and Prevention Unit, (unpublished data). 8. Rose, DJ (2003).
Fallproof! A comprehensive balance and mobility training program. Windsor, Ontario, Human Kinetics. 9. Rubenstein LZ
(2006). Falls in older people: epidemiology, risk factors and strategies for prevention. Age Ageing, 35-S2:ii37-ii41. 10.
Rubenstein LZ et al. (2006). The summary
of the newly updated ABS/BGS guideline: Evidence based practice guideline for the prevention of falls in older persons.
Chicago: American Geriatrics Society Plenary Symposium, May 4, 2006. 11. Tinetti ME, Speechley M, Ginter SF (1988). Risk
factors for falls among elderly persons living in the community. New England Journal of Medicine, 319(26):1701-1707. 12.
Skelton D, Todd C (2004). What are the main
risk factors for falls amongst older people and what are the most effective interventions to prevent these falls? Copenhagen,
WHO Regional Office for Europe, Health Evidence Network report (http://www.euro.who.int/ document/E82552.pdf, accessed
27 August 2007). 13. Chang JT et al. (2004). Interventions for the
prevention of falls in older adults: systematic review and meta-analysis of randomised clinical trials. British Medical Journal,
328:680-683. 14. Gillespie LD et al. (2004). Interventions
for preventing falls in elderly people. Cochrane Database of Systematic Reviews, (4):CD000340.
15. Gardner MM, Robertson MC, Campbell AJ.
(2000). Exercise in preventing falls and fall related injuries in older people: a review of randomised controlled trials. British
Journal of Sports Medicine, 1(34):7-17. 16. Wolf SL et al. (2003). Selected as the best paper in the 1990s: Reducing frailty and
falls in older persons: An investigation of tai chi and computerized balance training. Journal of the American Geriatrics Society,
51(12):1794-1803. 17. Kannus P et al. (2000). Prevention of hip
fracture in elderly people with use of a hip protector. New England Journal of Medicine, 343(21):1506-1513. 18. Hill K et al.
(2000). An analysis of research on
preventing falls and falls injury in older people: community, residential care and hospital settings (2004 update). Canberra,
Australia, National Ageing Research Institute for the Commonwealth Department of Health and Aged Care. 19. Oliver D,
Hopper A, Seed P (2000). Do hospital
fall prevention programs work? A systematic review. Journal of the American Geriatrics Society, 48(12):1679-1689. 20.
Registered Nurses’ Association of Ontario
(2005). Prevention of falls and fall injuries in the older adult. Toronto, Ontario, Registered Nurses’ Association of Ontario
(www.rnao. org/bestpractices/PDF/BPG_Falls_rev05.pdf, accessed 27 August 2007). 21. Barss P et al. (1998). Injury prevention:
An
international perspective. Epidemiology, surveillance, and policy. New York, Oxford, Oxford University Press. 22. World Health
Organization (2002). Active ageing: A policy framework. Geneva.
WHO GLOBAL REPORT ON FALLS PREvENTiON iN OLDER AGE