Study Strengths
The strength of the study design is the joint development of
implementation strategies in a participatory community
planning, involving partners, for example, from the health care
system, the community, and older people themselves. The risk
of falling shares parallels with other chronic conditions, such
as diabetes. In both conditions, the occurrence of an acute event
(a cardiovascular event in the case of diabetes, or a fracture in
the case of a risk of falling) can be reduced by preventive efforts,
like changes in lifestyle by older people themselves, through
professionals and providers [18]. In line with the Innovative
Care for Chronic Conditions framework of the World Health
Organization, population-based fall prevention programs are
operating within the structures of a community [13,46].
Study Limitations
A problem that we anticipate is the dependency on the
stakeholders’ willingness to be actively engaged in the project.
To maximize cooperation, potential barriers and facilitators for
each partner have to be identified at the beginning. A further
difficulty of population-based programs is the evaluation of
hard end points. Fracture rates, awareness, or lifestyles might
not change within the three year duration of the study. These
processes, as well as changes of structures and procedures in
communities, might take many years and require longer
observation periods. During this observation period, other
factors, like migration or secular trends, can influence the effects
of these community level approaches, which might lead to
dilution bias. Therefore, Lindholm and Rosén, for example,
state that hard end points are inappropriate options for
community-based primary interventions [47]. Rather, our study
intents to identify strategies that are feasible and acceptable in
the context of the German social and health care system.