• Positive reinforcement strategies increase
the likelihood of maintenance
of an activity. Examples of effective-reinforcement
strategies include recruitment
incentives, rewards for reaching
targeted goal, and public recognition for
attendance and adherence.
Environmental modification: There is now
good evidence that home-hazard assessment
and modification that is professionally
prescribed for older persons with a
history of falling is effective in reducing
risk. However, the value of home visits
and home-hazard assessments in low-risk
populations is less clear. Among the factors
addressed in a typical-home visit include
the assessment and improvement of lighting,
the identification and removal of rugs
and other trip hazards, and the installation
of railings on staircases in bathrooms
and toilets. The value of systematic hazard
assessment and intervention has also been
shown to be effective in decreasing falls
in retirement homes and seniors centers
where large numbers of individuals with
elevated risk live or regularly visit.
There is growing interest in examining the
impact of community level interventions
designed to identify and correct environmental
hazards that reduce physical and
social activity and increase the risk of older
persons falling. Among the environmental
hazards assessed in environmental audits
and “walkability” assessments are: unsafe
sidewalks, poorly lit roadways, and inaccessible
or unsafe neighborhoods. Although
evidence of the impact of environmental
changes on the incidence of falls and the
number of fall-related injuries is insufficient
to draw definitive conclusions, these
interventions show promise and additional
research is necessary to shed more light on
the relationship between environmental
changes and both fall risk and actual falls.
Health management: There is good evidence
that access to appropriate and affordable
medical care can significantly impact
health and quality of life as well as decrease
the likelihood of developing noncommunicable
diseases. Because older people
are more likely to suffer from a variety of
chronic conditions, their access to medical
care is especially important and can
make the difference between early detection
and timely intervention, and delayed
and/or non-existent treatment and care. In
the area of falls prevention, the accurate
identification of individuals at high risk
for falling is an important element in the
selection of the evidence-based intervention
with the greatest chance of a positive
outcome. There is evidence that identifying
patients who attend accident and emergency
departments after falls, and referring
them for subsequent therapy significantly
reduces subsequent falls.