b) Pillar Two – Improving the identification
and assessment of risk factors and determinants
of falls:
There is a growing appreciation that a
complex combination of individual-level,
community-wide, and societal factors influence
the probability of falls and fall-related
injuries among older persons. Although the
evidence base regarding how best to identify
and assess the various risk factors and
determinants for falls is growing, there are
many areas where information is lacking
and improvements are needed. A systematic
multisectoral strategy for reducing falls
and fall-related injuries will require concerted
efforts to improve assessment and
identify critical determinants in each of the
following domains:
Health and social services: Convenient and
affordable access to health and social services
can greatly impact an older persons’
likelihood of experiencing a fall or fallrelated
injury. Health and social services
should be structured in such a way as to
routinely screen older persons for knownrisk
factors for falls. Health professionals
should be trained to use evidence-based
protocols and procedures that help to identify
those individuals who are at the greatest
risk. Suitable follow-up strategies should
be in place to assist clinicians to recommend
culturally-appropriated and affordable
evidence-based treatment programmes
when indicated. The WHO Active Ageing
Framework notes that health and social
services need to be integrated, coordinated
and cost-effective.
Furthermore, there must be neither age nor
gender discrimination in the provision of
services and service providers should treat
people of all ages with dignity and respect.
Behavioural: : There is a growing appreciation
that a number of important behavioural
factors impact older persons vulnerability to
falls and their likelihood to seek treatment
or care for falls and fall-related conditions.
Many older adults incorrectly believe that
it is too late to change their behaviour and
adopt a healthy lifestyle in old age. Others
experience a significant fear of falling that
greatly limits their activity choices, reduces
their independence and decreases their
engagement in society. It is not sufficient to
simply educate older adults about the importance
of falls and falls prevention, it is also
crucial to assess their readiness to change
their lifestyles and adopt preventative and/
or rehabilitative therapies. Any integrated
strategy to reduce falls at the individual and/
or community level will need to acknowledge
and assess the critical behavioural determinants
known to impact an individual’s
risk for falling. Attention to these factors
can significantly increase the chance that a
person will engage in appropriate preventive
behaviours such as physical activity, healthy
eating, not smoking and using alcohol and
medications wisely. These behaviours can in
turn help to prevent disease and functional
decline, extend longevity and enhance quality
of life.