Age and Ageing Advance Access originally published online on March 22, 2007
Age and Ageing 2007 36(3):351-352; doi:10.1093/ageing/afm027
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Research on the prevention of fall injuries still makes prediction for practice difficult
SIR—Several papers published recently address the increasing problem of falls among the elderly [1]. Medical and social costs of fall-induced injuries are even larger when considering work, sports and leisure activities in the total population. A wide range of subject characteristics have been shown to predict falls [2]. Much uncertainty remains still, as to which factors determine fall risk and which factors should be the primary targets for intervention. In spite of large investments in research on both causes and prevention, the problem is not affected much in practice. The benefits of research for public health need some further understanding.First, due to the scarcity of resources in society, we will be forced to define the most vulnerable groups at risk. Several studies show that a minor group of patients with repetitive injuries do not follow the Poisson distribution including a fear of falling [3]. Thus, there is a need for a shift towards more longitudinal studies using a follow-up design to increase understanding of cost-effective interventions in practice.
Second, there is obviously a lack of multidisciplinary research between home- and work-related fall-induced injuries. Research on risk groups at work [4] or among the elderly does not consider each others' results [2, 4] . There are also inconsistencies when recommending countermeasures on the individual level, e.g. the value of strength and balance training. Others are more cautious and emphasise the relative importance between muscular and neural factors, i.e. if the latter are of prime importance, strength training not likely to be the most effective approach [4]. A revised state-of-the-art programme is recommended in order to stimulate collaboration and new ideas.
Third, it is difficult to understand and predict interventions without including community organisation and the daily context of human activity. There is, thus, a need for more context-dependent research programmes [5]. Only a few elements such as gravity, friction and kinetic energy are in fact context-independent. Current limitations are compliance when transforming results from bio-mechanic research into a social context, and how to meet and handle shifting traditions and job cultures both in private homes and among the home help services. Accordingly, there is a need to develop criteria as to how to define best practice. Often, case studies are recommended to solve the problem of lack of context-dependent knowledge. One advantage is the closeness to real-life situations. However, the critical issue is the strategic selection of critical cases, i.e. what constitutes a critical case and how to identify such cases [5]. A shift towards more case intervention studies focusing on contextual variation is warranted. So, there is still a long way to go before we can make reliable predictions on how to prevent fall-induced injuries in real-life situations.
Karolinska Institutet, Department of Public Health Sciences, Division of Social Medicine, Norrbacka Building, S-17176 Stockholm, Sweden
Email: bjarne.jansson{at}ki.se
References
- Hauer K, Lamb SE, Jorstad EC, Todd C, Becker C, PROFANE-Group. Systematic review of definitions and methods of measuring falls in randomised controlled fall prevention trials. Age Ageing (2006) 35:5–10.
[Abstract/Free Full Text] - Cumming RG. Intervention strategies and risk-factor modification for falls prevention. A review of recent intervention studies. Clin Geriatr Med (2002) 18:175–89.[CrossRef][Web of Science][Medline]
- Jansson B, Stenbacka M, Leifman A, Romelsjö A. A small fraction of patients with repetitive injuries account for a large portion of medical costs. Eur J Public Health (2004) 14:161–7.
[Abstract/Free Full Text] - van Dieen JH, Pijnappels M, Bobbert MF. Age-related intrinsic limitations in preventing a trip and regaining balance after a trip. Saf Sci (2005) 43:437–53.
- Flyvbjerg B. Why Social Inquiry Fails and How it Can Succeed Again (2001) Cambridge, UK: Cambridge University Press. Making social science matter.
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