The social epidemiology of falls among community-dwelling elderly: guidelines for prevention

Social epidemiology offers a conceptual model that organizes the risk factors for falls into demographic, medical and psychosocial host factors, environmental factors and the agent in falls. Once identified in such a manner it is possible to differentiate between those factors which are or are not amenable to change or treatment, thus suggesting methods of fall prevention. Fall prevention strategies are feasible before a fall, at the time of a fall, and following an injurious fall, corresponding to primary, secondary, and tertiary prevention. At each level of prevention, prevention strategies are described, and together they constitute a complete fall prevention programme for community-dwelling elderly. A review of those strategies that have been evaluated shows that their efficacy in reducing the incidence of falls and their adverse complications is generally limited. Thus, further evaluation research is needed in order to incorporate the most effective fall prevention programmes into standard community care for the elderly.