Falls prevention activities among community-dwelling elderly in the Netherlands: A Delphi study

This study aimed to provide an overview of the current falls prevention activities in community-dwelling elderly with an increased risk of falling in the Netherlands. Therefore, we determined: a) how health professionals detect community-dwelling elderly with an increased risk of falling; b) which falls prevention activities are used by health professionals and why; c) how elderly can be stimulated to participate in falls prevention programs; and d) how to finance falls prevention.

A two-round online Delphi study among health experts was conducted. The panel of experts (n=125) consisted of community physiotherapists, community nurses, general practitioners, occupational therapists and geriatricians, from all over the Netherlands. The median and Inter Quartile Deviation (IQD) were reported for the questions with 5-point Likert scales, ranging from 'least' (1) to 'most' (5).

Respectively 68% (n=85/125) and 58% (n=72/125) of the panel completely filled in the first and second round questionnaires. According to the panel, regular detection of fall risk of community-dwelling elderly with an increased risk of falling hardly takes place (median=2 [hardly]; IQD=1). Furthermore, these elderly are reluctant to participate in annual detection of fall risk (median=3 [reluctant]; IQD=1). According to 73% (n=37/51) of the panel, 0-40% of the elderly with an increased risk of falling are referred to exercise programs. In general, the panel indicated that structural follow-up is often lacking. Namely, after one month (n=21/43; 49%), three months (n=24/42; 57%), and six months (n=27/45; 60%) follow-up is never or hardly ever offered. Participation of elderly in falls prevention programs could be stimulated by a combination of measures. Should a combination of national health education, healthcare counseling, and removal of financial barriers be applied, 41-80% of the elderly is assumed to participate in falls prevention programs (n=47/64; 73%). None of the panel members indicated full financing of falls prevention by the elderly. A number of individuals are considered key in falls prevention activities, such as the general practitioner, physiotherapist, and informal caregiver.

This Delphi study showed clear directions for improving falls prevention activities and how to increase participation rates.