Barriers and facilitators for the implementation of a nationwide falls prevention pathway for older adults in the Netherlands

Falls contribute significantly to injury and mortality among community-dwelling older adults, with societal costs expected to rise. In the Netherlands, a nationwide falls prevention pathway, aligned with World Falls Guidelines was introduced. This includes case finding, multifactorial falls risk assessments, evidence-based interventions and sustained exercise programs. This study explores its implementation, focusing on barriers and facilitators.

A qualitative study using semi-structured interviews with 37 stakeholders from 11 regions in the Netherlands, including representatives from municipalities, health insurers and healthcare providers. Data were analysed using thematic analysis and guided by the Consolidated Framework for Implementation Research to explore stakeholders' roles, intersectoral collaboration, barriers and facilitators to implementation and future perspectives.

Barriers include unclear role delineation, in conducting the multifactorial risk assessment, difficulties reaching high-risk older adults, and complex cross-sectoral collaboration. Limited monitoring infrastructure and inconsistent terminology hindered implementation. Facilitators included nationwide funding, regional coordination and local project leaders.

Clearer roles, stronger healthcare-social sector partnerships and robust monitoring systems are recommended. Although substantial progress has been made, particularly in regions with pre-existing collaborative network, additional efforts are required to operationalise shared responsibility and address remaining barriers. By doing so, the pathway may enhance healthy ageing, reduce falls related injuries and alleviate the societal burden of falls.