Mike: Hello, I'm Mike Clarke, podcast editor for the Cochrane Library. There are several Cochrane reviews of strategies and interventions to reduce falls, particularly in older people. In January 2024, we published a new review of population-based approaches for falls prevention, and, in this podcast, Chris Todd, talks to co-author Lisa McGarrigle, both from the University of Manchester in the UK about the findings.

Chris: Hello Lisa, let's begin with what is meant by "population-based" approaches in falls prevention?

Lisa: Hello Chris. Approaches to prevent falls in older adults are usually aimed at individuals at an increased risk of falling, such as those with a history of falls or mobility problems. Population-based approaches are different because they are aimed at entire communities rather than individuals. Examples include public health initiatives to inform the public about the benefits of evidence-based interventions such as strength and balance exercises, visiting all older people at home to help them identify and reduce fall hazards; or local councils improving public walkways and lighting in towns or cities. To put it simply, population-based interventions are not targeted at individuals considered to be at risk, rather they are designed to reach the whole community, or at least a large proportion of it.

Chris: Moving on to the review, why was this needed for assessing the effects of these interventions for preventing falls?

Lisa: Falls in older people are very common and can have serious consequences for both the individual and healthcare services. To our knowledge, ours is the first systematic review to investigate whether population-based approaches are effective for falls prevention. We've done it by taking the Cochrane Review of population-based interventions for the preventing fall-related injuries and updating and extending it to include fall incidence as an outcome.

Chris: And what did the review find out about the effectiveness of population-based interventions?

Lisa: We found nine studies across eight different countries. Approaches generally involved multiple components such as exercise, education, or reducing fall hazards in the home or community. One study also looked at the benefit of a free-of-charge daily supplement of calcium and vitamin D. Overall, though, this evidence base still leaves us uncertain about whether population-based approaches that have multiple components reduce the incidence of falls. We're also unsure whether they make any difference to the number of people with fall-related broken bones, or if they reduce the number of people with other fall-related injuries or fall-related hospital admissions. Furthermore, we are uncertain whether these approaches provided savings to the healthcare service and whether offering calcium or vitamin D supplements to all older people in the community reduces the number who need hospital treatment for falls.

Chris: Why do you think the evidence is so uncertain?

Lisa: There are a few reasons. Some studies did not randomly chose the communities to receive the falls prevention approaches, which is a common design for population-based studies, but can mean that there are differences between communities that might affect the results. Also, studies did not provide enough information to judge whether they were well-conducted and findings often differed between studies, for reasons that we could not identify.

Chris: To finish, what's the key take-home message from the review?

Lisa: The main message is for future research. Due to the uncertainly of the current evidence, future studies need to be well-designed and provide up-to-date descriptions of their interventions. Ideally, the studies should be carried out in several communities rather than just two, each community in the study should have a large population, and the older people should be representative of the country in which the research takes place. If this happens, it would be of huge benefit to future reviews looking to synthesise evidence in this area.

Chris: Thanks Lisa. If people would like to read the review, where can they find it?

Lisa: Thanks Chris. The review is available online in the Cochrane Library. If people go to Cochranelibrary.com and search 'population‐based interventions for preventing falls', they will find a link to it.