Prevention of falls and fall-related injuries in older people.

As people get older, they may fall more often for a variety of reasons including problems with balance, poor vision, and dementia. About a third of community-dwelling people over 65 years old fall each year, and the incidence of falls, and fallrelated injuries, increases with age. Although less than 10% of falls in community-living older people result in a fracture, these are a significant source of morbidity and mortality. More commonly, falls result in minor injuries such as bruising and lacerations. They can also result in fear of falling and loss of confidence, and admission to a nursing home. Many risk factors appear to interact in older people who suffer fractures, and it is possible that fall-prevention strategies have limited effect on falls that result in injuries, or are ineffective in populations at a higher risk of injury. Interventions designed to reduce falls would require large effects to have an impact on the incidence of fractures. In the past, fall-prevention trials have not been adequately powered to detect effect on injury outcomes, and variation in the definition of these outcomes has hindered meta-analysis. The Prevention of Falls Network Europe (ProFaNE) consensus document recommending that fall-related fractures should be the injury outcome of choice should help to address this. The Cochrane Bone, Joint and Muscle Trauma Group has supported the production of the review ‘‘Interventions for preventing falls in elderly people’’, since it was first published in 1997. This review, which has been withdrawn from the Cochrane Database of Systematic Reviews, has been replaced by a review of interventions for preventing falls in communitydwelling older people, summarised below, and a second review of fall-prevention interventions in nursing care facilities and hospitals, which is nearing completion.