Fall prevention in older people: past, present and future

Over the past 50 years we have transitioned from accepting falls as an inevitable consequence of ageing to something that can and should be prevented. Numerous studies have elucidated the contributors to falls and how to assess a person's risk of falling. There are many effective approaches to preventing falls in older people including those with cognitive and physical impairments. Exercise is the most tried and tested approach with good evidence that moderate to high intensity balance training is an effective fall prevention strategy. Other successful single modality interventions include enhanced podiatry, home safety interventions, expedited cataract extraction, cardiac pacing for people with carotid sinus hypersensitivity and vitamin D supplementation in people living in care homes. Multiple interventions (everyone receives the same intervention package) and multifactorial interventions (interventions tailored to identified risk factors) are effective particularly in high-risk populations. In more recent years we have seen the emergence of new technologies such as devices and software programs that can offer low-cost interventions which may be more sustainable than our traditional time- and resource-limited approach to prevention. There is still more to be done and a translational focus is needed to ensure that effective interventions are scaled up and delivered to more people while at the same time maximising adherence and maintaining the fidelity of the interventions.