Young-old and old-old motivation in cooperative fall-prevention programmes

SIR—The quantum and tempo of ageing in Japanese society are dramatic, particularly in rural, depopulated areas [1]. The fiscal pressure of long-term care costs and the shortage of health care resources have been so severe in these areas that they have stimulated the consolidation of small municipalities , which carry responsibility for public health and welfare programmes into larger units. This has resulted in effective use of public care services and extensive endorsement of disability-postponing (kaigo yobou, in Japanese) programmes [2]. Most prominent for the health maintenance of the elderly population are fall-prevention programmes, which are highly individualised to each municipality. In 2003, we initiated a unique programme in Onishi Town, Gumma Prefecture, in which community-dwelling elderly people themselves coordinate and share responsibilities of running such a programme based on mutual cooperation. The elderly population of Onishi has grown, with 28.1% of the population (total population of 7,300 as of October 2003) aged 65 years and above. Fall-prevention seminars were publicised in advertisements in the town office newspaper, through public relations activities at senior centres, and at meetings of elderly people's clubs. In this programme, younger old people led the activities and played a dual role as participant and in transporting older people to the programme by car. Since recruitment in the initial stage was successful, the programme was subsequently expanded to other municipalities in the region. Two hundred and twenty-nine participants (mean age 72.8 +/−, range 60–91 years) participated in the fall-prevention seminars. All applications were voluntary, and the organisers distributed no invitations. First-time participants were interviewed regarding fall-prevention measures they currently used, and the measures were classified according to the Guideline for the Prevention of Falls in Older Persons [3]. The majority of the subjects (58.5%) responded that they had taken or were taking actions to avoid falling. The most common actions taken by the participants included concentrating more on not falling (92 persons; 68.7%), exercises (28 persons; 20.8%), and modifications of the living environment (8 persons; 5.9%). Multiple regression analysis indicates that older age (odds ratio 0.34, 95% CI 0.15–0.94 in the 60s compared with the 80s) and shorter functional reach (odds ratio 2.53, 95% CI 1.12–5.68 in the lowest quartile compared with the highest quartile) are important predictors of taking fall-prevention measures. Gender, hospital visits, frequency of going out, instrumental activities of daily living, history of falling, falls efficacy scale, and knee extensor muscle strength did …