Re: The impact of cognition on falls prevention programmes

SIR—We read with interest the findings of the paper by Irvine et al. [1]. This paper further highlights the difficulties geriatricians face in finding effective ways to prevent falls in the community. One of the points we felt may have been overlooked was the effect of cognition on the falls rate and future attendance to a falls prevention program. Previous research has shown that cognitive impairment has a significant impact on falls and risk of future falls [2]. In our own day hospital cohort up to two-thirds of our communitybased falls referrals would have some degree of cognitive impairment. The screening tool used did not take this into consideration and may have contributed to the large drop-out rate and subsequent negative analysis of the falls prevention programme. Also in the subsequent analysis of the paper the authors did not stipulate whether they felt this had played a role in the negative outcome of the paper. The concern is that in a time of fiscal constraints—particularly in a European context—these papers lend weight to a lack of provision for falls prevention in older people. As geriatricians we must aim to emphasise the heterogenous nature of older patients attending our clinics. Differentiating between cognitively impaired and cognitively intact patients may help better inform the design of falls prevention strategies, and which particular patient groups to target.