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SUMMARY Older people form a large and growing segment of our population, experience disproportionately more illness and require more use of health services than any other group. This differential is largely due to falls, which are the leading cause of injury for those aged 65 plus. The North Coast 'Stay On Your Feet'programme is a 4-year multi-strategic, community-based intervention to address this problem among 80 000 older residents. This paper presents key results of the first 18 months of the pro- gramme. It demonstrates potential achievements of this type of intervention and examines some barriers. Pro- gramme effect was measured quasi-experimentally by monitoring indicators of awareness, knowledge, attitudes and risk factors via a telephone survey with random cohorts in intervention and control areas. After allowing for baseline covariates, the intervention was significantly associated with: raised awareness both of the problem of falling and its preventability; improved knowledge of the risk factors for falling; and a higher self-rated risk of falling. As expected, there is as yet no population change in falls rate. Initial changes shown in risk factors for falling raise interesting challenges. A reduction in phy- sical activity may indicate that older people, now more aware of risk, are being advised to restrict their activ- ities. An increase in proportion of older people taking medications which may cause unsteadiness also presents a challenge. However, a concomitant decrease in reported dizziness may indicate that medications are now better managed. This evaluation shows that in 18 months, a well-funded and managed community- based falls prevention programme can achieve changes in awareness, knowledge and attitudes but that continued intervention is required to substantially change beha- vioural risk factor profiles and the likelihood of an older person falling.

Meeting the challenge of falls prevention at the population level: a community-based intervention with older people in Australia