Commentary on: Falls prevention research in residential aged care is itself tripped up by medical clearance issues [1]

The authors of this article are correct in assuming that fallsprevention in residential aged care (RAC) is an increasingproblem and that appropriate exercise is a likely effectiveprevention strategy [1]. However evidence will be hard toestablish in a population with limited life expectancy; asshown by community-based care (75+ health assessment)research, which required a meta-analysis of trials on nearly100 000 people before solid evidence was established [2].Beswick et al.’s meta-analysis did establish positive gains inareas consistent with the older people’s wishes for them-selves: preserved independence, fewer falls and fewer acuteand long-term admissions.Unfortunately for researchers, ‘recruitment is hard work’;often because participants are not as enthusiastic nor asinformed about research as the investigators; successfulrecruitment depends on establishing a thorough process andpersevering. Australian health reform is struggling becausenew programs all require general practitioners (GPs) to com-plete processes (paperwork/e-forms) that increase GP work-load and reduce the time available for the clinical work atwhich they are uniquely skilled. So it is not surprising theyare not keen, let alone when their indemnity organisationplaces risk aversion ahead of advancing clinical research.‘Opt out’ ethics has been well established, typically creates>85% participation [3] and has been used in ethically low-risk primary care research [4]. Opt out approval should beconsidered in this study; RAC residents are informed of thefalls prevention trial and automatically included unless theyactively choose to exclude themselves.Dr Joanne Dollard’s PhD work shifts our emphasis in fallsprevention from a negative message of ‘