Mind the gap: From Evidence to Action in Community-Based Fall Prevention

Falls affect approximately 30% of community-dwelling adults aged 65 years and older annually, and their incidence is expected to rise with global population aging. In addition to serious physical, psychological, and social consequences, falls impose a substantial economic burden on healthcare systems, making them a major public health concern. Falls are typically caused by multiple interacting risk factors, including mobility limitations, cognitive decline, poor nutrition, and environmental hazards. Multidomain fall prevention interventions (FPIs), which combine strategies such as exercise programs and home hazard modifications, have proven effective in reducing fall rates. However, their systematic implementation in community settings remains limited.

The complex and multifactorial nature of falls requires effective interprofessional collaboration among health and social care professionals (HSCPs) across sectors and settings, yet achieving such collaboration in practice is challenging. Additionally, participation of older adults in exercise-based FPIs is often low, highlighting the need for strategies to enhance engagement. This dissertation addresses these challenges by developing, implementing, and evaluating tailored implementation strategies to improve both the delivery of FPIs and participation among community-dwelling older adults.

To inform strategy development, Chapter 2 presents a scoping review identifying contextual determinants influencing the implementation of community-based FPIs, based on scientific literature and HSCP experiences. A wide range of determinants was identified, emphasizing the importance of comprehensive context analysis and tailored approaches. Key determinants included availability of resources, responsiveness to older adults’ needs, coordination, and interprofessional collaboration.

Chapter 3 further explores interprofessional collaboration through a systematic review of qualitative studies. While collaboration is widely recognized as essential, it is often hindered by unclear role definitions, differing professional perspectives, and limited communication structures. Facilitators included shared goals, supportive organizational cultures, and adequate reimbursement.

Building on these findings, Chapter 4 describes the development, implementation, and evaluation of a multifaceted tailored implementation strategy aimed at improving interprofessional collaboration. Using a mixed-methods approach, four key themes were identified: network building, team dynamics, coordination, and implementation dynamics. Continuous monitoring and iterative adaptation were found to be critical for addressing context-specific needs and supporting sustainable collaboration.

Chapter 5 focuses on older adults’ perspectives on participation in exercise-based FPIs. Qualitative findings indicate that engagement is enhanced by positively framed communication, avoidance of aging-related terminology, and personalized approaches addressing both practical and motivational factors.

Chapter 6 examines the effectiveness of reframed communication strategies. Messages emphasizing positive outcomes, such as maintaining independence and wellbeing, were more effective in promoting intention to participate than risk-focused messages.

In conclusion, successful implementation of FPIs in community settings requires addressing multiple interconnected determinants. Tailored, iterative implementation strategies that foster interprofessional collaboration and actively engage older adults—supported by positively framed communication—are essential to improve both the delivery and uptake of fall prevention interventions.