Table 2

 Recommendations for promoting uptake of falls-related interventions

Recommendation (clarification)Rating*General theory/evidenceFalls-related theory/evidence
*Median agreement rating (with interquartile range in brackets) on the 9-point scale used in the internet consultation.
1. Raise awareness in the general population that undertaking specific physical activities has the potential to improve balance and prevent falls. (Uptake may be encouraged by promoting greater awareness among older people, their families and carers, and health professionals of how undertaking specific physical activities may contribute to improving balance and reducing the risk of falls.)2 (1–3)For people to make well-informed, rational, positive choices about what forms of health-promoting behaviour they should carry out, it is necessary for them to have basic information about the benefits of preventive behaviours.13Falls are often regarded as an inevitable consequence of ageing,14 and most older people assume that falls prevention involves unwanted activity restriction order to reduce risk. There is little awareness among older people and carers that falls can be actively prevented by improving strength and balance.9,15
2. When offering or publicising interventions, promote immediate benefits that fit with a positive self-identity. (Examples of benefits that are highly valued by older people include increased independence, confidence in functional capabilities and proactive self-management of health.)2 (1–3)Uptake of an activity is influenced by whether it seems compatible with the individual’s identity and social norms.16 Uptake is usually promoted more by perceived benefits of preventive activities than by perceived risk of harm.17Older people may refuse to engage in falls prevention if they consider it suitable only for old, frail or anxious people at high risk of falling, since this is a negative social identity.9,18,19 The reasons older people give for undertaking strength-training and balance-training focus on the many immediate benefits compatible with a positive identity (eg interest, enjoyment, increased confidence, maintaining general health, mobility and independence) rather than reducing the risk of a possible fall some time in the future.6,10,20