title: A population-based intervention for the prevention of falls and fractures in home dwelling people 65 years and older in South Germany: protocol.
abstract: BACKGROUND
  Falls and fall-related injuries pose a major threat to older peoples' health, and are associated with increased morbidity and mortality. In the course of demographic changes, development and implementation of fall prevention strategies have been recognized as an urgent public health challenge. Various risk factors for falls and a number of effective interventions have been recognized. A substantial proportion of falls occur for people who are neither frail nor at high risk. Therefore, population-based approaches reaching the entire older population are needed.
  
  
  OBJECTIVE
  The objective of the study presented is the development, implementation, and evaluation of a population-based intervention for the prevention of falls and fall-related injuries in a medium sized city in Germany.
  
  
  METHODS
  The study is designed as a population-based approach. The intervention community is a mid sized city named Reutlingen in southern Germany with a population of 112,700 people. All community dwelling inhabitants 65 years and older are addressed. There are two main measures that are defined: (1) increase of overall physical activity, and (2) reduction of modifiable risk factors for falls such as deficits in strength and balance, home and environmental hazards, impaired vision, unsafe footwear, and improper use of assistive devices. The implementation strategies are developed in a participatory community planning process. These might include, for example, training of professionals and volunteers, improved availability of exercise classes, and education and raising awareness via newspaper, radio, or lectures.
  
  
  RESULTS
  The study starts in September 2010 and ends in December 2013. It is evaluated primarily by process evaluation as well as by telephone survey.
  
  
  CONCLUSIONS
  Physical activity as a key message entails multiple positive effects with benefits on a range of geriatric symptoms. The strength of the design is the development of implementation strategies in a participatory community planning. The problems that we anticipate are the dependency on the stakeholders' willingness to participate, and the difficulty of evaluating population-based programs by hard end points.
authors.affiliation: Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany. diana.klein@rbk.de.
authors.forename: Diana
authors.initials: D
authors.lastname: Klein
authors.forename: Kilian
authors.initials: K
authors.lastname: Rapp
authors.forename: Michaela
authors.initials: M
authors.lastname: Küpper
authors.forename: Clemens
authors.initials: C
authors.lastname: Becker
authors.forename: Torben
authors.initials: T
authors.lastname: Fischer
authors.forename: Gisela
authors.initials: G
authors.lastname: Büchele
authors.forename: Petra
authors.initials: P
authors.lastname: Benzinger
keywords: accidental falls; aged; community; fall prevention; falls; population-based intervention; risk factors