Falls, once thought to be an inevitable consequence of aging are now known to be the result of multiple pathological, psychological and social factors. Moreover, well-conducted research has shown that they can be prevented. Initially it appeared that multiple interventions by a multi-disciplinary team would be the most sensible and indeed the only effective approach. However, single interventions may sometimes be appropriate and on cost grounds would be preferable, provided that they are effective. This is clearly the case in the use of pacemakers for patients who are falling because of cardioinhibitory syncope. However, home modification, a seemingly obvious and intuitively correct intervention, has not been shown to prevent falls, although advice from an experienced occupational therapist can reduce falls, especially in those who have fallen previously. Whether balance training on its own is effective in reducing falls, or needs to be combined with muscle-strengthening exercises and other interventions, will be examined.
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