Young-old and old-old motivation in cooperative fall-prevention programmes.

SIR—The quantum and tempo of ageing in Japanese society are dramatic, particularly in rural, depopulated areas [1]. The fiscal pressure of long-term care costs and the shortage of health care resources have been so severe in these areas that they have stimulated the consolidation of small municipalities, which carry responsibility for public health and welfare programmes into larger units. This has resulted in effective use of public care services and extensive endorsement of disability-postponing (kaigo yobou, in Japanese) programmes [2]. Most prominent for the health maintenance of the elderly population are fall-prevention programmes, which are highly individualised to each municipality. In 2003, we initiated a unique programme in Onishi Town, Gumma Prefecture, in which community-dwelling elderly people themselves coordinate and share responsibilities of running such a programme based on mutual cooperation. The elderly population of Onishi has grown, with 28.1% of the population (total population of 7,300 as of October 2003) aged 65 years and above. Fall-prevention seminars were publicised in advertisements in the town office newspaper, through public relations activities at senior centres, and at meetings of elderly people’s clubs. In this programme, younger old people led the activities and played a dual role as participant and in transporting older people to the programme by car. Since recruitment in the initial stage was successful, the programme was subsequently expanded to other municipalities in the region. Two hundred and twenty-nine participants (mean age 72.8 +/−, range 60–91 years) participated in the fallprevention seminars. All applications were voluntary, and the organisers distributed no invitations. First-time participants were interviewed regarding fall-prevention measures they currently used, and the measures were classified according to the Guideline for the Prevention of Falls in Older Persons [3]. The majority of the subjects (58.5%) responded that they had taken or were taking actions to avoid falling. The most common actions taken by the participants included concentrating more on not falling (92 persons; 68.7%), exercises (28 persons; 20.8%), and modifications of the living environment (8 persons; 5.9%). Multiple regression analysis indicates that older age (odds ratio 0.34, 95% CI 0.15–0.94 in the 60s compared with the 80s) and shorter functional reach (odds ratio 2.53, 95% CI 1.12–5.68 in the lowest quartile compared with the highest quartile) are important predictors of taking fall-prevention measures. Gender, hospital visits, frequency of going out, instrumental activities of daily living, history of falling, falls efficacy scale, and knee extensor muscle strength did not reach statistical significance. The old-old and those experiencing more functional aging seem to have participated in the programmes with the concrete goal of extending their current daily practice of fall prevention. However, additional factors may also motivate participants. Japanese elderly in both urban and rural settings increasingly experience isolation from family and community. Even those living in twoor three-generation families have a strong desire to avoid becoming a burden on their relatives and strive to maintain independence and meaningful social roles [4]. Thus, the cooperation of youngold and old-old in this programme offers an additional incentive for participation. Health care professionals in cooperation with municipal offices are primarily responsible for introducing these programmes. However, in fiscally strapped rural areas where older people comprise over one-quarter of the population, elderly citizens are not simply recipients of community programmes, but must also share in the responsibility for health promotion and community reform. Previous reports of fallprevention programmes have focused on multifaceted menus for individual clients, but do not consider interpersonal relationships developed through the programme. The success of the Onishi fall-prevention programme challenges communities to examine ways of creating meaningful relationships across generations and of fostering mutual help among older people.