Despite methodological limitations of the evaluation studies reviewed, the consistency of reported reductions in fall-related injuries across all programmes support the preliminary claim that the population-based approach to the prevention of fall-related injury is effective and can form the basis of public health practice. Randomised, multiple community trials of population-based interventions are indicated to increase the level of evidence in support of the population-based approach. Research is also required to elucidate the barriers and facilitators in population-based interventions that influence the extent to which population programmes are effective.
The Harstad injury prevention study: community based prevention of fall-fractures in the elderly evaluated by means of a hospital based injury recording system in Norway.
To describe a community based programme to prevent fractures resulting from falls and evaluate the outcome in terms of changes in fracture rates and short term hospital care costs.
                Prospective intervention study.
                The Norwegian municipalities of Harstad (intervention) and Trondheim (reference) from 1 July 1985 to 30 June 1993.
                The person-years of the study were estimated from yearly census data on people aged 65 years and over. There were 22970 person years in Harstad and 158911 in Trondheim.
                The variables were selected and coded according to the Nordic system and the data were collected as part of a national injury surveillance system. The first three years of the study provided baseline data, while the last five years involved community based interventions-eg, the removal of environmental hazards in homes and promotion of the use of safe footwear outdoors in winter. Rates of fracture from falls did not decline in nursing homes but decreased 26.3% in private homes (p < 0.01). In 65-79 year olds, there was a 48.7% reduction in fall-fracture rates for men in traffic areas in winter (p < 0.05). The data from the reference city, Trondheim, suggested a significant rise in fractures caused by falls. There was a 16.7% reduction in hospital admission rates of fall-fracture patients from private homes, indicating a substantial saving in short term hospital costs. The observed fall-fracture rate reductions in private homes and traffic areas suggest that major parts of the interventions were effective.
                Fall-fracture prophylaxis in the aged is possible in a community based setting that utilises high quality, local injury data.