There is, I think, something ethereal about i —the square root of minus one. I remember first hearing about it at school. It seemed an odd beast at that time—an intruder hovering on the edge of reality.

Usually familiarity dulls this sense of the bizarre, but in the case of i it was the reverse: over the years the sense of its surreal nature intensified. It seemed that it was impossible to write mathematics that described the real world in …

I and i

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Prospective Cohort Study

As people get older, they may fall more often for a variety of reasons including problems with balance, poor vision, and dementia. Up to 30% may fall in a year. Although one in five falls may require medical attention, less than one in 10 results in a fracture.
This review looked at the healthcare literature to establish which fall prevention interventions are effective for older people living in the community, and included 159 randomised controlled trials with 79,193 participants.  
Group and home-based exercise programmes, usually containing some balance and strength training exercises, effectively reduced falls, as did Tai Chi. Overall, exercise programmes aimed at reducing falls appear to reduce fractures.
Multifactorial interventions assess an individual's risk of falling, and then carry out treatment or arrange referrals to reduce the identified risks. Overall, current evidence shows that this type of intervention reduces the number of falls in older people living in the community but not the number of people falling during follow-up. These are complex interventions, and their effectiveness may be dependent on factors yet to be determined.  
Interventions to improve home safety appear to be effective, especially in people at higher risk of falling and when carried out by occupational therapists. An anti-slip shoe device worn in icy conditions can also reduce falls.
Taking vitamin D supplements does not appear to reduce falls in most community-dwelling older people, but may do so in those who have lower vitamin D levels in the blood before treatment.  
Some medications increase the risk of falling. Three trials in this review failed to reduce the number of falls by reviewing and adjusting medications. A fourth trial involving family physicians and their patients in medication review was effective in reducing falls. Gradual withdrawal of a particular type of drug for improving sleep, reducing anxiety, and treating depression (psychotropic medication) has been shown to reduce falls.
Cataract surgery reduces falls in women having the operation on the first affected eye. Insertion of a pacemaker can reduce falls in people with frequent falls associated with carotid sinus hypersensitivity, a condition which causes sudden changes in heart rate and blood pressure.
In people with disabling foot pain, the addition of footwear assessment, customised insoles, and foot and ankle exercises to regular podiatry reduced the number of falls but not the number of people falling.
The evidence relating to the provision of educational materials alone for preventing falls is inconclusive.

Interventions for preventing falls in older people living in the community

The Pharmacological Basis of Therapeutics A Textbook of Pharmacology, Toxicology and Therapeutics for Physicians and Medical Students. By Prof. Louis Goodman and Prof. Alfred Gilman. Pp. xiii + 1383. (New York: The Macmillan Company, 1941.) 50s. net.

The Pharmacological Basis of Therapeutics

Understanding the relationship between white matter hyperintensities (WMHs) and cognitive and physical decline in people with dementia will assist in determining potential treatment strategies. Cur...

The association between white matter hyperintensity volume and cognitive/physical decline in older people with dementia: A one-year longitudinal study

Home-based exergaming: an effective fall preventive measure for the elderly

P3-564 RESILIENCE, COGNITIVE DECLINE AND DEMENTIA IN OLDER ABORIGINAL AUSTRALIANS: A LONGITUDINAL, POPULATION-BASED STUDY Kylie Radford, Kim Delbaere, Brian Draper, Gail Daylight, Wendy Allan, Terrence Donovan, Robert Cumming, Thi Yen Hill, Danielle Lasschuit, Gail Garvey, G. A. (Tony) Broe The Koori Growing Old Well Study Team, Neuroscience Research Australia, Sydney, Australia; University of New South Wales, Sydney, Australia; Prince of Wales Hospital, Randwick, Australia; University of Sydney, Sydney, Australia; Menzies School of Health Research, Brisbane, Australia. Contact e-mail: k.radford@neura.edu.au

P3‐564: resilience, cognitive decline and dementia in older aboriginal australians: a longitudinal, population‐based study

Falls pose a major threat to the well-being and quality of life of older people. Over 90% of hip fractures result from a fall, and falls are the leading cause of injury-related hospitalization and death in people aged over 65 years. There is now robust evidence on fall risk factors and effective targeted intervention strategies to prevent falls in older people in a range of settings. This chapter provides a summary of fall risk assessment and fall prevention strategies for older people in community, hospital, and residential aged care facilities. Validated fall risk assessment tools can give a strong indication of a person’s risk of falling and can be incorporated into clinical practice. Effective interventions for reducing falls include exercise, multifactorial interventions, enhanced podiatry intervention, home safety occupational therapy interventions, medication review, expedited cataract extraction and daily or weekly vitamin D supplementation in people with low levels of vitamin D.

Kim Delbaere

Papers

The association between white matter hyperintensity volume and cognitive/physical decline in older people with dementia: A one-year longitudinal study

Home-based exergaming: an effective fall preventive measure for the elderly

P3‐564: resilience, cognitive decline and dementia in older aboriginal australians: a longitudinal, population‐based study

Fall prevention interventions

Valpreventie: bij thuiswonende ouderen met verhoogd risico