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Objective: Most studies of falls among older people have focused on those with some degree of balance or mobility impairment. This study aimed to establish whether falls and associated injuries were a major problem among healthy, older women, whether there were some common features in the falls, and whether these falls could be accurately predicted. Method: Ninety‐six healthy, active community‐dwelling women in Melbourne, Australia, aged at least 70 years (mean 74.1 ±4.0) were initially measured on a comprehensive series of laboratory and clinical balance tests, gait, strength and psychometric measures. Subjects were monitored for falls events, circumstances and consequences by use of falls diaries and monthly phone calls. Baseline measures of clinical balance measures and gait were comparable to other studies reporting scores on these measures in samples of healthy older people. Results: During the 12‐month follow‐up period, 49% of subjects fell, with 23% falling more than once; 9% suffered fractures as a result of their fall and 10% suffered strains or other moderate injuries. Many of the falls occurred during non‐threatening activities such as walking, often under altered sensory or environmental conditions. Multivariate logistic regression identified gait symmetry and gait double support duration as the variables most strongly associated with prediction of multiple falters. Conclusions: The results highlight that falls are a major problem among healthy active older women, and that targeted falls prevention programs are required for this group.

The aim of this study was to identify common themes and differences in structure and function of Falls Clinics in Australia, to provide a framework for planning future activity. A paper-based survey was circulated to 20 identified Falls Clinic services throughout Australia in late 2000. Fifteen responses (75%) were received, although two of the 15 Clinics were not operating at the time of the survey, and so their responses were not included. Nine of the Clinics had commenced operation since 1998. Staffing commonly included a physiotherapist, geriatrician, and an occupational therapist, with the comprehensive multidisciplinary assessment process taking an average of 130 minutes. Although standard assessment tools were used by more than half of the Clinics, there were no universally applied assessment tools. Waiting lists for initial assessments ranged up to 16 weeks (average 6 weeks). Most Clinics instituted a number of management options themselves, but also used a range of existing community services to provide some of the planned interventions. Limited formal evaluation of the effectiveness of Clinics was reported. Recommended future activity included increasing staff levels and operating times for Clinics to more adequately meet identified need, increased networking and data sharing between Clinics, and a greater emphasis on research and staff training. We conclude that the recent increase in the number of Falls Clinics around Australia has occurred in a relatively unstructured manner, with many differences in staffing, operation and evaluation. There is a need for improved communication and standardisation of core procedures and assessment tools to facilitate best practice in all Clinics, and to provide a framework for a systematic evaluation of the effectiveness of Falls Clinics in Australia.

Objective: To test the reliability, validity and utility of an "up-timer", an automated device to measure time spent standing and walking.Design: Repeat measurement of mobility one week apart in a convenience sample. Setting: Hostel and nursing homes in Melbourne.Participants: 26 hostel and 24 nursing home residents (aged 70-99 years) participated. They were mobile, with or without the use of walking aids or personal assistance. Outcome measures:"Up-time" (measured with the up-timer); functional activity (measured with the Barthel Index, Functional Independence Measure, Timed Up & Go, and Human Activity Profile); and disability (measured by the Rapid Disability Rating Scale). Results:The test-retest reliability of the up-timer was high (Pearson's r=0.84; P<0.001). Pearson's correlation between the up-timer results and results of functional and disability measures ranged from r=0.47 to r=0.55. The functional measures correlated more highly among themselves (r=0.79 to r=0.92). The performance-based Timed Up & Go test had moderate levels of correlation with both the up-timer and the functional measures. Use of the device was well accepted by both participants and staff. Conclusions:The up-timer is a practical, objective and reliable means of measuring mobility. The useful information it provides is different from, but overlaps with, that obtained from subjective observation or self report. It will complement existing subjective and performance-based measures of activity and mobility.

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