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You are here: Home Modules Main Case Examples The Fall Prevention and the Elderly Program Socio-ecological determinants of falls among the elderly
Socio-ecological determinants of falls among the elderly Print E-mail
Ontario Public Health Practioners
Level of socio-ecological model

Example and reference to supporting empirical literature


Patterns and type of exercise (Benjamin et al., 2005)
Seniors’ perceptions of barriers to physical activity (Lockett, Willis & Edwards, 2005)


Buddy systems in apartment buildings where neighbours check on each other to see if anyone has fallen and been injured


Coalitions or other groups working to prevent falls by raising awareness and addressing policy change (Edwards et al., chapter on falls, 1999)

Built/physical environment



Grab bars in bathrooms, safe stairs
(Edwards, Lockett et al., 2003; Aminzadeh et al., 2001)

Social environment


Safe and clean public lavatories near walking paths in parks (Lockett, Willis & Edwards, 2005).
Esthetically pleasing and safe walking areas near seniors’ housing (Giles-Corti & Donovan, 2003).

Organizational policy
(workplaces, places of worship, housing)

Skilled volunteers organized in the community to make home modifications such as installing handrails on indoor and outdoor stairs (Edwards, Lockett & Benjamin, 2006)

Municipal policy

Traffic-control policies on amount of time allowed for pedestrians to use a crosswalk
Policies on marking cracks in public sidewalks and the average length of time to fix them (Gallagher & Scott, 1997)

Provincial policy

Provincial building codes for private and public housing (Edwards, Birkett, Nair, Murphy et al., 2006)

National policy

Recommendations for building codes by the National Research Council (Aminzadeh, 1996)

Fall prevention and the elderly – Selecting intervention options

Multiple intervention programs must target at least two levels of the socio-ecological system with different interventions, but finding and assessing which interventions to use can be daunting, as we found in our work with the regional fall-prevention coalition. The problem was huge and there was a large range of interventions to consider. We started by meeting partner organizations to discuss where joint action would be most effective, and decided to work together on environmental hazards. Even with this narrower focus, there was a long list of hazards to address. On top of that, the coalition was new, and unaccustomed to working together.

With input from the research team, the coalition agreed on criteria to prioritize environmental hazards. Our research team provided data from the literature and regional studies to rate objective criteria, which included effectiveness (the expected impact of intervention strategies), the reach of the interventions and the feasibility of change. This led the coalition to tackle two hazards – stairs and bathtubs – and we began to research and develop integrated intervention programs.

At the same time we were developing our program criteria, we were working on subjective criteria to develop an effective coalition, which was important as we started our work together. These subjective criteria included the likelihood that working jointly on environmental hazards would make the coalition feel like a team, and the potential that the intervention would to yield an early success story, which would also build team spirit.

Last Updated on Monday, 01 June 2009 07:53