When evidence is not enough: the challenge of implementing fall prevention strategies.

PROBLEM: As the evidence-based movement has advanced in public health, changes in public health practices have lagged far behind creating a science to service gap. For example, science has produced effective falls prevention interventions for older adults. It now is clearer WHAT needs to be done to reduce injury and death related to falls. However, issues have arisen regarding HOW to assure the full and effective uses of evidence-based programs in practice. SUMMARY: Lessons learned from the science and practice of implementation provide guidance for how to change practices by developing new competencies, how to change organizations to support evidence-based practices, and how to change public health systems to align system functions with desired practices. The combination of practice, organization, and system change likely will produce the public health benefits that are the promise of evidence-based falls prevention interventions. IMPACT ON PUBLIC HEALTH: For the past several decades, the emphasis has been solely on evidence-based interventions. Public health will benefit from giving equal emphasis to evidence-based implementation. IMPACT ON INDUSTRY: We now have over two decades of research on the effectiveness of fall prevention interventions. The quality of this research is judged by a number of credible international organizations, including the Cochrane Collaboration (http://www.cochrane.org/), the American and British Geriatrics Societies, and the Campbell Collaboration (http://www.campbellcollaboration.org/). These international bodies were formed to ponder and answer questions related to the quality and relevance of research. These developments are a good first step. However, while knowing WHAT to do (an evidence-based intervention) is critical, we also need to know HOW to effectively implement the evidence. Implementation, organization change, and system change methods produce the conditions that allow and support the full and effective use of evidence-based interventions. It is time to focus on utilization of implementation knowledge in public health. Without this focus the vast amount on new evidence being generated on the prevention of falls and related injuries among older adults will have little impact on their health and safety.

A public health approach to fall prevention among older persons in Canada.

In 2008 to 2009, there were 53,545 fall-related hospitalizations among Canadian seniors, accounting for 85% of all injury-related hospitalizations and 7% of all hospitalizations for those aged 65 years and older. The estimated cost of fall-related injuries to the Canadian health care system in 2004 was more than $2 billion among a population of 4.1 million seniors. This article describes highlights of how policy makers, researchers, and practitioners are applying a public health approach to the issue of seniors' falls in Canada, including the successes, challenges, and recommendations for the future.

Plasticity of the association between visual space and action space in a blind-walking task.

Many experiments have shown that a brief visual preview provides sufficient information to complete certain kinds of movements (reaching, grasping, and walking) with high precision. This suggests that participants must possess a calibration between visual target location and the kinaesthetic, proprioceptive, and/or vestibular stimulation generated during movement towards the target. We investigated the properties of this calibration using a cue-conflict paradigm in which participants were trained with mismatched locomotor and visual input. After training, participants were presented with visual targets and were asked to either walk to them or locate them in a spatial updating task. Our results showed that the training was sufficient to produce significant, systematic miscalibrations of the association between visual space and action space. These findings suggest that the association between action space and visual space is modifiable by experience. This plasticity could be either due to modification of a simple, task-specific sensory motor association or it could reflect a change in the gain of a path integration signal or a reorganisation of the relationship between perceived space and action space. We suggest further experiments that might help to distinguish between these possibilities.