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Abstract
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The Article by Michael Keall and colleagues in The Lancet Public Health addresses the important area of health inequality for Indigenous populations, in this case Māori in New Zealand. Despite strong advances in the research evidence base for prevention of falls in the community setting, some important knowledge gaps remain. One of these gaps relates to the scarcity of culturally relevant falls prevention interventions for older First Nations people (commonly reported as age >55 years), in whom falls and high falls risk are common, and falls and fall-related injuries occur at higher rates than in other older populations (commonly reported as age >65 years) in general, and at younger ages.
The particular public health focus of the paper by Keall and colleagues relates to reducing injuries from falls, with an intervention targeting home environment (indoor and outdoor) modifications. Environmental hazards are an important contributor to falls in older people, both at home, as well as away from home. For younger, healthier, more active older people, a higher proportion of falls occur away from home, whereas for older, frailer, less active older people, the majority of falls occur within the home environment. As such, interventions targeting falls prevention through home modification are likely to have greater effect on frailer older people, who spend most of their time within the home environment. Keall and colleagues also acknowledge that Māori homes can have greater home environmental hazards that might contribute to increased risk of injuries, including from falls. It is important to note that most falls are multifactorial, often involve an environmental hazard, and that intrinsic factors (such as poor vision, impaired balance, or cognitive impairment) can also be important; as such comprehensive falls prevention assessment and intervention are crucial. Home environment safety interventions only address part of the falls risk for people at risk. However, the approach reported by Keall and colleagues was relatively low cost, was able to be applied widely, and substantially reduced falls injuries at home.
The study by Keall and colleagues is a well designed single-blind randomised trial of households with Māori occupants in two regions of New Zealand, with stratification by region. The study built on a...
Language: en |