8 | Chapter 1 INTRODUCTION Perhaps you also have a neighbor like my neighbor Jan, once active and cheerful, who had to go to the hospital after a stumble and injurious fall. After an emergency surgery, Jan had to stay in the hospital for weeks, followed by intensive rehabilitation. His world suddenly became very small. This fall and injury impacted Jan’s life, leaving him much weaker and less confident than before. Even simple tasks, like getting dressed or making a cup of coffee, became a challenge. Jan started to feel dependent on others, something he had always wanted to avoid. Jan also became afraid of falling, which made him extra cautious, and sometimes even too cautious and fearful. Mentally, it was tough as well. The lively, independent person he was before the fall began to feel down and isolated, and his self-confidence decreased. This anecdote may be familiar to many and shows that falls among older adults are not only common, but can result in serious injuries and can impact independence and quality of life of older adults considerably. In this thesis, my aim was to get better insight into fall risk factors and evaluate a program to prevent falls among older adults. A fall is defined as an unexpected event in which a person comes to rest on the ground, floor, or lower level (1). Falls and their consequences Every year, 30 to 40% of the adults over the age of 65 experience a fall, and this rate increases to 50% for those aged 75 and older (2). There are numerous factors that contribute to the increased fall risk of older adults, including environmental, neural, medication, cognitive and disease-related factors (3). Environmental hazards, such as uneven surfaces or poorly lit spaces, can further increase fall risk, while social isolation, polypharmacy, and chronic diseases can also be risk factors (3). One of the most important factors for age-related physical decline are balance impairments due to diminished proprioception and vestibular function (4). Moreover, sarcopenia, defined as the loss of muscle mass and function with aging can impair physical stability and mobility, making walking and balance corrections after perturbations such as slips and trips more challenging for older individuals (5, 6). Furthermore, cognitive decline can play a crucial role, as decreased cognitive function can impair judgment, reaction time, and spatial awareness, all of which are essential for maintaining balance and avoiding falls (7, 8). Physical injuries The consequences of falls are considerable, with 30 to 50% of these falls resulting in minor injuries such as bruises or small wounds, and 20 to 30% of the falls leading to moderate to severe injuries in older adults, such as a hip fracture or traumatic brain injury (9-11). Although only 1% of the falls results in hip fractures, 90% of all hip fractures are caused by falls (9). As
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