1 General introduction | 9 people age and/or become frail, the consequences of falls tend to be more severe due to decreased bone density, slower recovery, and a higher likelihood of complications (12, 13). Psychosocial consequences In addition to the immediate physical injuries, older adults can experience psychosocial consequences after a fall (14). A fall can result in concern about falling, and can set off a downward spiral, where the initial incident leads to structural avoidance of daily activities, such as (stair) walking, visiting family or friends or doing household chores (15). As a result, older adults may not only be less physically active, but can also become more socially isolated (15). Furthermore, concerns about falling may undermine a person’s self-efficacy, which is defined as the confidence in one’s ability to manage daily tasks (15-17). This diminished self-efficacy can contribute to feelings of helplessness and depression (18). Moreover, the combination of reduced physical activity, self-efficacy, and social withdrawal not only exacerbates the risk of future falls, but also leads to a deterioration in quality of life, affecting overall well-being (19-21). Economic impact The economic impact of fall-related injuries is substantial, not only due to direct healthcare costs but also because of the broader strain they place on societal resources (22). These include the burden on caregivers, reduced work participation, and diminished community engagement in older adults (22). In 2023, the direct costs associated with fall-related injuries among older adults in the Netherlands exceeded one billion euros (2). With an aging population, these costs are expected to rise even more in the coming years, placing an increasing strain on healthcare systems and societal resources (23, 24). Effective fall prevention not only has the potential to reduce these costs but also is expected to alleviate pressure on healthcare services and improves the quality of life for older adults (23-25). In summary, falls and fall-related injuries represent an increasing problem in the growing older population. Focusing on fall prevention can help older adults to maintain their independence, maintain or improve daily life functioning, enhance their quality of life, and reduce the economic burden on healthcare systems if interventions are (cost-)effective. Physical activity and functional status in relation to falls and fall-related injuries Physical activity plays a complex role in the occurrence and prevention of falls and fall-related injuries among older adults. A physically active lifestyle enhances balance, and bone and muscle strength, but prolonged or intense physical activity may increase fall risk due to exposure to situations where falls and thus injuries might occur (26, 27). On the other hand, avoidance of activities, physical inactivity and sedentary behaviour are also risk factors for
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