8 General discussion and summary | 165 populations and help determine which criteria are most relevant for specific outcomes, such as fall prevention. Table 8.2. Exploring how the fall risk classification according to the World Guidelines relate to the frailty classification used in this study. Fall risk Total Non-frail Pre-frail Low 77 (29%) 28 (36%) 49 (26%) Moderate 43 (16%) 11 (14%) 32 (17%) High 129 (49%) 35 (45%) 94 (50%) Unknown 15 (6%) 3 (4%) 12 (6%) Strengths and limitations of our studies Measuring falls and fall-related injuries An important aspect in fall prevention research is the accurate measurement of falls and fall-related injuries. We used daily fall diaries with monthly monitoring. However, the measurement of falls is inherently challenging due to underreporting, recall bias, and differences in how falls are defined and recorded (321, 322). These challenges can lead to the underestimation or overestimation of fall incidence, which in turn impacts the validity of study outcomes and policy recommendations (322). Therefore, the accuracy and standardization of fall measurement is crucial (322). In Chapter 5, we found that 62% of the intervention group and 66% of the control group experienced at least one fall per person per year, which is higher than the 33% reported in other studies (236, 323). Moreover, between 20% and 60% of older adults experience fall-related injuries according to the literature (9-11), while in our study, 43% of the In Balance group and 50% of the control group suffered an injury. The high rates of falls and injuries may be attributed to our study population already having an increased fall risk, and besides intensive prospective monitoring through fall diaries and monthly calls. This intensive monitoring likely captured more falls than studies using retrospective methods, such as questionnaires, and is therefore a strength of this study (324). A similar study using the same monitoring methods reported 59% of participants falling at least once, with 36% experiencing fall-related injuries (325). These high fall rates raise questions about whether retrospective studies underreport falls or use stricter definitions, particularly for a relatively healthy population (324). Since our study focused on non- and pre-frail older adults, these findings are not expected to be influenced by population frailty, as frail older adults have the highest fall risk, followed by pre-frail and non-frail individuals (30).
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