8 General discussion and summary | 167 Fall prevention in the Netherlands In the Netherlands, fall prevention is integrated in a healthcare pathway and chain approach, as outlined in the 2021-2025 coalition agreement (330). The current coordinated care pathway involves risk screenings, targeted interventions, and follow-up programs, as recommended by both national guidelines and the World Guidelines, aiming that older adults receive continuous support to reduce falls and injuries, see Figure 8.1 for an overview of the chain approach in the Netherlands (243, 273). This agreement tasks municipalities with organizing fall prevention programs and offering them to older adults. The aim is to screen 14% of community-dwelling older adults annually for fall risk, with 3% expected to follow a program (330). This means that approximately 90,000 people should be screened/offered a fall prevention program yearly, a great challenge given the current lack of capacity (330). To meet this demand, the number of fall prevention programs and therapists must be expanded, and a well-developed organizational structure with effective coordination is essential (331). Although we did not find statistically significant differences in costs or effects in Chapter 6, the probability that In Balance was cost-effective compared to control was 98% at a willingness-to-pay of 0 €/unit of effect gained. This shows that In Balance can be considered a promising intervention and that de-implementation is not warranted, but further refinements are necessary to maximize its impact and sustainability. To further implement fall prevention interventions in the Netherlands, municipalities should collaborate with local health organizations to train therapists, secure funding, and create centralized systems for managing program availability and participant intake. To improve accessibility, fall prevention programs like In Balance, Otago, and the Nijmegen falls prevention program could be scaled up, with some elements offered online for those who prefer and can safely follow this format. Suggestions to make fall prevention interventions more accessible are to provide interventions in local community centres to reduce potential travel barriers. Additionally, follow-up exercise programs should be emphasized to maintain or enhance health benefits when the intervention ends.
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