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The present research aims to explore falls and injury prevention interventions for older people, with focused investigations of different but complementary aspects of fall and injury prevention. The research was carried out using quantitative and qualitative methodologies: a Cochrane Overview of Reviews of falls prevention interventions; a focused quantitative assessment of shock absorbing flooring in a hospital setting for those with different risks of fracture, as a sub-analysis of a pilot cluster-randomised controlled trial (The HIP-HOP Flooring study); and a qualitative examination of the relationship between falls and injury prevention interventions and the resulting psychosocial effects for care home residents and staff. The Overview identified two Cochrane systematic reviews which included rate of falls and number of fallers as outcomes. Intervention comparisons were assessed to determine whether the quality of evidence was of a high enough standard for the Overview authors to have confidence in the estimate of effect. Comparisons within two (of a possible nine) single intervention categories, exercise and medication, as well as comparisons in the multiple and multifactorial interventions categories reached this standard and reduced the rate of falls or the number of fallers. Focusing on a specific fall and injury prevention intervention, the assessment of the effect of shock absorbent flooring for hospital patients according to their fracture risk was part of a larger pilot cluster randomised trial. As a pilot, the study informed the methodology and organisation required for a full trial. Tentative findings indicate that more people fell on the shock absorbing flooring than on the control flooring, but sustained less injuries. Additionally, more falls and injuries were sustained by people with an intermediate fracture risk, although again this finding was a little tenuous due to missing data. The interview study presents the experiential aspects of using interventions for fall and injury prevention for care staff and residents in a care home setting. Through this exploration, the study revealed some of the dynamics of the relationship that the carers have with residents concerning the interventions themselves. This also uncovered a much deeper, complex process that the residents were undergoing through the changes that have taken place in their lives, as they move from independent adults in their own homes to semi-dependent adults in a care home. The overall discussion reviews the findings of the studies and highlights that there is still much research to be done around fall and injury prevention interventions in order to not only evaluate the effectiveness and efficacy of interventions, but also to assess the usefulness of the interventions and acceptability on a practical level.

Introduction. Bien que rappelé dans la loi de Santé Publique de 2004, la prise en charge des déterminants de santé liés au vieillissement est insuffisamment prise en compte dans la démarche de soins primaires par les médecins généralistes (MG). Objectifs En comprendre les raisons et révéler les tensions éthiques qui en découlent. Quelles pistes pour améliorer cette prise en charge ? Méthodologie Phase 1 : Entretiens semi-directifs auprès de MG. Phase 2 : Analyse des comptes rendus d'hospitalisations. Phase 3 : Analyse d'une méthode de coordination ville-hôpital. Résultats Les MG reconnaissent faire de la prévention cardiovasculaire essentiellement. Pour les autres déterminants, ils sont favorables à un transfert de compétence dont le champ reste à définir, mais ils souhaitent rester au centre de la prise en charge préventive. Les services hospitaliers abordent peu la prévention du vieillissement et ne prennent le relai que sur ce qui relève de leur spécialité. Les raisons sont multiples dont notamment le mode de financement et une approche médicale par pathologie. Conclusion La médecine intégrée devrait permettre une prise en charge de ces déterminants au prix d'un changement de paradigme concernant l'organisation des soins allant au-delà d'une meilleure coordination interprofessionnelle et ville-hôpital. / Introduction Although it is recalled in the 2004 public health law, taking care of health determinants linked to ageing is inadequately taken into account in the primary care procedure by general practionners (GP) Objectives To understand the reasons and reveal the ethical tensions linked to this. How can we take care of this better? Methodology Phase 1: semi-directive interviews with GPs. Phase 2: analysis of hospital reports. Phase 3: Analysis of a hospital-GP coordination method. Results GPs acknowledge doing mainly cardiovascular prevention. For the other determinants, they are favourable to an area of competence transfer, but they want to remain central in the preventive action. Hospital wards do not deal much with ageing prevention and only deal with what is linked to their speciality. There are many reasons for this of which funding and a medical approach per pathology. Conclusion Integrated medecine should enable to take care of these determinants. The care organisation model will have to change with a better hopital -GP coordination.