Active Ageing Project: Desk research report

Ref. Ares(2025)11600205 - 26/12/2025

DESK RESEARCH REPORT

Funded by the European Union. Views and opinions expressed are however those of the author(s) only and do not necessarily reflect those of the European Union or the European Education and Culture Executive Agency (EACEA). Neither the European Union nor EACEA can be held responsible for them.

ABOUT THE PROJECT The Active Ageing for Falls Prevention project, coordinated by the Sports Union of Slovenia, is a Europe-wide initiative addressing one of the most significant public health challenges faced by ageing societies: the high incidence of falls among older adults. Falls are a leading cause of injury, disability, and loss of independence in older populations, yet research shows that many falls can be prevented through targeted physical activity focused on balance, strength, coordination, and functional fitness. The project brings together a broad partnership of organizations from several European countries, including national sport federations, local sport clubs, public health organizations, research institutions, and community-based service providers. The consortium works collaboratively to design, test, and implement effective, evidence-based exercise programmes that help older adults maintain mobility, improve balance, and build strength — thereby significantly reducing their risk of falling.

At the core of the project is the ABC+ Movement Program, a structured exercise methodology specifically tailored to meet the needs of seniors. The programme includes carefully designed group training sessions that combine: Balance training to improve stability and prevent loss of balance; Strength exercises to maintain muscle mass, joint stability, and postural control; Functional mobility exercises to support daily activities and independence; Coordination drills to support movement control and confidence.

The project emphasizes not only the delivery of exercise sessions but also the training of trainers and local instructors, who are equipped with scientifically validated methodologies and practical tools to safely work with older populations. To support this, the partnership has developed a comprehensive set of resources, including: Exercise programme for older adults, focused on falls prevention Guidelines for organisations Training materials for trainers with videos Pilot programmes will be implemented in Slovenia, Italy, France, and Finland. These pilots will engage local sport clubs, municipalities, and senior organizations, in the roll-out of the ABC+ Movement Program. Regular assessments, participant feedback, and functional tests have demonstrated not only improved physical function among participants but also enhanced psychological well-being, greater social engagement, and improved quality of life.

Beyond the direct health benefits, the project also aims to build sustainable local and national capacities for fall prevention through: Awareness-raising activities, Knowledge exchange between sectors, Policy recommendations for integrating fall prevention into community sport and health promotion strategies.

Active Ageing for Falls Prevention demonstrates the powerful role that community sport organizations can play in public health promotion and ageing policies. The project offers a scalable, replicable model that can be implemented by local sport clubs, municipalities, and health organizations across Europe.

The initiative is co-funded by the European Union under the Erasmus+ programme and is part of consortium’s broader effort to promote physical activity as a key component of healthy, active, and independent ageing.

Project landing page: https://active-ageing.isca.org/

INTRODUCTION Falls in older adults represent a major public health challenge globally, associated with severe medical, functional, psychological, and socioeconomic consequences. Increasing longevity, together with the demographic ageing of European societies, amplifies the magnitude of this problem. Falls are, however, largely preventable through multifactorial interventions that combine medical management, environmental adjustments, and targeted physical activity. This report synthesises current scientific knowledge on falls prevention in older adults, with a particular focus on evidence-based exercise interventions and national preventive models.

The demographic transformation driven by increasing life expectancy has positioned population ageing as one of the central societal challenges of the 21st century. Globally, the number of people aged 65 years and older is projected to double by 2050, reaching nearly 1.5 billion individuals (WHO, 2021). In Europe, this demographic shift is particularly pronounced, with countries such as Slovenia already witnessing a steady increase in the ageing index and a substantial proportion of older adults within their populations. As a result, the burden of ageassociated health conditions, including falls, is intensifying.

Falls are recognised as a major public health issue affecting older adults and represent one of the leading causes of injury, disability, institutionalisation, and mortality in this population (Tinetti, 2003; WHO, 2021). The World Health Organization defines a fall as “an unexpected event in which the person comes to rest on the ground, floor, or lower level” (WHO, 1977; WHO, 2007).

Importantly, falls are rarely attributable to a single factor; rather, they are typically the result of complex interactions between intrinsic factors (such as sarcopenia, impaired balance, visual deficits, cognitive impairment, chronic diseases, and polypharmacy) and extrinsic factors (such as environmental hazards and unsafe footwear) (Rok Simon, 2020).

The epidemiological data are striking. Each year, approximately one-third of adults aged over 65, and up to 42% of adults aged over 70, experience at least one fall (Montero Odasso et al., 2022; WHO, 2021). Approximately 5% of all falls result in fractures, most notably hip fractures, which account for 95% of all fall-related fractures in the elderly and represent one of the most severe consequences due to their association with increased mortality and long-term functional decline (Peel, 2002; Rok Simon, 2020). Furthermore, falls are responsible for a substantial proportion of healthcare resource utilisation, with estimates suggesting that fall-related injuries contribute to approximately 1% of total healthcare expenditures in high-income countries (O Mahony et al., 2015).

In addition to their physical consequences, falls can trigger a cascade of psychological and social effects, including fear of falling, loss of confidence, reduced mobility, social withdrawal, and increased dependence on caregivers or institutional care. The cyclical nature of these consequences often leads to progressive deconditioning and increased frailty, further amplifying fall risk.

Importantly, despite the multifactorial nature of falls, robust scientific evidence demonstrates that many falls are preventable through comprehensive, multidisciplinary interventions. Among these, physical activity — particularly programmes targeting balance, strength, mobility, and functional fitness — has emerged as the most effective, accessible, and sustainable strategy for primary and secondary prevention of falls (Macaluso et al., 2004; Vandervoort, 2002; Sherrington et al., 2017; Gillespie et al., 2012).

Given the complexity of fall risk and the heterogeneity of the older adult population, successful fall prevention requires coordinated action at multiple levels — including healthcare, community services, sport organisations, and public health policy. The Slovenian national approach exemplifies an integrated model that combines early risk detection, individualised assessment, targeted exercise interventions, and community-based health promotion, developed within the framework of the Active Ageing for Falls Prevention Erasmus+ project. This report aims to synthesise current scientific evidence on falls prevention, highlight the critical role of physical activity, and present the Slovenian approach as a case study of effective implementation within the broader European context of healthy ageing policies.

THE PHYSIOLOGICAL BASIS OF FALL RISK The risk of falls in older adults is primarily rooted in complex physiological changes associated with the natural ageing process. While some decline in physical capacity is considered an inevitable consequence of biological ageing, the extent and rate of decline are highly variable and influenced by multiple modifiable and non-modifiable factors (Macaluso et al., 2004; Vandervoort, 2002).

Neuromuscular Degeneration and Sarcopenia One of the most significant contributors to fall risk is the age-related loss of skeletal muscle mass and strength, a condition referred to as sarcopenia. Sarcopenia leads to reduced power output, impaired joint stability, decreased mobility, and diminished capacity to respond effectively to balance perturbations (Macaluso et al., 2004). Muscle strength declines by approximately 1–2% per year after the age of 50, accelerating to 3% per year beyond the age of 70 (Vandervoort, 2002). Lower limb weakness in particular compromises gait stability, step height, and the ability to perform critical protective responses such as rapid stepping after a loss of balance.

Impairments in Balance and Postural Control Postural stability is the result of complex interactions between the neuromuscular, sensory, and central nervous systems. Ageing is associated with deterioration in all three domains: Vestibular dysfunction reduces the ability to perceive head and body position relative to gravity.

Proprioceptive decline impairs joint position sense and movement accuracy.

Slower central processing delays the detection and correction of postural disturbances.

These deficits lead to impaired static and dynamic balance, increased sway, and higher variability in gait patterns, all of which substantially elevate fall risk (Howe et al., 2011; Tinetti, 2003).

Cognitive and Executive Function Decline Emerging evidence highlights the important role of cognitive function — particularly executive function — in maintaining postural control and gait safety (Montero Odasso et al., 2022).

Executive functions such as attention, dual-tasking ability, and response inhibition are crucial for navigating complex environments, avoiding obstacles, and reacting to unexpected situations.

Cognitive impairment and dementia significantly increase fall risk, underscoring the need for interventions that address both physical and cognitive components of balance control.

Sensory Deficits Age-related declines in visual acuity, contrast sensitivity, and depth perception reduce the ability to detect hazards, judge distances, and adapt to changes in lighting or terrain. Hearing impairment, while less directly associated with falls, may contribute to environmental awareness deficits that elevate risk indirectly (Rok Simon, 2020; WHO, 2021).

Cardiovascular and Autonomic Changes The ageing cardiovascular system may contribute to orthostatic hypotension, reduced cerebral perfusion, and transient dizziness, all of which predispose individuals to instability during positional changes or prolonged standing (Montero Odasso et al., 2022). Polypharmacy, particularly the use of sedatives, antihypertensives, and psychotropic medications, further exacerbates these effects.

Comorbidity Burden and Frailty The presence of multiple chronic conditions — such as diabetes, osteoporosis, arthritis, depression, and Parkinson’s disease — further compounds functional impairments. The syndrome of frailty, characterised by exhaustion, unintended weight loss, weakness, slow gait speed, and low physical activity, strongly predicts falls and adverse outcomes following falls (Fried et al., 2001).

The Multifactorial Nature of Fall Risk In most older adults, no single factor fully explains fall risk. Instead, falls typically arise from the interaction of multiple vulnerabilities that collectively overwhelm compensatory mechanisms.

Consequently, effective fall prevention requires comprehensive assessment and intervention across multiple domains, rather than isolated focus on any single risk factor (Gillespie et al., 2012; Montero Odasso et al., 2022).

Summary Table: Key Physiological Risk Factors for Falls Risk Domain

Key Age-Related Changes

Impact on Fall Risk

Muscle system

Sarcopenia, reduced strength and power

Impaired balance, reduced mobility

Balance control

Proprioceptive decline, vestibular dysfunction,

Postural instability

Cognitive function

Executive dysfunction, dual-tasking

Gait variability, hazard detection

Sensory systems

Visual decline, depth perception deficits

Impaired navigation and hazard detection

Cardiovascular system

Orthostatic hypotension,

Dizziness, syncope

Medication effects

Sedatives, antihypertensives,

Impaired balance and alertness

Comorbidities

Osteoporosis, diabetes, arthritis, depression

Frailty, reduced function

In this complex physiological landscape, physical activity emerges as one of the few modifiable interventions capable of targeting multiple domains of risk simultaneously — preserving muscle function, enhancing balance and coordination, supporting cognitive processing, and reducing fear of falling (Macaluso et al., 2004; Vandervoort, 2002; Sherrington et al., 2017).

Psychosocial Dimensions and Fear of Falling In addition to physiological and clinical risk factors, psychosocial variables play a critical role in fall risk among older adults. One of the most significant psychological contributors is fear of falling, which can emerge after a previous fall or even in individuals who have never experienced one. This fear leads to activity restriction, social withdrawal, and reduced confidence in performing daily tasks — all of which accelerate physical deconditioning and further elevate fall risk (Delbaere et al., 2004). This phenomenon, often referred to as the "post-fall syndrome", creates a selfperpetuating cycle of inactivity, frailty, and increasing dependence. Interventions targeting fall prevention must therefore address not only physical capacity but also confidence, perceived selfefficacy, and emotional resilience.

Functional Decline and Environmental Mismatch Age-related changes often result in a mismatch between the individual's functional capacity and the environmental demands of their living space. Even seemingly minor obstacles — such as uneven flooring, poor lighting, high shelves, or lack of handrails — can pose significant hazards for individuals with impaired balance, slower reaction times, or reduced flexibility. Furthermore, the interplay between physical limitations and cognitive decline may result in poor hazard recognition or unsafe behaviour in the home. This underscores the importance of environmental assessments and modifications as part of a multidimensional fall prevention strategy. Importantly, physical activity interventions that enhance adaptability, motor planning, and real-world functional movement can help bridge the gap between physiological capacity and environmental challenge.

THE ROLE OF PHYSICAL ACTIVITY IN FALLS PREVENTION Given the complex, multifactorial origins of falls, effective prevention strategies must address multiple physiological, cognitive, and psychosocial domains simultaneously. Among all modifiable interventions studied to date, physical activity—particularly structured, targeted exercise programmes—consistently demonstrates the strongest preventive effect on falls in older adults (Sherrington et al., 2017; Gillespie et al., 2012; Montero Odasso et al., 2022).

Physical activity acts upon numerous biological mechanisms implicated in fall risk. Resistance training directly combats sarcopenia and dynapenia by preserving and improving muscle mass, strength, and power, particularly in the lower limbs (Macaluso et al., 2004; Vandervoort, 2002).

Balance training enhances postural stability through improved neuromuscular coordination, proprioception, and adaptive motor control. Functional mobility exercises increase gait stability, agility, and the capacity to execute protective reflexes during perturbations (Howe et al., 2011).

Furthermore, accumulating evidence supports the role of physical activity in preserving cognitive function, including executive processes and attention, both of which are essential for safe ambulation in complex, real-world environments (Liu-Ambrose et al., 2010; Montero Odasso et al., 2022). Regular exercise also exerts positive effects on mood, self-confidence, and fear of falling— critical psychosocial determinants of fall risk (Delbaere et al., 2004).

The preventive effect of exercise has been extensively confirmed in numerous randomised controlled trials (RCTs) and summarised in multiple systematic reviews. A comprehensive Cochrane meta-analysis by Gillespie et al. (2012), based on 159 trials with over 79,000 participants, demonstrated that exercise interventions reduce the rate of falls by 23% and the risk of experiencing one or more falls by 15%. More recent updates by Sherrington et al. (2017, 2020) reinforced these findings, highlighting that: Balance-challenging exercises are the most effective single modality.

Programmes combining balance, strength, mobility, and functional tasks yield the largest benefits.

Interventions delivered three or more times per week over at least 12 weeks are necessary for optimal effect.

Exercise remains effective even in older adults aged over 80, including those at elevated fall risk.

The World Guidelines for Falls Prevention and Management (Montero Odasso et al., 2022) recommend that falls prevention exercise programmes should: Be progressive, individualised, and supervised by trained professionals.

Include multicomponent exercises targeting balance, strength, gait, and functional mobility.

Be delivered at sufficient frequency (minimum of 150 minutes per week).

Be maintained continuously to prevent decline after cessation of training.

General physical activity alone (e.g., walking) is insufficient for fall prevention unless complemented by specific balance and strength training. Therefore, specialised exercise protocols are critical for achieving maximal preventive impact.

A major challenge in fall prevention lies not only in initiating exercise programmes but also in ensuring long-term adherence and maintenance. Evidence suggests that the benefits of exercise diminish when participation ceases, underscoring the need for continuous opportunities to remain physically active throughout ageing (Montero Odasso et al., 2022; WHO, 2021).

Programmes embedded into daily routines, community organisations, or health promotion centres demonstrate higher sustainability than time-limited clinical interventions.

Importantly, physical activity confers benefits that extend beyond fall prevention alone. These include: Maintenance of independence in activities of daily living.

Preservation of mobility and social engagement.

Reduction in depression, anxiety, and loneliness.

Delayed onset of frailty and disability.

Potential reduction in healthcare utilisation and institutionalisation (O Mahony et al., 2015).

Thus, physical activity constitutes not only a fall prevention tool but a central pillar of healthy and active ageing (WHO, 2021).

Emerging research suggests that initiating structured physical activity interventions before significant functional decline occurs yields the greatest long-term benefits. Targeting older adults at the early stages of balance impairment, mobility reduction, or mild sarcopenia allows for a more robust physiological response to exercise, better preservation of neuromuscular plasticity, and greater prevention of future frailty syndromes (Montero Odasso et al., 2022; Macaluso et al., 2004). Early engagement in balance and strength training can delay or even reverse subclinical deficits, reduce compensatory maladaptive behaviours such as activity restriction, and ultimately preserve independent living for longer durations. This preventive approach is particularly relevant in public health planning, where broad population-based screening may help identify at-risk individuals before they enter high-risk trajectories.

While physical activity stands as the single most effective intervention for fall prevention, its effectiveness increases further when integrated into comprehensive, multidisciplinary fall prevention programmes. These typically combine exercise with medication reviews, vision correction, environmental hazard reduction, nutritional optimisation, and psychosocial support (Montero Odasso et al., 2022; WHO, 2021). Physical activity programmes serve not only as stand-alone interventions but also as a platform to engage older adults in holistic preventive care, fostering intersectoral collaboration between healthcare, rehabilitation, community organisations, and sport sectors. This integrative model is reflected in modern national strategies, such as Slovenia’s crosssectoral approach, which leverages exercise as the foundation for broader healthy ageing policies.

EUROPEAN AND GLOBAL HEALTHY AGEING FRAMEWORKS The rising prevalence of falls among older adults has prompted a coordinated response from multiple international bodies, including the European Union (EU) and the World Health Organization (WHO), both of which have identified falls prevention as a central priority within their broader healthy ageing and non-communicable disease (NCD) prevention strategies. Within this context, the Active Ageing for Falls Prevention Erasmus+ project contributes to transnational capacity building by developing and promoting the ABC+ Movement Programme — an evidencebased, community-oriented exercise model specifically designed to prevent falls among older adults.

Alignment with the WHO Decade of Healthy Ageing (2020–2030) The WHO’s Decade of Healthy Ageing 2020–2030 provides a comprehensive global action framework, emphasising the need to maintain functional ability and well-being across the lifespan, rather than focusing exclusively on disease management. The WHO defines healthy ageing as “the process of developing and maintaining the functional ability that enables wellbeing in older age” (WHO, 2021). Functional ability includes multiple intrinsic capacities such as mobility, cognition, sensory function, vitality, and psychosocial well-being — domains that are directly addressed by the ABC+ Movement Programme.

Moreover, the WHO identifies falls prevention as one of its five key priority areas for global ageing policies, calling for the implementation of multisectoral interventions that combine clinical care, rehabilitation, long-term care, and community-based services. The ABC+ Movement Programme is fully aligned with this recommendation by: Targeting key physical determinants of functional ability (balance, strength, mobility, flexibility).

Empowering older adults through supervised and home-based physical activity.

Being adaptable for integration into both healthcare settings and community organisations.

Offering scalable, low-cost solutions that can be implemented across diverse populations and regions.

In addition, the programme reflects WHO's 2021 Step Safely report, which specifically recommends community-delivered multicomponent exercise programmes as the most effective population-level intervention to reduce fall incidence and related disability.

Alignment with EU Strategies on Active and Healthy Ageing The European Union has developed multiple policy frameworks that directly support initiatives such as the ABC+ Movement Programme: The EU Green Paper on Ageing (2021) calls for the promotion of active and healthy ageing across all sectors of society, encouraging intersectoral cooperation between healthcare, sport, education, and social services.

The EU Council Recommendation on Health-Enhancing Physical Activity (HEPA, 2013) explicitly identifies older adults as a priority target group for physical activity promotion, calling for the development of

community-based, evidence-driven programmes to maintain functional independence.

The Healthier Together – EU Non-Communicable Disease Initiative (2022) emphasises fall prevention, physical activity promotion, and integrated care for older adults as key policy pillars in addressing NCD burden in Europe.

The ABC+ Movement Programme contributes directly to these EU-level objectives by: Operationalising evidence-based falls prevention through structured physical activity interventions.

Providing a model for cross-sectoral implementation, combining healthcare professionals, sport organisations, rehabilitation specialists, and local governments.

Supporting capacity building and knowledge exchange across European countries, as exemplified by the Erasmus+ project structure involving multiple transnational partners.

Generating scalable methodologies that can inform both national policies and EU-wide standards for falls prevention in ageing populations.

In addition to its scientific and policy alignment, the ABC+ Movement Programme introduces several added values that directly address practical implementation gaps observed across Europe: Trainer education modules prepare non-clinical exercise professionals to safely deliver falls prevention programmes at the community level.

Digital resources and learning platforms enable broad dissemination and accessibility.

Cultural and contextual adaptability allows the model to be tailored to varying national systems, local infrastructures, and resource settings across EU member states.

Sustainability focus, aiming for long-term integration into health promotion centres, sport organisations, and municipal service structures.

By bridging the evidence-to-practice gap, the ABC+ Movement Programme represents an innovative operational tool for advancing the WHO and EU agendas on healthy ageing, physical activity, and falls prevention at both national and European levels.

THE AGEING OF THE POPULATION The ongoing demographic shift towards population ageing represents one of the most significant structural transformations of the 21st century, with far-reaching consequences for health systems, economies, and societies worldwide. What distinguishes the current phase of demographic transition is not only the scale but also the unprecedented rapidity of the ageing process.

According to projections, by 2050 the global proportion of individuals aged 65 years and older will double, increasing from 11% to 22% of the total population (WHO, 2021).

A historic milestone will be reached within the next decade: for the first time in recorded human history, the number of people aged 65 and older will surpass the population of children under 5 years of age. While developing countries will experience the greatest absolute growth in the older adult population, high-income countries will face particularly steep increases in the oldest-old segment (aged 80 years and above), which is projected to quadruple by 2050 (WHO, 2021). This demographic evolution poses substantial and multifaceted challenges. The ageing of populations will directly affect healthcare demand, long-term care provision, pension systems, labour force participation, and family caregiving structures. It is therefore imperative to implement anticipatory and comprehensive policy responses aimed at ensuring the resilience and sustainability of health and social care systems.

Concurrently, global health patterns have undergone a profound epidemiological transition.

Whereas infectious and nutritional diseases once constituted the primary causes of morbidity and mortality, the contemporary burden of disease is now dominated by chronic degenerative conditions. In wealthier countries, cardiovascular and cerebrovascular diseases, alongside neuropsychiatric disorders such as depression and Alzheimer’s disease, account for the majority of the disability-adjusted life years (DALYs) lost (GBD, 2019; WHO, 2021). A similar increase in disability prevalence, primarily driven by non-communicable diseases (NCDs), is also emerging in low- and middle-income countries, particularly among older age groups.

The combination of increased longevity and shifting disease burden gives rise to complex socioeconomic risks. With the growing number of older adults requiring health services, long-term care, and financial support, the potential for a “longevity shock” — defined as a sudden rise in public sector expenditure — has been recognised by institutions such as the International Monetary Fund. This creates significant pressures for resource allocation, financing models, and intergenerational equity.

In addition, the rising incidence of age-related neurodegenerative disorders, particularly Alzheimer’s disease and other dementias, underscores the urgency of preventive approaches. Projects such as the Italian PRoject on the Epidemiology of Alzheimer’s disease (IPREA) have highlighted the accelerating prevalence of cognitive impairment as populations age (IPREA Project, 2020).

In the face of these challenges, effective public health strategies must prioritise health promotion, disease prevention, maintenance of functional ability, and support for independent living among older adults. Multisectoral policy integration — spanning healthcare, social services, urban planning, and community-based programmes — will be essential to mitigate the long-term consequences of population ageing while preserving quality of life.

Implications of Ageing for Health Systems and Society Ageing is a complex, multidimensional process that affects physiological, psychological, and social domains of human functioning. It is characterised by a progressive decline in both physical and cognitive capacities, accompanied by an increased prevalence of chronic diseases and functional impairments. However, health in older adults cannot be defined solely by the absence of disease. Rather, it encompasses a broader concept of physical, psychological, and social wellbeing, even in the presence of multiple comorbidities (WHO, 2021). In this context, the indicator of disability-free life expectancy (DFLE) has gained increasing importance as a more comprehensive measure of healthy ageing. Unlike traditional life expectancy, DFLE incorporates both longevity and functional ability by estimating the number of years individuals can expect to live without significant limitations in activities of daily living (ADL). As such, DFLE directly reflects an individual's ability to maintain autonomy, quality of life, and participation in society despite advancing age (Crimmins et al., 2016).

The primary goal of ageing policies is therefore not merely to extend lifespan, but to preserve selfsufficiency, functional independence, and quality of life throughout older adulthood. To achieve this, healthcare systems must not only provide adequate medical and rehabilitative care, but also prioritise preventive strategies aimed at mitigating risk factors across the life course. Promotion of healthy lifestyles — including physical activity, balanced nutrition, cognitive stimulation, and social engagement — plays a central role in maintaining functional capacity and delaying the onset of disability. Moreover, equitable access to healthcare, social services, and opportunities for social participation and integration is essential to prevent isolation, psychological decline, and premature institutionalisation among older adults. Ensuring inclusion and community participation contributes not only to well-being but also to long-term system sustainability. The importance of shifting towards an active ageing paradigm has been formally recognised at both European and global levels. In 2012, the EU designated the year as the "European Year of Active Ageing and Solidarity between Generations", emphasising the shared responsibility across sectors and generations to support ageing populations. The World Health Organization similarly dedicated its World Health Day 2012 to the theme of "Ageing and Health: Good Health Adds Life to Years", underscoring the global relevance of healthy ageing policies.

Nevertheless, as the proportion of older adults requiring care and support continues to increase, traditional welfare systems face mounting pressure.

With a simultaneous decrease in the working-age population and rising numbers of pensioners, many high-income countries are confronting a growing imbalance in social security systems, threatening the financial sustainability of healthcare, pensions, and long-term care infrastructures.

These dynamics underscore the urgent need for health system reform, increased investment in preventive care, and innovative models of service delivery that address the evolving needs of ageing populations.

The demographic shift towards population ageing necessitates profound adaptations in the organisation and delivery of both health and social care systems. In order to preserve functional ability, maintain independence, and reduce the burden on acute healthcare services, it is imperative to shift the focus from hospital-based care to community-centred, preventive, and rehabilitative approaches (WHO, 2021; OECD, 2020). Avoiding unnecessary hospitalisations through early intervention, comprehensive rehabilitation, environmental modifications, and socioeconomic support is critical for mitigating the risks of functional decline and institutionalisation among older adults.

An effective response to these complex needs lies in the establishment of integrated care networks, where multidisciplinary teams collaborate to provide coordinated and person-centred care. Such teams typically include physicians, nurses, physiotherapists, social workers, psychologists, and other professionals, who work together to assess and manage the needs of older adults, particularly those classified as frail or at risk of losing self-sufficiency (WHO ICOPE Guidelines, 2019). Central to this integrated approach is the multidimensional geriatric assessment (MGA), a comprehensive evaluation tool that systematically examines an individual’s: Physical health and comorbidities, Cognitive and mental health status, Functional ability and disability level, Social support networks and family situation, Economic resources and living environment (Stuck et al., 1993; Pilotto et al., 2017).

This holistic assessment enables the formulation of personalised, feasible, and context-sensitive intervention plans that reflect both the individual’s needs and the local resources available. The goal is to maximise autonomy, prevent further decline, and allocate healthcare resources efficiently. The case manager plays a pivotal role in coordinating the care pathway, ensuring that recommended interventions are implemented and adjusted as needed. The case manager may be the patient themselves, a designated family caregiver, a healthcare professional, or a social services representative. Effective care coordination improves the efficiency of interventions, reduces service fragmentation, and enhances the patient’s experience of care (Boult et al., 2009).

Despite the conceptual advantages of integrated care models, implementation remains a challenge in many countries. For example, in Italy — as in several other high-income nations — services for older adults often remain insufficient, fragmented, and primarily reactive rather than proactive. Access to comprehensive care is often delayed until advanced stages of frailty, multimorbidity, and polypharmacy are already present, typically affecting individuals over the age of 80 (Rizzuto et al., 2018).

At the scientific level, advancing ageing research remains crucial to better elucidate the biological, psychological, and social mechanisms underlying age-related vulnerability, multimorbidity, and geriatric syndromes. Greater understanding of these mechanisms will be essential for developing more precise preventive interventions, optimising treatment approaches, and informing health system reforms that can effectively meet the demands of rapidly ageing populations (Kennedy et al., 2014; Ferrucci et al., 2018).

The Demographic Challenge of Population Ageing in Europe The demographic ageing of European societies continues to accelerate, posing substantial challenges for economic sustainability, healthcare systems, and social welfare structures. Over the past decade alone, the average age in the European Union (EU) has increased by 2.3 years, rising from 42.2 years in 2013 to 44.5 years in 2023 (Eurostat, 2023). Certain countries, such as Italy, are experiencing particularly rapid demographic transitions: Italy’s average age increased by 4 years over the same period, making it one of the most rapidly ageing countries in Europe. Only Sweden and Malta recorded a decrease in average age, largely due to differing patterns of fertility, migration, and population renewal.

The primary drivers of this demographic shift are well-established. Firstly, sustained declines in fertility rates have led to a shrinking base of younger cohorts entering the population, resulting in an increasing median age. Secondly, continued gains in life expectancy — attributable to improvements in healthcare, public health, and living standards — have led to the expansion of older age groups within the population pyramid (WHO, 2021; OECD, 2020). Together, these two processes are generating a demographic structure characterised by a growing proportion of older adults and a simultaneous contraction of the working-age population. The consequences of this demographic transformation are wide-ranging. The expansion of elderly populations exerts increasing pressure on health and long-term care services, as well as on pension and social security systems. Simultaneously, the shrinking labour force poses challenges for economic productivity, tax base stability, and intergenerational solidarity. In certain regions, particularly those experiencing net out-migration, demographic ageing is also contributing to processes of depopulation and community decline, further complicating regional development and social cohesion (IMF, 2021).

Addressing these complex challenges requires comprehensive, multi-sectoral policy responses.

Proposed strategies include: Development of family support policies that encourage higher fertility rates through financial incentives, childcare provision, and work-life balance measures.

Promotion of labour market participation, particularly among women, older workers, and underrepresented groups.

Implementation of public awareness campaigns to foster social acceptance of active ageing and intergenerational cooperation.

Increased investment in research and innovation to advance biomedical science, ageing research, and health system adaptation.

Strengthening of preventive public health measures aimed at promoting healthy and active ageing to reduce the future burden of chronic disease and disability.

While population ageing presents significant and unprecedented challenges, it also reflects the successes of medical, economic, and social development over recent decades. Through shared societal commitment and evidence-informed policy action, European countries have the opportunity to transform the demographic shift into a platform for sustainable development, innovation, and improved quality of life for current and future generations.

INCREASED FALL RISK IN OLDER ADULTS Falls represent one of the most serious public health concerns in geriatric populations, with approximately one in four older adults experiencing a fall each year (CDC, 2020; WHO, 2021).

Falls are the leading cause of hip fractures and a major cause of traumatic brain injuries, contributing significantly to morbidity, disability, loss of independence, and mortality in older adults (Tinetti, 2003; Montero Odasso et al., 2022). A prominent contributor to falls in ageing populations is the development of balance impairment syndromes, collectively referred to as presbyastasis. Presbyastasis is characterised by a progressive decline in balance control, leading to gait instability, slower walking speeds, increased postural sway, and difficulty adapting to environmental challenges (Agrawal et al., 2009). While some decline in balance function is attributable to natural ageing, multiple intrinsic and extrinsic factors further contribute to balance deterioration and fall risk.

The pathophysiology of balance impairment in ageing is complex and often multifactorial, involving the interaction of sensory, neuromuscular, cardiovascular, and psychological systems (Muir et al., 2010). The following factors are commonly implicated: Vestibular dysfunction: The inner ear's vestibular system plays a central role in maintaining equilibrium. Age-related degeneration of the vestibular apparatus (labyrinth) and disorders such as labyrinthitis can cause vertigo, dizziness, and impaired postural control (Agrawal et al., 2012).

Cardiovascular dysregulation: Orthostatic hypotension, hypertension, cerebrovascular disease, and reduced cerebral perfusion contribute to dizziness, light-headedness, and balance instability (Freeman et al., 2011).

Medication side effects: Polypharmacy, particularly use of antihypertensives, sedatives, psychotropic medications, and certain antihistamines, can induce balance impairment, dizziness, and unsteadiness (Woolcott et al., 2009).

Neurological disorders: Conditions such as Parkinson’s disease, stroke, multiple sclerosis, and amyotrophic lateral sclerosis impair central nervous system control of posture, gait, and coordination (Bloem et al., 2001).

Musculoskeletal degeneration: Osteoarthritis, muscle weakness, joint stiffness, and reduced proprioceptive sensitivity compromise postural stability and adaptive balance responses (Macaluso et al., 2004).

Visual impairment: Declines in visual acuity, depth perception, and contrast sensitivity limit spatial orientation and hazard detection, especially in low-light environments (Lord et al., 2007).

Psychological factors: Anxiety, depression, and fear of falling may amplify postural instability through maladaptive movement patterns and reduced physical activity (Delbaere et al., 2010).

Nutritional deficiencies: Insufficient intake of vitamin D, calcium, and other micronutrients may exacerbate musculoskeletal frailty and increase fracture risk in the event of a fall (Bischoff-Ferrari et al., 2004).

Balance impairment in older adults often presents with a spectrum of symptoms that may serve as early warning signs of elevated fall risk. These include: Vertigo and dizziness: A sensation of spinning or unsteadiness, often exacerbated by positional changes.

Gait instability: Staggering, unsteady, or slow walking patterns with widened base of support.

Blurred vision: Visual instability, particularly during head movements.

Cognitive disorientation: Difficulty with spatial orientation, concentration, and mental focus.

Autonomic symptoms: Nausea, vomiting, fluctuations in heart rate and blood pressure.

Emotional symptoms: Heightened anxiety, panic, fear of falling, and depressive mood.

Fatigue: Generalised exhaustion, which may further impair motor control and adaptive responses.

The severity, frequency, and progression of these symptoms vary considerably among individuals.

In some cases, balance dysfunction may be mild and intermittent; in others, it may lead to persistent disability, social withdrawal, and institutionalisation. Given the substantial impact of balance impairment on fall risk and quality of life, early recognition of presbyastasis and related disorders is crucial. Comprehensive clinical assessment—including vestibular function testing, orthostatic blood pressure monitoring, medication review, neurological evaluation, and musculoskeletal examination—enables clinicians to identify treatable causes and initiate appropriate interventions (Montero Odasso et al., 2022).

Individualised management plans incorporating multicomponent exercise, balance training, strength conditioning, environmental modifications, and psychological support have been shown to significantly reduce fall incidence and improve functional stability (Sherrington et al., 2017). A personalised, timely, and interdisciplinary approach allows older adults to maintain autonomy, minimise fall risk, and preserve quality of life well into advanced age.

Falls in older adults are frequently associated with multiple risk factors that extend beyond physical decline alone. One important contributor is loss of functional independence, which significantly increases fall risk (Bloch et al., 2010). Individuals who experience difficulty performing at least one basic activity of daily living (ADL), such as bathing or dressing, or one instrumental activity of daily living (IADL), such as cooking or shopping, have been shown to have double the risk of falling compared to their fully independent peers. Similarly, reductions in mobility — whether limited to the immediate neighbourhood or resulting in institutionalisation — have been identified as predictors of elevated fall risk due to compounded functional and motor impairments (Bloch et al., 2010).

Social support networks also exert measurable effects on fall risk. Marital status has been found to play a protective role, particularly in individuals aged over 80 years. Loss of a spouse is associated with increased vulnerability due to reduced emotional, practical, and social support, contributing to functional decline, psychological distress, and elevated mortality (Sbarra, 2015; Umberson et al., 2014). These findings reinforce the growing recognition that psychosocial factors interact closely with biomedical and functional variables to influence fall risk trajectories in later life.

Importantly, falls often become recurrent events, rather than isolated accidents. Longitudinal research conducted in Singapore (Guat Cheng Ang et al., 2020) revealed that nearly 30% of individuals who experience one fall will sustain another within 12 months. Such recurrent falls frequently signal underlying, potentially modifiable medical and environmental risk factors, as well as post-fall psychological consequences. One particularly detrimental psychological consequence is the development of post-fall anxiety syndrome, wherein fear of falling leads to activity restriction, social withdrawal, depression, and a self-perpetuating cycle of deconditioning and elevated fall risk (Delbaere et al., 2010; Yardley et al., 2004).

The co-occurrence of multiple risk factors significantly elevates the probability of both first-time and recurrent falls. Comprehensive assessment and multifactorial intervention strategies addressing these modifiable domains are therefore critical to effective falls prevention.

Prevalence studies continue to document the high incidence of falls among older adults: approximately one-third of individuals aged 65 years and older experience at least one fall per year, a proportion that increases to nearly 50% among those over 80 years old (WHO, 2021; Montero Odasso et al., 2022). Many falls remain underreported or unrecognised ("silent falls"), as older adults may fail to disclose minor falls to family members or healthcare providers, contributing to missed prevention opportunities (Stalenhoef et al., 2002).

Falls frequently result in fractures, head injuries, mobility impairment, and even mortality.

According to data from the SAFE (Steps to Avoid Falls in the Elderly) programme, falls account for 85% of trauma-related emergency room admissions in older adults (Lord et al., 2007). Even in the absence of physical injury, the fear of falling remains a powerful determinant of activity avoidance, social isolation, depression, and progressive functional decline, further reinforcing the vicious cycle of fall-related disability.

Given the high prevalence of falls and their complex, multifactorial aetiology, primary care physicians play a critical role in early detection and prevention. Many "silent fallers" present to primary care for unrelated complaints but may not voluntarily report previous falls. As such, routine screening for falls history, gait disturbances, and balance impairments is recommended for all individuals over 65 years of age (Montero Odasso et al., 2022; American Geriatrics Society, 2011). Proactive screening and timely intervention enable clinicians to identify modifiable risk factors before recurrent falls occur. Incorporating falls assessments into annual comprehensive geriatric evaluations is an effective strategy to systematically address fall risk in older adults with chronic conditions (AGS/BGS Guidelines, 2011). This integrated approach allows primary care providers to serve as central coordinators in interdisciplinary fall prevention strategies, ultimately improving functional outcomes and preserving quality of life in ageing populations.

WORLD GUIDELINES MANAGEMENT

FOR

FALLS

PREVENTION

AND

The World Guidelines for Falls Prevention and Management for Older Adults: A Global Initiative (2022), published under the leadership of Montero Odasso et al. and endorsed by the World Falls Guidelines International Working Group, represent the first globally coordinated, evidence-based consensus recommendations addressing falls prevention and management in ageing populations.

The guidelines were developed through comprehensive systematic reviews of the scientific literature and expert consensus processes, providing a unified international framework for clinicians, policymakers, and researchers.

Rationale and Scope Recognising that falls remain the leading cause of injury, disability, and mortality among older adults worldwide, the guidelines address the urgent need for standardised, multidisciplinary, and globally applicable recommendations that can inform national strategies and clinical practice across diverse healthcare settings. The guidelines aim to promote early identification of fall risk, comprehensive assessment, and the implementation of multifactorial, evidence-based interventions to reduce fall incidence and related consequences.

The guidelines focus specifically on community-dwelling older adults, while also providing recommendations for institutionalised populations and high-risk clinical subgroups. They are intended for application across high-, middle-, and low-income countries, with adaptations based on healthcare system capacity and resource availability.

The World Guidelines for Falls Prevention and Management define a three-tiered approach: Screening Routine fall risk screening is recommended for all adults aged 65 years and older, regardless of whether a fall has already occurred.

Screening should include inquiries about recent falls, fear of falling, balance impairments, and walking difficulties.

Positive screening should trigger a more detailed assessment.

Comprehensive Falls Risk Assessment A multidimensional assessment should be conducted multidisciplinary team for individuals identified as being at risk.

Key domains assessed include: Fall history and circumstances Gait, balance, and mobility Visual and hearing function Cognitive status and mental health Foot and footwear conditions Comorbidities such as osteoporosis, depression, and incontinence

by

a

Cardiovascular function Muscle strength Medication review Environmental hazards Nutritional status

Intervention and Management Strategies The guidelines strongly recommend the implementation of multifactorial, individually tailored interventions, which include: Exercise-based interventions: Multicomponent exercise programmes, primarily focusing on balance and strength training, are identified as the single most effective strategy for falls prevention.

Medication optimisation: Deprescribing or adjusting fall-risk-increasing medications.

Environmental modifications: Home hazard assessments and adjustments to reduce environmental risks.

Vision correction: Screening and management of visual impairments.

Management of orthostatic hypotension and cardiovascular conditions.

Nutritional supplementation: Correction of vitamin D insufficiency when indicated.

Psychological support: Addressing fear of falling, anxiety, and depression.

Foot care and appropriate footwear recommendations.

Strength of Recommendations The guideline authors assign strong levels of recommendation to balance- and strength-based exercise interventions, given their consistently demonstrated efficacy in randomised controlled trials and meta-analyses. The guidelines also emphasise that exercise interventions should: Be individually tailored to the participant’s risk profile and functional ability.

Include progressively challenging balance exercises.

Be supervised initially and incorporate adherence strategies to ensure long-term participation.

The guidelines acknowledge that some subpopulations, such as individuals with dementia, Parkinson’s disease, and frailty, require modified assessment and intervention protocols, though these groups still benefit from structured fall prevention programmes.

The guidelines distinguish between non-syncopal and syncopal falls, emphasising that the latter require specific cardiovascular investigations and tailored management.

The guidelines promote a systems-based approach, recommending that falls prevention be embedded within integrated models of geriatric care, primary care, and public health systems.

The World Guidelines for Falls Prevention and Management provide an internationally harmonised roadmap to reduce the global burden of falls through: Standardised clinical practice recommendations.

Promotion of evidence-based, scalable interventions.

Cross-disciplinary collaboration among healthcare providers, researchers, policymakers, and community organisations.

Adaptability to diverse healthcare settings, from high-resource to resource-limited contexts.

By defining falls prevention as a public health priority rather than an isolated clinical task, the guidelines contribute to the broader goals of the WHO Decade of Healthy Ageing (2020–2030), advocating for the maintenance of functional ability, autonomy, and quality of life throughout the lifespan.

CONCLUSION Falls among older adults represent a highly prevalent, serious, yet largely preventable public health challenge. As this desk research report has demonstrated, the multifactorial nature of falls requires equally multidimensional interventions that address both intrinsic and extrinsic risk factors across physiological, psychological, environmental, and behavioural domains. Among all available interventions, structured physical activity programmes remain the most effective, evidence-based, scalable, and cost-efficient strategy for falls prevention in community-dwelling older adults.

Extensive scientific evidence supports the role of multicomponent exercise — incorporating balance, strength, functional mobility, flexibility, and coordination — as the core of falls prevention.

These effects are further amplified when integrated into comprehensive public health frameworks, as illustrated by the Slovenian national approach, which successfully merges healthcare, community-based health promotion, and sport-sector collaborations.

The development of the ABC+ Movement Programme within the Erasmus+ Active Ageing for Falls Prevention project offers an important contribution to both national and European-level capacity building in this domain. The ABC+ model reflects international best practices, is fully aligned with the WHO Decade of Healthy Ageing and EU Healthy Ageing frameworks, and provides a highly adaptable operational tool that can be scaled across diverse healthcare and community infrastructures throughout Europe.

Based on the accumulated evidence and practical experiences presented in this report, several key implications emerge for policy, research, and implementation: Early identification and screening for fall risk should be systematically integrated into primary care and community health services, enabling timely referral to preventive interventions before functional decline accelerates.

Multidisciplinary collaboration between healthcare providers, rehabilitation specialists, sport organisations, and municipal governments is critical for delivering effective, sustainable, and locally adapted falls prevention programmes.

Training of non-clinical exercise professionals (e.g. sport instructors, fitness trainers, community workers) provides a scalable workforce capable of delivering evidence-based physical activity interventions at population level.

Long-term maintenance strategies should ensure continued access to structured physical activity opportunities beyond initial programme completion to sustain functional gains and prevent relapse into inactivity.

Policy alignment at EU level offers the opportunity to establish shared quality standards, certification frameworks, and cross-border knowledge exchange platforms that facilitate consistent implementation across Member States.

While the evidence base for physical activity in falls prevention is strong, several areas warrant further research attention: Longitudinal studies examining the sustainability of functional improvements beyond 12-24 months.

Optimisation of exercise delivery models for high-risk subpopulations, including frail elderly, individuals with cognitive impairment, or multimorbidity.

Application of digital technologies, such as remote monitoring, tele-rehabilitation, and artificial intelligence-based personalisation to enhance adherence and individual tailoring.

Economic evaluations to demonstrate long-term healthcare cost savings attributable to structured falls prevention programmes.

In summary, the combination of robust scientific evidence, national-level implementation, and innovative models such as the ABC+ Movement Programme provide a strong foundation for advancing effective falls prevention strategies within the broader global healthy ageing agenda.

Coordinated European action through platforms such as Erasmus+, WHO collaborations, and national public health systems will be crucial in realising the full potential of these interventions for safeguarding the independence, dignity, and well-being of Europe’s ageing population.

BEST PRACTICE COLLECTION

TOGETHER FOR HEALTH PROGRAMME The Together for Health (Skupaj za zdravje) programme represents a cornerstone of Slovenia’s national public health strategy. Originally developed for chronic disease prevention, it has been successfully expanded to address the complex health needs of older adults, including falls prevention, functional decline, and active ageing promotion. The programme reflects a comprehensive, population-level approach, rooted in the principles of prevention, early detection, and empowerment for sustainable lifestyle change. It is implemented across multiple sectors of the healthcare system and engages national, regional, and local stakeholders, ensuring wide accessibility and adaptability.

The Together for Health programme operates across three interconnected levels of intervention: Primary Healthcare Level (Family Medicine Units) Preventive check-ups are offered to all adult patients, with particular attention to those aged 65 and older. These check-ups systematically screen for risk factors associated with chronic diseases, falls, and functional decline. Identified risks trigger referrals to further assessments or appropriate interventions.

Health Promotion Centres Located within community health centres, these centres deliver a broad range of services including: Health education workshops focusing on physical activity, nutrition, mental health, weight management, diabetes management, smoking cessation, and alcohol use.

Individual counselling for behaviour change, stress management, anxiety, and depression.

Physical fitness assessments for older adults, including evaluations of balance, strength, aerobic capacity, and mobility.

The centres serve as a key infrastructure for delivering structured group-based preventive interventions, including falls prevention exercise programmes.

Community-Based Health Promotion Activities Local municipalities and partner organisations implement public health events, such as: Health days, open-door community events, municipal walking tests, and workshops.

Educational outreach through local media channels (radio, TV, newspapers).

Networking with schools, sports organisations, patient associations, NGOs, urban planners, and businesses to promote active living environments.

This multilevel delivery system ensures that preventive care is embedded not only in healthcare institutions but also within the social and living environments of the target populations.

While the programme is open to the entire adult population, a particular focus has been placed on older adults living in the community.

VADBECEDA The vAdBeCeDa programme represents Slovenia’s first nationally developed and publicly funded exercise programme specifically designed to promote healthy ageing, functional independence, and falls prevention in older adults. Developed by the National Institute of Public Health (NIJZ), in collaboration with healthcare professionals, physiotherapists, and public health experts, the programme provides a scientifically validated model for preventing functional decline and reducing fall risk across the older adult population. vAdBeCeDa aims to: Preserve functional capacity and independence in daily living.

Improve balance, muscle strength, mobility, and coordination — key components directly linked to fall prevention.

Delay the onset of frailty, chronic disease complications, and disability.

Support psychological well-being and social inclusion by encouraging participation in guided group activities.

The vAdBeCeDa programme follows a progressive and structured exercise model, consisting of: Twelve exercise sessions conducted in small group settings under professional supervision.

Exercises targeting: Balance control and postural stability.

Lower limb muscle strength.

Joint mobility and flexibility.

Functional coordination and gait stability.

Safe stretching routines.

Progressive adaptation according to the participant’s fitness level, functional ability, and specific health conditions.

The programme follows the principle of graded advancement across four difficulty levels (A, B, C, D), allowing for individualised progression as participants improve their physical function. vAdBeCeDa is delivered free of charge to all adults covered by the national health insurance system. Sessions are provided by trained physiotherapists and kinesiologists within the national network of Health Promotion Centres. In addition to supervised group sessions, the programme offers home-based digital resources, including: Mobile application support.

Online video exercise tutorials.

Printable exercise instructions for self-guided practice.

This hybrid model ensures accessibility to participants with varying mobility levels and personal circumstances, while promoting long-term adherence to physical activity. By addressing both intrinsic fall risk factors (muscle weakness, balance impairments, mobility limitations) and modifiable lifestyle determinants, the programme provides a robust foundation for national-level fall prevention strategies.

UKK INSTITUTE WEEKLY PHYSICAL RECOMMENDATION FOR ADULTS 65+

ACTIVITY

The UKK Institute in Finland has developed a comprehensive and evidence-informed set of weekly physical activity recommendations designed specifically for adults aged 65 and over.

These guidelines are part of a broader public health strategy aimed at maintaining vitality, functional independence, and fall prevention among older populations.

Core Recommendations Finland’s model advocates a balanced activity framework comprising four interrelated components: Muscle Strengthening, Balance & Flexibility Exercises: At least twice weekly sessions focusing on major muscle groups, dynamic and static balance, and flexibility (e.g., gym, home workouts, yoga, dance).

Moderate Aerobic Activity: Accumulate ≥ 2 hours 30 minutes per week of moderate-intensity activities (e.g., brisk walking, Nordic walking, dancing), with each session lasting ≥ 10 minutes.

Alternatively, ≥ 1 hour 15 minutes of vigorous aerobic activities (e.g., cycling, stair climbing).

Light Physical Activity: Engage in low-intensity, daily movement (“every step counts”) through household tasks, gardening, walking the dog, etc., as frequently as possible.

Breaking Sedentary Behaviour & Ensuring Adequate Sleep: Take frequent breaks from sitting; incorporate standing or movement into sedentary routines. Emphasise restorative sleep (e.g., night-time rest sufficient to feel refreshed).

The programme highlights that short sessions are beneficial, and provides a detailed 16-page presentation, brochure, online resources, and promotion tools for both individuals and professionals.

The UKK Institute supports implementation with a suite of downloadable materials: Brochures and posters summarising the weekly recommendations.

Slide decks for community or clinical group guidance.

Online activity assessment tools, including questionnaires and apps.

KaatumisSeula® fall-risk screening tools, featuring self-assessment forms, checklists, preventive advice, and exercise guidance.

The Finnish programme aligns with international evidence and WHO recommendations, emphasising the necessity of multicomponent exercise regimens to maintain musculoskeletal strength, balance, cardiopulmonary fitness, and neurocognitive health, all of which are central to fall prevention and functional resilience. By formally integrating these guidelines into public health infrastructure and developing user-friendly dissemination tools, Finland offers a scalable, evidence-based model that can inform similar initiatives worldwide.

HEALTHY EXERCISE ABC Healthy Exercise ABC, also known as Zdrava vadba ABC, is Slovenia’s structured, multilevel exercise programme designed to re-engage physically inactive individuals and support healthy ageing through evidence-based training. Developed collaboratively by the Športna unija Slovenije and NIJZ experts—including specialists in sports science, rehabilitation, and public health—the programme has rapidly become a national reference model for community-based physical activity promotion.

Target population: Inactive or minimally active adults aged 18 and above, including those recovering from injury, illness, or sedentary lifestyles.

Primary goals: Restore baseline fitness, improve functional strength and flexibility, and enable sustainable participation in longer-term community or club-based exercise initiatives.

The programme is structured into three progressive phases, each lasting six weeks (A, B, C), with each phase subdivided into two three-week blocks (e.g., A1, A2). Participants train twice per week, each session divided into: Preparatory phase: Aerobic warm-up and dynamic stretching Main phase: Functional strength and flexibility exercises, including pelvic floor strengthening Cool-down phase: Static stretching and relaxation This design ensures gradual increases in workload, volume, and complexity, advancing participants from foundational to more challenging functional movements by the end of phase C. Key components: Functional exercises targeting essential daily-living movement patterns (squats, lunges, core strengthening).

Pelvic floor training, uniquely embedded to promote balance, continence, and core stability.

Utilisation of accessible equipment (e.g., resistance bands, light dumbbells, therapy balls).

Delivered under qualified supervision, ensuring safety, progressive overload, and correct technique.

Format supports social engagement and group-based motivation, increasing adherence.

Designed as a stepping-stone: upon completion, participants are encouraged to transition into club-based or broader community physical activity opportunities.

PROFOUND – PREVENTION OF FALLS NETWORK FOR DISSEMINATION The Prevention of Falls Network for Dissemination (ProFouND) was a major EU-funded initiative aimed at reducing the burden of falls among older adults across Europe. Funded under the European Commission’s Health Programme 2008–2013, ProFouND brought together more than 21 partners from 12 EU member states, including universities, healthcare providers, public health agencies, and patient organisations.

ProFouND’s core mission was to: Support the widespread implementation of evidence-based falls prevention interventions.

Build national and regional capacity for multidisciplinary collaboration on falls prevention.

Standardise and disseminate best practice models for integration into public health systems.

Foster cross-border knowledge exchange and policy alignment within EU Member States.

ProFouND aligned closely with WHO falls prevention guidelines, European Council HEPA recommendations, and the emerging WHO Healthy Ageing framework.

Key activities are: Creation of a European Falls Prevention Network Established a transnational network of clinical experts, researchers, policymakers, and practitioners committed to falls prevention.

Development of Standardised Training Programmes Designed a series of evidence-based, competency-based exercise instructor training modules, including the widely adopted Otago Exercise Programme (OEP) Train-the-Trainer programme, which has been successfully implemented in multiple European countries.

Online Knowledge Platform Built an interactive e-learning platform for healthcare professionals, trainers, and policymakers, offering falls risk screening protocols, intervention guidelines, and educational materials for older adults and caregivers.

Public Awareness Campaigns Launched multi-language public awareness campaigns promoting fall prevention, safe mobility, and environmental safety at home and in communities.

Policy Engagement Collaborated with national health ministries and EU institutions to advocate for formal inclusion of falls prevention into ageing, health promotion, and rehabilitation policies.

AGE-EN-FRIENDLY The AGE-EN-FRIENDLY project is a German national initiative focused on creating safer, more supportive environments for older adults as part of a comprehensive approach to falls prevention, functional independence, and active ageing. It was developed through collaboration between federal public health authorities, municipal governments, urban planners, and ageing researchers, and reflects Germany’s commitment to implementing WHO’s age-friendly cities concept at national scale.

The AGE-EN-FRIENDLY project aims to: Reduce the incidence of falls and age-related disability by modifying both physical and social environments.

Support independent living and safe mobility for older adults in community settings.

Integrate falls prevention strategies into urban planning, healthcare services, and local public health systems.

Foster intersectoral collaboration between healthcare, social services, municipal infrastructure, and community organisations.

Key intervention components are: Community-Based Falls Prevention Programmes Municipal exercise groups offering balance, strength, and mobility training.

Adapted evidence-based interventions (e.g. OTAGO, Tai Chi, functional movement training).

Public education campaigns to increase awareness of modifiable fall risks at home and in public spaces.

Health System Integration Primary care providers systematically screening for fall risk using validated assessment tools.

Integration of physiotherapy and occupational therapy referrals within coordinated care pathways.

Development of electronic health record modules for routine falls risk documentation.

Interdisciplinary Training Programmes Capacity-building programmes for urban planners, architects, healthcare providers, and social care professionals on how environmental factors interact with fall risk.

Professional education on early identification of frailty, sarcopenia, and balance impairments.

Built Environment Modifications Age-friendly city audits assessing: Sidewalk safety and maintenance.

Barrier-free public transport access.

Safe pedestrian crossings.

Improved lighting and visibility.

Public seating and resting opportunities.

Urban design recommendations that directly reduce outdoor fall hazards and promote safe physical activity for seniors.

DUTCH NATIONAL FALLS PREVENTION PROGRAMME The Netherlands has developed a comprehensive, population-wide strategy for falls prevention in older adults that integrates evidence-based exercise interventions, structured risk screening, and coordinated community care pathways. The Dutch model is internationally recognised for its strong foundation in both scientific research and healthcare system integration.

The Dutch National Falls Prevention Programme seeks to: Reduce fall incidence, fall-related injuries, and hospital admissions among older adults.

Identify high-risk individuals early through systematic screening and health system integration.

Provide access to evidence-based, multicomponent exercise interventions for balance, strength, and mobility.

Develop sustainable models for delivering fall prevention programmes at the community level.

The Dutch National Falls Prevention Programme integrates healthcare, community, and public health interventions into a coordinated national model: Systematic Fall Risk Screening: Primary care providers routinely assess fall risk during consultations using validated tools such as the Timed Up and Go test, balance evaluations, medication reviews, orthostatic blood pressure measurements, and cognitive assessments.

This allows early identification of high-risk individuals.

Multidisciplinary Falls Clinics: High-risk patients receive comprehensive evaluations in falls clinics, where geriatricians, physiotherapists, occupational therapists, pharmacists, and nurses collaborate to create personalised care plans addressing physical, medical, and psychosocial risk factors.

Evidence-Based Community Exercise: Supervised group exercise programmes focus on balance, strength, and mobility. The Otago Exercise Programme, Tai Chi, and the LiFE approach integrate strength and balance training into daily routines, adapted for both frail and cognitively impaired individuals.

Municipality Engagement: Local governments co-finance prevention programmes, organise public awareness campaigns, promote home safety, and run community walking groups and workshops, ensuring local accessibility and long-term engagement.

Professional Training: Physiotherapists, nurses, and instructors undergo specialised training to deliver standardised, evidence-based falls prevention interventions, ensuring programme quality and patient safety.

GOOD LIFE WITH OSTEOARTHRITIS (GLA:D®) Denmark has developed one of the most comprehensive integrated community models for managing musculoskeletal health, preventing falls, and promoting functional independence in older adults. While the GLA:D® programme was initially designed for osteoarthritis management, it has been successfully incorporated into Denmark's broader falls prevention strategies due to its impact on strength, balance, and mobility — key fall risk factors.

The Danish approach aims to: Reduce falls through early management of musculoskeletal disorders, which are major contributors to balance deficits.

Integrate evidence-based exercise and education directly into primary care and municipal services.

Empower older adults to maintain independence and prevent functional decline through long-term behavioural change.

General practitioners and physiotherapists identify individuals at risk for falls or functional decline related to joint problems, sarcopenia, or early frailty. Screening is systematically embedded into routine consultations and preventive visits.

Patients participate in a 12-week structured programme combining: Two educational sessions on joint health, pain management, and self-care.

Twice-weekly supervised neuromuscular exercise sessions focusing on lower-limb strength, functional movement, balance, and stability.

Although primarily aimed at patients with knee or hip osteoarthritis, the programme significantly improves functional strength, balance confidence, and walking stability — all directly linked to fall risk reduction. The structured approach helps patients continue physical activity long after programme completion.

GLA:D® and other falls prevention exercises are widely offered through: Municipal rehabilitation centres, accessible to the entire population.

Collaboration with local physiotherapy clinics.

Public health campaigns promoting physical activity, joint health, and safe movement.

Municipalities, healthcare providers, and rehabilitation professionals work together, ensuring early intervention for frail older adults or those reporting mobility issues. Denmark’s strong municipality-driven public health system ensures that falls prevention, physical activity, home safety assessments, and counselling on medication and nutrition are systematically offered to vulnerable older adults.

The Danish approach exemplifies how musculoskeletal management, community-based rehabilitation, and fall prevention can be integrated into national health and social care systems. Its emphasis on early intervention, evidence-based exercise, and local accessibility serves as a transferable model for ageing societies across Europe.

PREVENTION OF FALLS IN THE ELDERLY The region of Catalonia (Spain) has implemented a structured, system-wide approach to falls prevention through the Catalan Health Plan and its "Prevention of Falls in the Elderly" (Prevenció de Caigudes en Gent Gran) programme. This initiative integrates health services, social care, and local community resources to address both intrinsic and extrinsic fall risk factors in ageing populations.

The Catalonian programme is designed to: Reduce the incidence of falls and fall-related injuries among older adults.

Integrate systematic screening for falls risk into primary care and geriatric services.

Provide targeted, multidisciplinary interventions addressing physical, medical, environmental, and behavioural risk factors.

Promote healthy ageing through active lifestyles, self-management, and community participation.

Primary care physicians routinely assess fall risk for all patients over 65 using standardised tools: Fall history.

Functional tests (Timed Up and Go, gait speed).

Polypharmacy and medication reviews.

Cognitive and sensory function assessments.

Comorbidity screening (osteoporosis, cardiovascular health, frailty status).

For high-risk individuals, coordinated care teams composed of general practitioners, geriatricians, physiotherapists, occupational therapists, nurses, and social workers create individualised prevention plans. These plans address: Physical function (strength, balance, mobility).

Medication management.

Vision and hearing optimisation.

Environmental home safety assessments.

Nutritional support and vitamin D supplementation.

Management of fear of falling and anxiety.

Falls prevention exercise classes are widely available through: Municipal health centres.

Community sports clubs.

Physiotherapy practices.

These programmes focus on balance, lower-limb strength, functional mobility, and coordination, with protocols often adapted from evidencebased models such as Otago and Tai Chi interventions.

NATIONAL FALLS PREVENTION STRATEGY (SWEDEN) Sweden has developed a highly coordinated, multi-level national approach to falls prevention that integrates health services, municipalities, national public health institutions, and social care systems. The Swedish model reflects the country’s broader healthy ageing policy and universal welfare system, which aims to maintain functional capacity, autonomy, and safe mobility in older adults.

The Swedish national falls prevention approach is designed to: Systematically identify older adults at increased fall risk.

Prevent first-time and recurrent falls through evidence-based, multicomponent interventions.

Embed falls prevention across healthcare, home care, rehabilitation, and community health promotion.

Promote cross-sectoral collaboration between healthcare providers, municipalities, and national authorities.

The Swedish approach begins with systematic risk screening and early detection embedded across both healthcare and municipal services. All older adults undergoing routine medical checkups, home care assessments, or hospital discharge planning are screened for fall risk factors using validated tools such as the Downton Fall Risk Index, Timed Up and Go (TUG), and Berg Balance Scale. Screening covers intrinsic risk factors (e.g. balance deficits, medication, vision, cognitive impairment, and chronic diseases) as well as extrinsic risks, including home safety hazards. This allows early identification of individuals who may benefit from preventive interventions before a fall occurs.

Once fall risk is identified, individuals are referred to multidisciplinary falls prevention teams, which include physiotherapists, occupational therapists, nurses, geriatricians, and social care professionals. These teams develop personalised care plans addressing multiple domains: targeted exercise interventions, medication adjustments, sensory optimisation, nutritional support (including vitamin D), home environment adaptations, and psychological counselling to manage fear of falling. The integrated approach ensures comprehensive risk reduction across both medical and functional aspects of fall risk.

At the community level, Swedish municipalities deliver widespread access to exercise-based interventions, which form the foundation of falls prevention.

Programmes include supervised group training sessions focusing on balance, strength, flexibility, and functional movement. In addition, the innovative Safe Step digital exercise programme provides technology-assisted homebased balance and strength training for older adults unable to attend group sessions. These interventions follow the international evidence base, particularly emphasising multicomponent exercise as the most effective strategy to reduce fall incidence.

ANZIANI IN MOVIMENTO The Emilia-Romagna region in northern Italy has developed a comprehensive falls prevention and healthy ageing initiative called Anziani in Movimento (Seniors in Movement). This programme serves as a leading example of how regional healthcare systems can integrate preventive physical activity interventions with public health services and municipal resources to address falls prevention in ageing populations.

The programme is designed to: Prevent falls and frailty-related disability among older adults.

Maintain functional independence, mobility, and quality of life.

Encourage regular, supervised physical activity tailored to the needs of older people.

Reduce healthcare costs associated with fall-related injuries and long-term care admissions.

Older adults are screened for fall risk during regular medical consultations or following hospital discharges for fall-related injuries. Screening includes assessments of balance, mobility, gait, lower-limb strength, vision, cognitive function, medication use, and home safety. Primary care physicians, geriatricians, and physiotherapists collaborate to identify individuals at high risk who would benefit from preventive interventions.

The central component of Anziani in Movimento is its structured exercise programme, delivered by trained physiotherapists, kinesiologists, and certified exercise professionals. Group classes focus on: Balance training.

Lower limb strength.

Functional mobility.

Flexibility and joint stability.

Dual-task exercises combining cognitive and motor skills.

The programme typically lasts several months and is conducted in community centres, gyms, or municipal spaces, ensuring accessibility and social engagement.

The programme operates within Emilia-Romagna’s integrated care system, where municipalities, health authorities (Aziende Sanitarie Locali), and social services work collaboratively. Falls prevention is linked with other services such as home care, medication reviews, environmental modifications, and nutritional counselling. Municipalities provide logistical support and promote active ageing policies alongside healthcare providers.

Healthcare professionals, physiotherapists, and fitness instructors receive specialised training in falls prevention and exercise prescription for older adults, following national and international guidelines. Training covers both clinical assessment skills and safe delivery of exercise interventions.

FALLS PREVENTION FOR OLDER ADULTS PROGRAMME France has developed a comprehensive national framework for falls prevention through its Falls Prevention for Older Adults programme, which is coordinated under the umbrella of the French Ministry of Health and supported by regional health agencies (Agences Régionales de Santé – ARS). This programme operates within the national strategy for healthy ageing (Stratégie nationale de santé), as part of broader efforts to prevent dependency, promote autonomy, and reduce hospitalisations related to falls.

The French falls prevention strategy aims to: Reduce the incidence of falls and fall-related injuries among adults aged 65 and older.

Promote early detection of fall risk through routine healthcare assessments.

Implement multidisciplinary, evidence-based interventions addressing both intrinsic and environmental risk factors.

Support ageing in place and reduce institutionalisation by preserving functional autonomy.

The French programme begins with comprehensive fall risk screening integrated across healthcare and home care services. Older adults are routinely screened for fall risk during general practitioner visits, hospital discharges, geriatric assessments, and home care evaluations.

Screening protocols include fall history, medication review, cognitive and sensory assessments, and functional mobility tests such as the Timed Up and Go (TUG) and One Leg Stand Test.

Polypharmacy, vision problems, cognitive impairment, environmental hazards, and comorbidities such as osteoporosis or cardiovascular disease are systematically assessed, allowing for early detection of modifiable fall risk factors.

Once risk is identified, multidisciplinary care teams develop personalised prevention plans. These teams typically include physiotherapists, occupational therapists, geriatricians, pharmacists, nurses, and social workers. Intervention plans combine multiple evidence-based components: supervised multicomponent exercise to improve balance, strength, and functional mobility; medication adjustments to reduce fall-risk-increasing drugs; home modifications and assistive device provision; nutritional optimisation (vitamin D, calcium); and psychological support to address fear of falling, anxiety, and social isolation. This comprehensive care pathway ensures coordinated, patient-centred management of complex fall risks.

At the community level, municipal and regional agencies deliver supervised group exercise programmes tailored to older adults, including Otago-based balance training, Tai Chi, and dual-task cognitive-motor training. Public health campaigns educate older adults and caregivers about fall risks, home safety, and healthy lifestyles. Municipalities also support home safety inspections, environmental modifications, and accessibility improvements, while regional health agencies coordinate professional training, public funding, and programme monitoring. This cross-sector integration allows for wide accessibility and high levels of participation across the older population.

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Authors of the Desk research with best practice collection: Riccardo Lana (CUS Palermo) Mojca Markovič (Sports Union of Slovenia)

Funded by the European Union. Views and opinions expressed are however those of the author(s) only and do not necessarily reflect those of the European Union or the European Education and Culture Executive Agency (EACEA). Neither the European Union nor EACEA can be held responsible for them.