Public Policies For The Prevention Of Falls Among Community-Dwelling Older Adults-An International Comparative Study

Background:Accidental falls occur in older adults more frequently,which may lead to individual disability or even death,growing care burden in family and depletion of medical resources,have become a major public health problem in aging countries.WHO advocates to include fall prevention in older adults as a public health priority in national policy planning,but the current fall-related policies in China are inclined to issue planning and technical guidance,and still lack details compared to some developed countries;In addition,there is insufficient research at home and abroad on the content,formulation process,and quality assessment of falls intervention policies for older adults in community.Based on this background,it is of great importance to analyze the composition and implementation progress of community-based falls intervention policies across different countries,in order to develop and amend policies,which related to aging services and health promotion of the elderly in China.Objective:This study described and analyzed the content,intervention measures,and implementation strategies of policies for the prevention of falls among community-dwelling older adults,aiming to explain the possible reasons for the differences in representative countries combined with national condition and medical system,and provide suggestions according to the actual condition of China to carry out falls intervention work for elderly in communities based on the perspective of welfare pluralism theory.Methods:Six countries including Japan,Singapore,Thailand,the United States,Germany,and Russia,were selected according to the degree of population aging and economic income.Accessing the following websites in each country:the websites of the Ministry of Health,the Center for Disease Control,and other relevant government departments and directly affiliated institutions,Non-Governmental Organizations,such as Prevention of Falls Network Europe,National Council On Aging,U.S.,Association of Fall Prevention,Japan,and National Association of Statutory Health Insurance Funds,Germany,as well as relevant enterprises,medical institutions,academic institutions.Using "the elderly,fall/accidental injuries,prevention" as keywords,the text of national community-dwelling elderly fall intervention policy documents released from January 2010 to May 2023 was retrieved.Considering the theoretical triangulation,an analysis framework based on the policy tool theory and a three-dimensional analysis framework named as "policy cube" were established respectively.Policy documents were analyzed from the dimensions of policy tools such as demand-side type,supply-side type and environmental-side type.The document analysis was applied to describe policy contents from the dimensions of policy comprehensiveness,focus and effectiveness,and health equity.The qualitative analysis software Nvivo 11 was used for coding and frequency statistics.Results:1.National Level Public Policies for the Prevention of Falls Among Community-Dwelling Older Adults——A Policy Tool-based Analysis in International Comparative Study:Among the 24 policy texts,there were 212 reference points in the dimension of policy tools,and environmental-side type policy tools were applied most frequently(45.3%).High-income countries tend to apply supply-side type policy tools,while non-high-income countries focus on the application of environmental-side type policy tools.High-income countries are at the stage where multi-sectoral collaborative implementing policy,while non-high-income countries are at the stage where the Ministry of Health dominating the development of policy.2.Descriptive analysis of falls intervention policies for older adults in community—a comparative study that introduces a ’policy cube’ approach:Fall management processes in five countries are generally consistent with recommendations of guidelines,providing the necessary interventions for older adults in accordance with normative steps from risk screening to addressing preventable risk factors.The relatively clear accountability is expressed in documents in four countries,including the organizational structure,personnel appointment,function description,the qualification,task and supervision authority of the executive agency,and the operation mechanism of the accountability.All countries gave clear articulation on budgetary for falls intervention,and strategies to promote equity in health.Conclusion:The application of supply-side type policy tools in six countries can be summarized as a multi-factor comprehensive intervention model,single-factor focused intervention model and medical intervention model guided by fall risk screening.According to the degree of financial allocation and medical insurance coverage,the application of demand-side type policy tools are intervention services managed by medical insurance,intervention projects supported by financial funds,and price subsidies offered to attract the purchase of services.Environmental-side type policy tools focused on reprogramming,organization,advocacy,and standard setting.China suffers from a lack of national intervention policy for elderly falls in the community.The emphasis of the coverage of policies and the implementation of intervention measures is to mobilize primary medical resourses and deal with the "willing" and"ability" of elderly.The establishment of sound accountability and financing mechanisms may bring about the effective implementation of policies.Some countries’ provisions on remedial actions/sanctions/fines haven’t outlined if implementation progress does not occur.On the basis of comprehensive consideration of social,economic and cultural factors,intervention strategies for vulnerable population could be formulated.