Evidence-based public health © Harcourt Brace and Company Ltd 1998

Elderly disabled people were able to identify priorities for public action to prevent falls

these, one-half required medical attention. The single most common type of problem reported was an uneven surface; 100 of the 427 reports described the condition of the surface on which they fell as 'wet,' which was the main reason for the fall. A workshop was set up at which all the relevant departments gathered to consider the reports made by the senior citizens and identify priorities for action.

Gallagher E M, Scott V J. The STEPS Project: participatory action research to reduce falls bz public places amoug seniors attd persous with disabilities. Can J Public Health 1997; 88:129-131

Objective

To measure the degree to which elderly people and people with disabilities can identify hazards that lead to falls.

Setting

British Columbia, Canada.

Method

A telephone hotline was set up to allow people to report trips or falls that occurred within a defined population (the Capital Regional District of British Columbia, comprising the city of Victoria and 13

municipalities: no total population given.) For 9 months, callers to the telephone hotline were identified and analyzed.

Literature review

No explicit strategy; 24 references.

Results

533 people made use of the hotline. 80% were female and the average age was 65.27 years. 186 (35%) reported some type of physical disability and 106 were using a mobility aid such as a walking stick or zimmer frame at the time of their accident. 75% of callers had suffered injury and of

Authors' conclusions

The authors concluded that community action, organized through a telephone hotline, was 'a powerful tool' for influencing policy changes and focusing the need for repairs, for example on routes between blocks of fiats for older people and shopping ~enters. The authors emphasized that the study sample was not randomly selected and that generalizability of the findings was limited as a result of this, but they argued that generalizability was not their primary intent but rather the 'testing of a model of enquiry that highlights issues in a given community.' The authors concluded that the involvement of large numbers of older people in the process of public policy- making was in itself of value in shifting the balance of power from professionals to the community they serve.

:OMMENTAR'

Gallagher and Scott present one of the few reports in the l iterature on the impact of community efforts to decrease falls among elderly and disabled people. The literature is abounding wi th studies of the association among falls and a myriad of 'risk factors.' This l i terature is another example in which epidemiologists confined to academic health science centers crank out observational studies identifying 'risk factors' of ten w i thout considering whether any could be or are modifiable. Their ivory tower attitudes prevent them from having useful discussions wi th community policy-makers, payers, purchasers or providers of care. The neat thing about the Gallagher and Scott study is that it focused on modifying the environment once a fall had occurred.

The article deals directly wi th the issue of

'academic' health researchers. Gallagher and Scott point out that the study was unique because it involved senior citizens, people wi th disabilities, health practitioners and researchers as research partners. They also state that whi le this participatory action research was time-consuming, there was ' . . . a shift of power and control away from the principal investigator and into the hands of the participants.'

When a fall report was telephoned in by the faller, details of each report were transmitted to the relevant municipal offices or building managers for action. It is unfortunate that the authors were not able to continue the project to determine whether the requested repairs had been completed and to determine repair rates. While the fol low-up rate was reported to be 30%, the authors should have reserved more project resources to pin this f igure down more accurately.

In summary, I commend the authors for their ambitious and innovative project. I also urge readers to seek out the article and the authors to learn more about this community- wide ef fort to deal wi th one of the top 13 problems contributing to the 'global burden of disease' in 1990, according to Murray and Lopez in their recent World Health Organization report. +

Reference

1. Murray C J I., Lopez A D. Global Health Statistics. Cambridge MA: Harvard University Press, 1996

Professor Larry W. Chambers Hamilton-Wentworth Department of Public

Health Services Hamilton, Ontario, Canada

MARCH 1998 EVIDENCE-BASED HEALTH POLICY AND MANAGEMENT 13