• Any fall in the elderly may be the first in a series of falling incidents, omens of a rapid decline or an approaching end. Any fall of an elderly person must be regarded as an alarm signal of a possible underlying ailment.

• A preventive policy with respect to falling must be based on knowledge of the significant risk factors. The GP must investigate the risk factors relevant to the fall and draw up an adapted policy. Preventive measures are appropriate but account must always be taken of the patient's specific circumstances and quality of life. The GP must always weigh up what is necessary, appropriate, attainable and justifiable.

• The GP must routinely pay attention to fall prevention in any elderly person who presents following a fall or any elderly person who belongs to the group of vulnerable elderly.

• In the group of vulnerable elderly, the GP can make a good estimate of the risk of falling on the basis of some screening questions and the 'get up and go' test.

Measures the GP can take in the case of increased risk

• Attention is primarily paid to intrinsic risk factors present:

  • detection and treatment of ailments posing risk

  • interventions to improve gait – balance and muscle strength

  • review of medication

• But a health dose of attention to extrinsic factors must also be given:

  • safety of the surroundings

  • adjustment of footwear

  • use of (walking) aids

  • instructions with regard to fall-breaking techniques and getting up after a fall

• In the case of elderly persons who frequently fall and had already fractures as a result of a fall, the emphasis is more on guidance in relation to fear of falling, offering contact to lonely isolated elderly persons and social central alarms. Rehabilitation activities for elderly persons who have had a fall-related injury are also included.

• The assistance of home nursing and home care is essential for preventive interventions to be carried out properly. The involvement of physiotherapists and occupational therapists will be necessary in a number of cases. The feasibility of a preventive approach is naturally determined in part by the follow-up behaviour of elderly persons with regard to advice given and proposed