Nineteen studies were included. Sample size (where reported) ranged from eight to 187 participants; one study focused on 277 provider facilities. Study quality appeared to be generally good.
Three main concepts were identified as barriers and facilitators to implementing falls prevention programmes. Many studies contributed to more than one concept, and concepts were overlapping in some cases.
Practical considerations (economic - 12 studies; access to intervention - seven studies; and time - nine studies):
Economic issues identified for the individual included financial costs of assistive devices, transport to and from fall-prevention interventions, and attendance fees. Many participants suggested that reasonable cost would not be a barrier to participation, although treatment choices often needed to be made in countries where this was not free-of-charge. For healthcare professionals, decisions to carry out individual fall risk assessments were inhibited by reimbursement schemes in some countries and national funding priorities in others.
Ease of access to interventions was affected by older people's ability to drive, availability of public transport, travelling distance, car parking facilities, and seasonal factors (such as weather conditions).
There was mixed response from individuals in perceived lack of time for intervention participation. Health professionals felt strongly that this was often a significant factor limiting their ability to provide complete fall risk assessments as part of the wider service.
Adapting for community (social and cultural - 11 studies):
Different social and cultural influences were noted on the use of assistive devices, types of exercise and their delivery format, and fatalistic attitudes towards falling.
Psychosocial (transforming identifies - eight studies; defining the expert - 13 studies):
Changes to a person's identity after a fall was a major theme throughout the included studies. Mismatches were noted between the views of healthcare professionals and older people in the latter's ability to cope at home. Willingness of older people to accept intervention was diminished often due to fear of loss of independence.
Some studies highlighted difficulties health professionals sometimes had in involving older people and their families in decision-making about fall risk and prevention. Particular problems included traditional assumptions about medical experts knowing best, and perceptions of competence in whether individuals and family members could properly identify fall risk; studies demonstrated difficulties of this approach from the perspective of the health professional and the individual.