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Background: Common expressions of falls risk do not include exposure to hazards. We compared two expressions: the commonly used population incidence (fallers per 1000 person-years) and the FARE (FAlls Risk by Exposure): the number of fallers per 1000 physically active person-days., Methods: Prospective follow-up study among community dwelling older persons (N=771) aged between 71 and 96 years in The Netherlands, 2005. Baseline data on age, gender, disabilities (vision, mobility), and number of days per week with minimally 30 min of physical activity were collected. Falls were registered monthly. Falls risk was expressed as the number of falls per 1000 person-years and as the FARE. A balance control difficulty score was based on the sumscore of 11 disability items., Results: Increased difficulty controlling balance was linearly associated with reduced exposure to risky situations (Spearman correlation coefficient=-.56) and to an increased falls risk per 1000 person-years. In contrast, the FARE score increased exponentially, which is more indicative of the real risk people face, taking into account their activity restriction., Conclusions: The FARE is recommended for use in public health policy and research on falls prevention because it takes into account reduced physical activity of older persons who experience increased difficulty controlling their balance., (2009. Published by Elsevier Inc.)

Objectives: Most research on falls among older persons focuses on health-related factors that affect the ability to maintain balance. The objective of the study is to determine the association between physical activity and occurrence of falls among community-dwelling older persons., Methods: The distribution of falls and person-hours of physical activity in the home over 24 h was compared. The falls data (n=501) were extracted from a pooled dataset of three follow-up studies conducted between 1994 and 2005 (n=3587). The 1995 Dutch National Time-Budget Survey provided hour-by-hour information on activities performed by older individuals (n=459) in the home; this sample was representative for the Netherlands. The association between the 24-h distribution of falls and physical activity and the risk of falling (the ratio between the distribution of falls and physical activity) were determined. Participants were community-dwelling older persons aged 65 years and older., Results: More physical activity was positively associated with more falls (Spearman correlation=.89, p<.000). The risk of falling at night (1 a.m.-6 a.m.) was almost eight times higher compared to 7 a.m.-12 p.m., Conclusions: Physical activity is strongly associated with the number of falls in the home, measured over 24 h. Older persons may be at increased risk of falling if they are encouraged to become more physically active, or if they often get out of bed at night. Thus in addition to health-related factors, changes in level of physical activity should also be taken into account when estimating a person's risk of falling.

Background: In their letters to the editor, Lacherez et al. [Lacherez, P.F., Wood, J.M., Kerr, G.K., 2007. Does activity level mediate or suppress the association between fear of falling and falls? Prev. Med. 31; (Electronic publication ahead of print)] and Hafeman and Schwartz [Hafeman, D., Schwartz, S., 2007. Assessing mediation: The necessity of theoretical considerations. Prev. Med. 26; (Electronic publication ahead of print)] questioned the correctness of using the term 'mediation' in our paper [Wijlhuizen, G.J., Jong, R. de, Hopman-Rock, M., 2007. Older persons afraid of falling reduce physical activity to prevent outdoor falls. Prev. Med. 44, 260-264.]. In this paper, we concluded that (outdoor) Physical activity mediates the relationship between Fear of falling and outdoor Falls. We investigated whether the term 'inconsistent mediation' might be a more appropriate term to use in this context., Methods: Based on literature, we describe the relationship between fear of falling, physical activity, and falls within a causal model., Results: Two causal pathways between Fear and Falls exist, with the causal pathway going from Fear of falling via Physical activity to Falls counteracting (is inconsistent with) the causal pathway going from Fear of falling via Hesitancy to Falls., Conclusion: The term 'inconsistent mediation' might be more appropriate to describe the causal relationships between Fear of falling, Falls, and Physical activity.