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Pierre Louis Bernard,1 Xavier de la Tribonniere,2 Alessandra Pellecchia,2 Lucie Gamon,3 Fanchon Herman,3 Marie-Christine Picot,3 Nathalie J Raffort,4 Thierry Paillard,5 Jean-Baptiste Robiaud,6 Gregory Ninot,7 Jean Bousquet,8 Hubert Blain6 1Euromov Digital Health in Motion, Université de Montpellier, IMT Mines d’Ales, France; 2Transversal Patient Education Unit (UTEP), University Hospital of Montpellier, Montpellier, France; 3Centre d’Investigation Clinique 1411, University Hospital of Montpellier, Montpellier, France; 4Balaruc-les-bains balneotherapy centre, Balaruc-les-bains, France; 5Movement, Balance, Performance and Health Laboratory, University of Pau and Pays de l’Adour, Tarbes, France; 6Department of Geriatrics, University of Montpellier, Montpellier, France; 7Desbrest Institute of Epidemiology and Public Health UMR 1318 Inserm - University of Montpellier, Montpellier, France; 8Institute of Allergology, Charite - Universitätsmedizin Berlin, Berlin, GermanyCorrespondence: Hubert Blain, Email h-blain@chu-montpellier.frBackground: The effects on gait and posture of balneotherapy in fallers are unknown. We assessed the effects on physical functioning and fear of falling of a balneotherapy program alone or combined with a physical activity and educational program in older adult fallers.Methods: A multicenter randomized controlled trial enrolled patients aged 65 or older referred to a 3-week balneotherapy program, and screened for risk of falling (a history of falls in the last year and a timed up and go test or a five chair rising test > 12 sec or a 4-meter walk test > 4 sec). In addition to balneotherapy, patients had either no intervention (controls) or twelve 60-minute sessions of physical activity including 15 minutes of health education and three 90-minute sessions of an educational program (intervention).Results: There were 118 control and 105 intervention patients. The balneotherapy program alone had a clinically significant effect on (i) the grip strength, (ii) the five chair rising test, (iii) the 4-meter walk test, and (iv) the short physical performance battery (Cohen’s d 0.29– 0.46). It had no effect on (i) the maximum time stood on one foot, and (ii) the timed up and go test. Furthermore, it worsened the falls efficacy scale (d = 0.27). Adding a physical activity and educational program significantly improved (i) the time stood on one foot (Cohen’s d =− 0.34), and (ii) the timed up and go test (d=- 0.44), (iii) and reduced the concern about falling (Falls Efficacy scale, d=− 0.25), and (iv) the fear of falling (d=− 0.34).Conclusion: Older patients referred to a balneotherapy program and at high risk of falling when screened at the entrance of the center should be offered an additional physical and educational program to further improve the functional effects of balneotherapy on the timed up and go test, balance, and the fear of falling.Keywords: balneotherapy, falls, physical activity, educational program, fear of falling, physical performances

Background: Falls and fall-related injuries are a major public health problem in industrialized countries. Faced with this challenge, a French national plan was launched in 2022 aiming to reduce by 20% the incidence of falls-related hospitalizations or deaths., Objectives: To describe the main pillars of the 2022-2024 French national plan against falls in older persons. Methods and assessment: The six pillars of the plan are: 1) screening and monitoring risks of falls and alert health and care workers; 2) home safety assessment and getting out safely; 3) developing technical aids for mobility and the use of assistive technologies at home; 4) appropriate physical activity, best weapon against falls; 5) tele-assistance devices for all older persons; 6) a cross-cutting pillar: Informing, raising awareness, training, and involving local actors. The plan, deployed in the 18 French regions, will provide a unique opportunity to determine the best strategies to achieve the objectives and the barriers encountered., Conclusions: The deployment of the French national plan will bring useful data for considering a long-term strategy in France and helping countries or regions wishing to implement a fall prevention plan on their territory.

Background: Falls and fall-related injuries are common in older adults, have negative effects on functional independence and quality of life and are associated with increased morbidity, mortality and health related costs., Objective: To synthesize evidence-based and expert consensus-based 2022 world guidelines for the management and prevention of falls in older adults. These recommendations consider a person-centred approach that includes the preferences of the patient, caregivers and other stakeholders, gaps in previous guidelines, recent developments in e-health and both local context and resources., Recommendations: All older adults should be advised on falls prevention and physical activity. Opportunistic case finding for falls risk is recommended for communitydwelling older adults. An algorithm is proposed to stratify falls risk and interventions for persons at low, moderate or high risk. Those considered at high risk should be offered a comprehensive multifactorial falls risk assessment with a view to co-design and implement personalised multidomain interventions. Other recommendations cover details of assessment and intervention components and combinations, and recommendations for specific settings and populations., Conclusions: The core set of recommendations provided will require flexible implementation strategies that consider both local context and resources.

"Falls prévention in older persons Falls in persons aged 65 or older are a major public health problem. Some simple questions (have you experienced any fall in the previous year ? Do you have a fear of falling when walking ?) And a few simple examinations (one-leg stance, timed up and go, chair-rising, stop walking when talking test) allow to differentiate between patients at low risk of falling, for whom education and risk reassessment at 12 months are offered, patients at moderate risk of falling, for whom a physical examination and a prescription review to modify the cause of instability, and referral to a adapted physical exercise program are offered, the effect of which will be evaluated at 3-6months, and patients at high risk of falls, for whom a standardized geriatric assessment shoud be offered, at best carried out by a geriatric team, allowing the establishment of an individualized program targeting all risk factors for falls, the effectiveness of which will be reassessed at 1-3 months.", Competing Interests: "H. Blain déclare des interventions ponctuelles (formations) pour Mylan, BMS, MSD, Gilead, Janssen. T. Bichet, J.-B. Robiaud et P-L. Bernard déclarent n’avoir aucun lien d’intérêts."