Background Around one‐third of older adults aged 65 years or older who live in the community fall each year. Interventions to prevent falls can be designed to target the whole community, rather than selected individuals. These population‐level interventions may be facilitated by different healthcare, social care, and community‐level agencies. They aim to tackle the determinants that lead to risk of falling in older people, and include components such as community‐wide polices for vitamin D supplementation for older adults, reducing fall hazards in the community or people's homes, or providing public health information or implementation of public health programmes that reduce fall risk (e.g. low‐cost or free gym membership for older adults to encourage increased physical activity). Objectives To review and synthesise the current evidence on the effects of population‐based interventions for preventing falls and fall‐related injuries in older people. We defined population‐based interventions as community‐wide initiatives to change the underlying societal, cultural, or environmental conditions increasing the risk of falling. Search methods We searched CENTRAL, MEDLINE, Embase, three other databases, and two trials registers in December 2020, and conducted a top‐up search of CENTRAL, MEDLINE, and Embase in January 2023. Selection criteria We included randomised controlled trials (RCTs), cluster RCTs, trials with stepped‐wedge designs, and controlled non‐randomised studies evaluating population‐level interventions for preventing falls and fall‐related injuries in adults ≥ 60 years of age. Population‐based interventions target entire communities. We excluded studies only targeting people at high risk of falling or with specific comorbidities, or residents living in institutionalised settings. Data collection and analysis We used standard methodological procedures expected by Cochrane, and used GRADE to assess the certainty of the evidence. We prioritised seven outcomes: rate of falls, number of fallers, number of people experiencing one or more fall‐related injuries, number of people experiencing one or more fall‐related fracture, number of people requiring hospital admission for one or more falls, adverse events, and economic analysis of interventions. Other outcomes of interest were: number of people experiencing one or more falls requiring medical attention, health‐related quality of life, fall‐related mortality, and concerns about falling. Main results We included nine studies: two cluster RCTs and seven non‐randomised trials (of which five were controlled before‐and‐after studies (CBAs), and two were controlled interrupted time series (CITS)). The numbers of older adults in intervention and control regions ranged from 1200 to 137,000 older residents in seven studies. The other two studies reported only total population size rather than numbers of older adults (67,300 and 172,500 residents). Most studies used hospital record systems to collect outcome data, but three only used questionnaire data in a random sample of residents; one study used both methods of data collection. The studies lasted between 14 months and eight years. We used Prevention of Falls Network Europe (ProFaNE) taxonomy to classify the types of interventions. All studies evaluated multicomponent falls prevention interventions. One study (n = 4542) also included a medication and nutrition intervention. We did not pool data owing to lack of consistency in study designs. Medication or nutrition Older people in the intervention area were offered free‐of‐charge daily supplements of calcium carbonate and vitamin D₃. Although female residents exposed to this falls prevention programme had fewer fall‐related hospital admissions (with no evidence of a difference for male residents) compared to a control area, we were unsure of this finding because the certainty of evidence was very low. This cluster RCT included high and unclear risks of bias in several domains, and we could not determine levels of imprecision in the effect estimate reported by study authors. Because this evidence is of very low certainty, we have not included quantitative results here. This study reported none of our other review outcomes. Multicomponent interventions Types of interventions included components of exercise, environment modification (home; community; public spaces), staff training, and knowledge and education. Studies included some or all of these components in their programme design. The effectiveness of multicomponent falls prevention interventions for all reported outcomes is uncertain. The two cluster RCTs included high or unclear risk of bias, and we had no reasons to upgrade the certainty of evidence from the non‐randomised trial designs (which started as low‐certainty evidence). We also noted possible imprecision in some effect estimates and inconsistent findings between studies. Given the very low‐certainty evidence for all outcomes, we have not reported quantitative findings here. One cluster RCT reported lower rates of falls in the intervention area than the control area, with fewer people in the intervention area having one or more falls and fall‐related injuries, but with little or no difference in the number of people having one or more fall‐related fractures. In another cluster RCT (a multi‐arm study), study authors reported no evidence of a difference in the number of female or male residents with falls leading to hospital admission after either a multicomponent intervention ("environmental and health programme") or a combination of this programme and the calcium and vitamin D₃ programme (above). One CBA reported no difference in rate of falls between intervention and control group areas, and another CBA reported no difference in rate of falls inside or outside the home. Two CBAs found no evidence of a difference in the number of fallers, and another CBA found no evidence of a difference in fall‐related injuries. One CITS found no evidence of a difference in the number of people having one or more fall‐related fractures. No studies reported adverse events. Authors' conclusions Given the very low‐certainty evidence, we are unsure whether population‐based multicomponent or nutrition and medication interventions are effective at reducing falls and fall‐related injuries in older adults. Methodologically robust cluster RCTs with sufficiently large communities and numbers of clusters are needed. Establishing a rate of sampling for population‐based studies would help in determining the size of communities to include. Interventions should be described in detail to allow investigation of effectiveness of individual components of multicomponent interventions; using the ProFaNE taxonomy for this would improve consistency between studies.

Strength recommendations have been embedded within the UK’s Chief Medical Officers’ physical activity guidelines since 2011. In 2019, they were given a more prominent position in the accompanying infographic. However, there is limited evidence that these recommendations have been successful in their population-wide dissemination. This study aimed to explore the engagement of community-dwelling older adults with the guidelines to date and to gain a nuanced understanding of the awareness, knowledge, and action that older adults take to fulfil strength recommendations. A total of fifteen older adults living in the UK participated in one online interview. A general inductive approach was used to generate themes from the data. There were four major themes that were found. 1. The strength component of the physical activity guidelines, 2. Barriers, 3. Motivators, and 4. Solutions. No participants were aware of the strength guidelines. When they were asked what activities they used to fulfil the ‘build strength on at least two-days-per-week′ criteria, walking, yoga, and Pilates were the most common responses. Ageism and strength training misconceptions were major barriers to participation in strengthening exercise. Older adults were much less aware of the benefits of building strength and strength training participation when compared to aerobic activities, so motivators to participation were generally not specific to strength training. Finally, there are several ways that practitioners can overcome the barriers to strength training participation. Solutions to improving the uptake and adherence to strength training participation are likely to be more successful when they include opportunities for social interaction, ability-appropriate challenge, and provide both short- and long-term benefits.

Wearable activity trackers have been recognised as effective tools for physical activity promotion, leading to their integration in healthcare services. Although, some qualitative literature indicated that device users may experience internal conflict. The current study is the first of our knowledge to directly examine the conflict faced by wearable activity tracker users. A qualitative, exploratory design was followed, with inductive thematic analysis conducted on semi-structured interview transcripts. The current study consisted of 11 regular wearable activity tracker users (8 female), aged between 18–59 years (M = 30.73). Four themes and nine sub-themes captured participants’ internal conflict. Themes were; Who knows best? Who’s in charge? Who am I without it? And What is happening to me?. Themes highlighted that device users faced conflict around navigating a data mismatch, how a wearable activity tracker impacted their behaviour, the amount of control a tracker had over them, whether their device use was positive, and how they would act and feel if they no longer used their wearable activity tracker. Participants experienced substantial internal conflict from wearable activity tracker use. The intensity of device-user relationship was clear, suggesting device dependency and perceived device importance. Findings hold crucial implications around the integration of activity trackers in healthcare services, recommendations around healthy use, and the potential long-term negative impact of using these devices on bodily intuition. Theoretical underpinnings remain unclear around wearable activity tracker use; results suggested blurred boundaries between intrinsic and extrinsic motivation - likely due to device embodiment - and highlighted the role of pressure in driving increased physical activity.

Physical activity guidelines and their supplementary messaging play an essential role in raising awareness and changing behaviour at a population level. However, recent research suggests a low awareness of, and adherence to, strength training guidelines, especially when compared to the aerobic guidelines. This study applied the Physical Activity Messaging Framework (PAMF) with an aim of co-designing strength training messaging guidance. Twenty adults (n=18 females, n=2 males) aged 40-60 years residing in the Greater Manchester area of the United Kingdom participated in one, four-hour, in-person workshop at the University of Salford. Participants were in the contemplation, preparation, action, maintenance, or relapse stage of health behaviour change. The focus group activities and resulting discussions aligned with the PAMF to identify message content, format, and delivery that would resonate with the target audience. Interestingly, discussions revealed that people in this age demographic knew ‘why you should do it’ (participate in strength training). However, guidelines or messaging campaigns telling people ‘what do to’ (‘build strength at least twice per week’) were not sufficiently detailed to change behaviour. Participants proposed that future messaging campaigns include a quick response (QR) code linking to more detailed information on ‘how to do it,’ practically and effectively. This is the first study to use the PAMF to create strength training messaging guidance and recommendations for future mass media campaigns.