Frailty is a clinical syndrome associated with greater risk of functional limitations and dependency. However, older people with or at risk of frailty who live at home can still lead fulfilling lives, engage with their community, and maintain a good quality of life, that is, age in place well. To support this and prevent resource-intensive care use, this expert consultation survey aimed to identify proxy indicators that capture ageing-in-place experiences in community-dwelling older people with frailty. Using a modified Delphi approach, two survey rounds were conducted to build consensus on proxy ageing-in-place indicators in relation to frailty. Eighty-nine indicators were extracted from a rapid literature review and grouped into five themes: Personal Characteristics of Older People, Place, Social Networks, Support, and Technology. Eighteen experts in geriatric care and gerontology rated indicators for importance for ageing-in-place and feasibility of routine measurement. Consensus for importance and feasibility was defined as mean scores ≥ 4.0 (scale 1–5), suggesting indicators were extremely/very important for ageing-in-place and extremely/very feasible to measure routinely. Public contributors, who were experts by lived experiences of frailty and ageing-in-place, also reviewed the indicators and survey findings. Only four proxy indicators reached consensus for importance and feasibility: “physical performance and mobility”, “multimorbidity”, “sensory function”, and “pressure ulcers” (all Personal Characteristics). Twenty-seven indicators were extremely/very important for ageing-in-place but not as feasible to measure routinely (17 related to Personal Characteristics, 4 to Social Networks, and 3 to Place and Support). Only five indicators (the four consensus indicators and “polypharmacy”) were extremely/very feasible to measure routinely. No technology-related indicators were extremely/very important or feasible to measure routinely. Mean scores of few indicators differed by experts’ occupations and areas of expertise. Public contributors generally agreed with the survey results but highlighted the importance of technology-related indicators (particularly “digital literacy”) and more integrated care records to support targeted care. This study lays the foundation for developing standardised proxy ageing-in-place indicators to monitor how older people with or at risk of frailty are living in their homes and communities. Future directions include assessing feasibility of capturing non-clinical indicators routinely; applying these indicators to guide personalised targeted interventions; and leveraging technology-related indicators to improve digital inclusion and literacy in older people to support ageing-in-place.

Abstract Background The gap in Disability-Free Life Expectancy between affluent and deprived areas of England is stark, at over 15 years. Successive governments have recognised the need to narrow this and extend the years of life spent without disability, but there is little evidence outlining how large an intervention must be to achieve meaningful gains. This study examines intervention scenarios to (i) extend Disability-Free Life Expectancy and (ii) reduce socioeconomic inequalities in Disability-Free Life Expectancy, among older people in England. Methods We applied multistate modelling to longitudinal data on 16 899 individuals, aged 50 + in England, incorporating disability data from three cohort studies: the English Longitudinal Study of Ageing, the Cognitive Function and Ageing Study II, and the Newcastle 85 + Study. Simulations assessed how reducing the risk of disability associated with age and area-based socioeconomic deprivation could extend Disability-Free Life Expectancy. In these simulations, deprivation-targeted interventions reduced the excess disability risk and differential recovery observed in people living in the 20% most deprived areas. Age-targeted interventions reduced the age-related increase in disability risk and the corresponding decline in recovery. Results Interventions targeted solely at the most deprived quintile yielded modest Disability-Free Life Expectancy gains (up to 2.8 years for women and 2.3 years for men, in deprived areas only). Interventions targeting age-related disability risk alone were associated with increases in Disability-Free Life Expectancy of 6.3 to 8.7 years under a 40% reduction in age-related disability risk, but exacerbated the gap between the most and least deprived populations. Interventions addressing both age- and deprivation-associated risks demonstrated the greatest potential. A 30% decrease in the age-based probability of disability, and commensurate increases in recovery from disability, alongside removal of deprivation-associated inequalities, increased Disability-Free Life Expectancy by 4.8 to 8.6 years for men and women aged 50, with women living in deprived areas benefiting most. Conclusions Extending Disability-Free Life Expectancy while reducing socioeconomic inequality is difficult, but possible by tackling both age- and deprivation-related risks. Taken on their own, age-based interventions risk increasing inequalities, as they disproportionately benefit people living in less deprived areas.

Abstract Aims The Falls Management Exercise (FaME) programme, delivered over 24 weeks, reduces falls in randomised controlled trials and ‘real world’ delivery, but some services deliver shorter, adapted FaME programmes. We investigated the ‘real-world’ effectiveness of FaME delivered for 12 or 24 weeks across three UK regions. Methods Design: prospective cohort study. Participants: 1,601 FaME programme attendees (median age 79.5 years), of whom 873 had follow-up data recorded. Setting: 14 provider organisations in Greater Manchester, Devon and the East Midlands. Procedure: Participant data were collected by FaME providers at baseline and up to 24 weeks later. Outcomes: Timed up-and-go (TUG); Short Falls Efficacy Scale-International (Short FES-I); at least one self-reported fall, and number of self-reported falls, in the past 3 months. Analysis: Univariate before-and-after tests; multivariable multilevel logistic, linear, Poisson, negative binomial regression. Results At final follow-up (≤24 weeks), compared to baseline, the odds of a self-reported fall within 3 months (Odds ratio 0.16 [95% confidence interval [CI] 0.10 to 0.25], p <.001) and TUG time had decreased (difference-between-paired-medians -1.0 (95% CI -1.50 to -1.0), p <.001). Short FES-I scores had not significantly changed. Twenty-four- rather than 12-week programmes were associated with faster TUG times (mean difference -3.31 seconds [95% CI -5.97 to -0.65]) and reduced concerns about falling (mean Short FES-I difference -2.00 [95% CI -3.65 to -0.34], p = 0.018), but no significant difference in the odds of a self-reported fall or number of falls within 3 months. Conclusions FaME programmes of both 12 and 24-weeks were associated with improved functional mobility and reduced falls. Participants who attended 24-, rather than 12-week, programmes had significantly greater improvements in functional mobility and reduced concerns about falling. Due to follow-up data missingness, the study was not adequately powered to detect differences in falls risk or rate between 12 and 24-week programmes.

Background: As populations age, there is a growing number of people who are affected by age-related hearing loss, who are living with chronic health conditions, treated using multiple medicines. Community pharmacy plays an important role in ensuring safe and effective medicine use. Objective: This study explored the barriers and facilitators to effective communication with people with age-related hearing loss in the community pharmacy setting. Methods: Semi-structured interviews were conducted with sixteen pharmacy users with self-reported age-related hearing loss in the United Kingdom (UK). Eight community pharmacists took part across two focus groups and one interview. Using a deductive-inductive approach to framework analysis, three overarching themes were generated. Results: ‘Navigating the environment’ highlights barriers related to pharmacists reportedly high workloads and time pressures, also reflected in pharmacy user's accounts. Background noise reduced the confidentiality and effectiveness of communication. Participants had differing views on the extent to which hearing aids could overcome these challenges. ‘Debating the need to communicate and to disclose hearing loss’ reflects barriers relating to pharmacy users' tendency to not disclose their needs, in relation to their personal feelings (embarrassment), perceptions of, and limited contact with, community pharmacy services. Yet, pharmacists emphasised a need to know about hearing loss to adapt communication effectively. Participants reported similar and distinct perspectives regarding ‘coping strategies and solutions to communicate effectively’. Conclusion: Participants identified a need to improve pharmacists' capacity to implement communication adaptations for people with hearing loss, for which pharmacists suggested digital interventions, and to visibly recognise sensory needs, to promote disclosure.

BackgroundInfection prevention and control (IPC) is vital in care homes as it can reduce morbidity and mortality by 30%. Ensuring good IPC practice is a perennial challenge in the varied and complex context of care homes. Behavior change interventions delivered via digital technology may be effective in improving IPC among care home staff. ObjectiveThis study aimed to evaluate how an evidence-based, digital behavior change intervention called Germ Defence can be rapidly adapted to meet the needs of care homes. MethodsThis study applied the person-based approach, which emphasizes iterative approaches to optimizing interventions via individual user feedback. Phase 1 involved initial edits to the website by the research team to create Germ Defence for Care Homes (GDCH) version 1. Phase 2 consisted of stakeholder consultation on GDCH version 1 followed by edits to create GDCH version 2. The formal research (phases 3 and 4) involved individual think-aloud interviews with 21 staff members from management, care, and ancillary positions in 4 care homes providing real-time feedback as they worked through GDCH. Edits were made to create GDCH version 3 between phases 3 and 4. During the development of GDCH versions 2 and 3, it became clear that the intervention would need more fundamental changes beyond the pragmatic, incremental changes that would be possible within the scope of this study. Analysis was completed via a rapid, qualitative descriptive approach to develop a high-level summary of key findings from the interview data. ResultsThere were mixed results about the attractiveness of GDCH and its suitability to the care home context. Participants felt that the images needed to be aligned much more closely with the meaning of adjacent text. Many participants felt that they would not have time to read a text-based website, and some suggested that more engaging content, including audio and video, may be preferable. Most participants felt that the overall concept of Germ Defence was clearly relevant to their context. Some felt that it might be a useful introduction for new staff members or a refresher for current staff, but others felt that it did not add anything to their existing IPC training. There were mixed opinions about the level of detail provided in the information offered by the site. While the goal-setting behavior change mechanism may have potential, the findings suggested that it may be unsuitable for care homes and more work is needed to refine it. ConclusionsMuch more work needs to be done to make Germ Defence more engaging, accessible, and relevant to the care home workforce. Our study highlights the challenges of rapidly adapting an existing intervention to a new context. Future research in this area will require a pragmatic methodological approach with a focus on implementation.

Digital technologies are crucial to drive the needed improvement in NHS primary care delivery and access. The impact of these digital interventions on health inequalities remains a critical area of concern and uncertainty. Transition to digital primary care services was rapidly accelerated during the COVID-19 pandemic. We explored what can be learnt from this transition to digital access by examining the patterns of remote general practice consultation before and after the pandemic and the influence of age, gender, social deprivation, and ethnicity on these patterns. This is a longitudinal study in primary care settings involving data from19 million men and women aged 18 + years registered with general practices in England between January 2019 and February 2022 using the OpenSAFELY platform. The main outcome was remote consultation (telephone, video, or electronic) of all appointments recorded by GPs. Binomial regression models including marginal effect probabilities were used to analyse the proportion of remote consultations in all appointments. Covariates including age, gender, deprivation, and ethnicity were adjusted for in the models. Remote consultations increased from 10.1 million per annum (March 2019 to March 2020) to 32.7 million per annum during the pandemic (March 2020 to March 2022). Pre-pandemic, 85 + year olds had the highest probability of remote consultation (0.133, 95

Falls among older adults represent a significant public health challenge due to their consequences, including serious injuries, increased morbidity and mortality, decreased quality of life, and heightened healthcare costs. The World Falls Guidelines (WFG), published in 2022, offer a robust framework for evidence-based interventions; however, the uptake of these guidelines into clinical practice across Europe remains inconsistent. Key barriers to implementation include insufficient resources, a lack of trained healthcare professionals, and limited integration into existing healthcare systems. This position paper by the EuGMS Special Interest Group (SIG) on Falls and Fractures addresses the implementation of the WFG among community-dwelling older adults and falls prevention across Europe by providing an overview of the current status of WFG adoption in Europe and discusses the challenges and opportunities for implementation. We provide an overview of the current resources to support the clinical practice of falls prevention, implementation guides, and educational programs. Additionally, we discuss what is necessary for the future development of these resources and for advancing research. The EuGMS SIG on Falls and Fractures advocates for a commitment of healthcare providers as well as insurers, policymakers, and other stakeholders to collaborative European initiatives-such as developing a standardised falls prevention strategy, promoting evidence-based implementation plans, establishing a European-wide research agenda, and creating under- and postgraduate curricula-which are essential for advancing falls prevention efforts across Europe.

A frailty index (FI) is a frailty assessment tool calculated as the proportion of the number of health-related deficits an individual has to the total number of variables in the index. Routinely collected clinical and administrative data can be used as sources of deficits to automatically calculate FIs. This scoping review aimed to evaluate the current research landscape on routine data-based FIs. We searched seven databases to find literature published in 2013-2023. Main inclusion criteria were original research articles on FIs constructed from routine data, with deficits in at least two of the following categories: "symptoms/signs", "laboratory values", "diseases", "disabilities", and "others". From 7526 publications screened, 218 were included. Studies were primarily from North America (47.7 %), conducted in the community (35.3 %), and used routine data-based FIs for risk stratification (51.4 %). FIs were calculated using various routine data sources; however, most were initially developed and validated using hospital records. We noted geographical differences in study settings and routine data sources. We identified 611 unique deficits comprising these FIs. Most were either "diseases" (34.4 %) or "symptoms/signs" (32.1 %). Routine data-based FIs are feasible and valid risk stratification tools, but research is confined to high-income countries, their routine adoption is slow, and deficits comprising these FIs emphasise a reactive and overtly medical approach in addressing frailty. Future directions include exploring the feasibility and applicability of using routine databases for frailty assessment in lower- and middle-income countries, and leveraging non-clinical routine data through data linkages to proactively identify and manage frailty.

Background StandingTall uses eHealth to deliver evidence-based balance and functional strength exercises. Clinical trials have demonstrated improved balance, reduced falls and fall-related injuries and high adherence. This study aimed to evaluate the implementation of StandingTall into health services in Australia and the UK.Methods Two hundred and forty-six participants (Australia, n = 184; UK, n = 62) were recruited and encouraged to use StandingTall for 2 h/week for 6-months. A mixed-methods process evaluation assessed uptake and acceptability of StandingTall. Adherence, measured as % of prescribed dose completed, was the primary outcome.Results The study, conducted October 2019 to September 2021 in Australia and November 2020 to April 2022 in the UK, was affected by COVID-19. Participants' mean age was 73 +/- 7 years, and 196 (81%) were female. Of 129 implementation partners (e.g. private practice clinicians, community exercise providers, community service agencies) approached, 34% (n = 44) agreed to be implementation partners. Of 41 implementation partners who referred participants, 15 (37%) referred >= 5. Participant uptake was 42% (198/469) with mean adherence over 6 months being 41 +/- 39% of the prescribed dose (i.e. 39 +/- 41 min/week) of exercise. At 6 months, 120 (76%) participants indicated they liked using StandingTall, 89 (56%) reported their balance improved (moderately to a great deal better) and 125 (80%) rated StandingTall as good to excellent. For ongoing sustainability, health service managers highlighted the need for additional resources.Conclusions StandingTall faced challenges in uptake, adoption and sustainability due to COVID-19 and a lack of ongoing funding. Adherence levels were lower than the effectiveness trial, but were higher than other exercise studies. Acceptance was high, indicating promise for future implementation, provided sufficient resources and support are made available.Trial registration Australian and New Zealand Clinical Trials Registry ACTRN12619001329156.

Objectives:1) Map FaME delivery across the UK, 2) explore and understand delivery of the FaME programme in practice.Methods:Sequential exploratory mixed methods. 1) survey of n=247 Postural Stability Instructor (PSIs) across the UK, 2) purposively sampled n=23 PSIs to take part in interviews. Quantitative data was described descriptively due to low sample size, and qualitative data coded using thematic analysis.Results:Instructors pre-dominantly delivered classes in a community-setting, were mostly White British females with a range of experience. Most respondents were exercise instructors, physiotherapists, or therapist assistants. Only 136 (55.1%) respondents currently delivered the programme. The essential components of the FaME programme that instructors did not implement routinely were backward chaining, floorwork and Tai Chi. Five main themes emerged from qualitative data: individual, delivery and set-up, evidence-based delivery, motivational strategies, and instructor-based factors. Most instructors reported fidelity to most components of FaME and shared barriers and facilitators to delivering classes.Conclusion:This study gives a UK overview of the implementation of FaME. PSIs present a complex picture of the ways set-up and delivery of evidence-based programmes in practice can influence older adults' attendance, adherence and experience of the programme, and barriers and facilitators to delivery of the programme with fidelity.

Background The Falls Management Exercise (FaME) Programme is a group-based, face-to-face and home-based, six-month multi-component exercise intervention for older adults. It reduces falls and fear of falling, increases physical activity and improves confidence and balance. FaME is also cost effective. Despite this evidence, it is not widely available in the UK. Objective To study the spread, implementation, adherence, 'real world' outcomes and quality management of FaME in 14 organisations across three demographically diverse regions of the UK. Programme Description Using the Consolidated Framework for Implementation Research to map themes, we undertook a qualitative analysis of 40 Semi-structured interviews with FaME commissioners, providers and participants, 25 class observations and content analysis of management documents. To assess participant outcomes we analysed quantitative functional and self-reported fall outcomes from 1601 participants. Outcomes and Learnings Class availability tripled in one region, whilst delivery remained consistent in others. Factors influencing spread included FaME's evidence base, perceived fit with organisational values and the personal experiences and beliefs of decision-makers. Univariate pre/post analyses of routinely-collected outcomes showed significant improvements in confidence and balance (Confbal p<0.001), falls (in the previous 3 months, p<0.001) and Timed-Up-and-Go (p<0.001). Participants valued social opportunities as well as improvements in their physical abilities and reported wellbeing benefits beyond fall prevention. Newer programmes or those with quality assurance systems in place showed higher fidelity and quality. Programmes varied in duration and aspects of delivery but a national community of practice forum provided improvement opportunities and mechanisms. Implications Complex and interacting factors influence FaME's availability, delivery, uptake, participant adherence and outcomes. Findings could be extrapolated to other exercise interventions and have informed the production of an updated implementation toolkit to assist its high-quality implementation. Conclusions FaME is an evidence-based fall prevention programme but delivery is often inconsistent and there are areas without any provision in the UK. Awareness of its evidence-base is necessary but not sufficient for spread and measures to ensure continued fidelity, quality, outcomes and adherence need to be designed into contracted delivery.

BACKGROUND:Frailty is characterised by a decline in physical, cognitive, energy, and health reserves and is linked to greater functional dependency and higher social care utilisation. However, the relationship between receiving care, or receiving insufficient care among older people with different frailty status and the risk of unplanned admission to hospital for any cause, or the risk of falls and fractures remains unclear. METHODS AND FINDINGS:This study used information from 7,656 adults aged 60 and older participating in the English Longitudinal Study of Ageing (ELSA) waves 6-8. Care status was assessed through received care and self-reported unmet care needs, while frailty was measured using a frailty index. Competing-risk regression analysis was used (with death as a potential competing risk), adjusted for demographic and socioeconomic confounders. Around a quarter of the participants received care, of which approximately 60% received low levels of care, while the rest had high levels of care. Older people who received low and high levels of care had a higher risk of unplanned admission independent of frailty status. Unmet need for care was not significantly associated with an increased risk of unplanned admission compared to those receiving no care. Older people in receipt of care had an increased risk of hospitalisation due to falls but not fractures, compared to those who received no care after adjustment for covariates, including frailty status. CONCLUSIONS:Care receipt increases the risk of hospitalisation substantially, suggesting this is a group worthy of prevention intervention focus.

Abstract Pharmacists have an important role in primary care, communicating with people and ensuring safe and appropriate medication use. However, inadequate communication is a barrier to the delivery of effective care for people with hearing loss. This study sought to explore factors that facilitate and impede communication with people with age-related hearing loss (presbycusis) in the community pharmacy, in order to identify solutions to improve these interactions. Online semi-structured interviews with people with age-related hearing loss (presbycusis), older people (>50 years old) without hearing loss, and online focus groups and interviews with community pharmacists were conducted. Data were analysed using the framework method. Sixteen people with age-related hearing loss, three older people without hearing loss and eight community pharmacists took part. Participants described a multitude of environmental barriers to communication and person-centred pharmaceutical care such as heavy workload, lack of privacy, noise levels and Covid-19 safety measures. There was a perception among participants that their hearing loss is not relevant to the community pharmacy setting and that more could be done to signify that a pharmacy recognises the needs of those with hearing loss, furthermore, participants discussed their limited interaction with pharmacy personnel. There were varying perceptions about communication and levels of awareness among pharmacists about the key facilitators to communication. Greater interdisciplinary collaboration to develop and implement strategies/adaptations tailored to the needs of people with hearing loss would support the engenderment of hearing-friendly community pharmacies and the safe use of medicines.

IntroductionFalls have major implications for quality of life, independence and cost to the health service. Strength and balance training has been found to be effective in reducing the rate/risk of falls, as long as there is adequate fidelity to the evidence-based programme. Health services are often unable to deliver the evidence-based dose of exercise and older adults do not always sufficiently adhere to their programme to gain full outcomes. Smartphone technology based on behaviour-change theory has been used to support healthy lifestyles, but not falls prevention exercise. This feasibility trial will explore whether smartphone technology can support patients to better adhere to an evidence-based rehabilitation programme and test study procedures/outcome measures.Methods and analysisA two-arm, pragmatic feasibility randomised controlled trial will be conducted with health services in Manchester, UK. Seventy-two patients aged 50+years eligible for a falls rehabilitation exercise programme from two community services will receive: (1) standard service with a smartphone for outcome measurement only or (2) standard service plus a smartphone including the motivational smartphone app. The primary outcome is feasibility of the intervention, study design and procedures. The secondary outcome is to compare standard outcome measures for falls, function and adherence to instrumented versions collected using smartphone. Outcome measures collected include balance, function, falls, strength, fear of falling, health-related quality of life, resource use and adherence. Outcomes are measured at baseline, 3 and 6-month post-randomisation. Interviews/focus groups with health professionals and participants further explore feasibility of the technology and trial procedures. Primarily analyses will be descriptive.Ethics and disseminationThe study protocol is approved by North West Greater Manchester East Research Ethics Committee (Rec ref:18/NW/0457, 9/07/2018). User groups and patient representatives were consulted to inform trial design, and are involved in study recruitment. Results will be reported at conferences and in peer-reviewed publications. A dissemination event will be held in Manchester to present the results of the trial. The protocol adheres to the recommended Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) checklist.Trial registration numberISRCTN12830220; Pre-results.

BackgroundFalls have implications for the health of older adults. Strength and balance interventions significantly reduce the risk of falls; however, patients seldom perform the dose of exercise that is required based on evidence. Health professionals play an important role in supporting older adults as they perform and progress in their exercises. Teleconferencing could enable health professionals to support patients more frequently, which is important in exercise behavior. ObjectiveThis study aims to examine the overall concept and acceptability of teleconferencing for the delivery of falls rehabilitation with health care professionals and older adults and to examine the usability, acceptability, and feasibility of teleconferencing delivery with health care professionals and patients. MethodsThere were 2 stages to the research: patient and public involvement workshops and usability and feasibility testing. A total of 2 workshops were conducted, one with 5 health care professionals and the other with 8 older adults from a community strength and balance exercise group. For usability and feasibility testing, we tested teleconferencing both one-to-one and in small groups on a smartphone with one falls service and their patients for 3 weeks. Semistructured interviews and focus groups were used to explore acceptability, usability, and feasibility. Focus groups were conducted with the service that used teleconferencing with patients and 2 other services that received only a demonstration of how teleconferencing works. Qualitative data were analyzed using the framework approach. ResultsIn the workshops, the health care professionals thought that teleconferencing provided an opportunity to save travel time. Older adults thought that it could enable increased support. Safety is of key importance, and delivery needs to be carefully considered. Both older adults and health care professionals felt that it was important that technology did not eliminate face-to-face contact. There were concerns from older adults about the intrusiveness of technology. For the usability and feasibility testing, 7 patients and 3 health care professionals participated, with interviews conducted with 6 patients and a focus group with the health care team. Two additional teams (8 health professionals) took part in a demonstration and focus group. Barriers and facilitators were identified, with 5 barriers around reliability due to poor connectivity, cost of connectivity, safety concerns linked to positioning of equipment and connectivity, intrusiveness of technology, and resistance to group teleconferencing. Two facilitators focused on the positive benefits of increased support and monitoring and positive solutions for future improvements. ConclusionsTeleconferencing as a way of delivering fall prevention interventions can be acceptable to older adults, patients, and health care professionals if it works effectively. Connectivity, where there is no Wi-Fi provision, is one of the largest issues. Therefore, local infrastructure needs to be improved. A larger usability study is required to establish whether better equipment for delivery improves usability.

The Prevention of Falls Network Europe (ProFaNE) aims to improve quality of life of the ageing population by focussing on a major cause of disability and distress: falls. The thematic network is funded by the European Commission and brings together scientists, clinicians and other health professionals from around Europe to focus on four main themes: taxonomy and coordination of trials, clinical assessment and management of falls, assessment of balance function, and psychological aspects of falling. There are 24 members across Europe as well as network associates who contribute expertise at workshops and meetings. ProFaNE, a 4-year project which started in January 2003, aims to improve and standardise health care processes, introducing and promoting good practice widely across Europe. ProFaNE undertakes workshops that bring together experts and observers around specific topics to exchange knowledge, expertise and resources on interventions that reduce falls. A key document for policy makers around Europe, written by ProFaNE members, was published by the World Health Organisation in March 2004. ProFaNE’s website has both public and private areas with resources (web links to falls prevention, useful documents for policy makers, researchers and practitioners) and a discussion board to encourage informal networking between members and the public. The ultimate aim of ProFaNE is to submit a collaborative bid to undertake a multi-centre, randomised controlled trial of a multi-factorial fall prevention intervention with peripheral fracture as the primary outcome. The success of the networking and relationship building in the first year and a half of ProFaNE’s work makes this an achievable goal.