The elderly are often considered or described as being frail, which is usually interpreted to mean being at increased risk of falls and accidents, illness and functional decline. Some approaches to reducing that risk are discussed in this issue. Prevention is always preferable, though the evidence for its effectiveness is weak. An evaluated intervention is described here in detail, allowing both use and replication. Falls are commonplace, and two approaches to reducing the risk of falls are evaluated. The first is training perceptual function of the foot. The training seemed to improve measured postural control. The second is an individually tailored programme to improve balance progressively, which led to reduced fear of falling and increased ability to do two things at once. Both studies need repeating in large groups to determine whether there is any actual effect upon falls. Falls lead to fractures, and a systematic review investigates whether vibration therapy improves bone density and leg strength. It might improve strength, but again the actual effect on fracture risk is unknown.
Stroke is one of the ‘big five’ problems faced by older people, and four studies in this issue concern stroke. An exploratory study demonstrates that a surprisingly large number of people do not have major abnormalities of foot posture after stroke. In those who do, having foot drop, there is still insufficient evidence to support an evidence-based approach to the use of ankle-foot orthoses and to selection. A study reported here suggests that a Chignon orthosis is better than a standard orthosis. Loss of arm function is perhaps the most distressing feature of stroke, and a further study illustrates that constraint induced motor therapy may be effective, but that most patients cannot participate. Finally, another large problem in most developed countries is that of low back pain. A neat randomized controlled study of four interventions found that the more interventions a patient is offered or allowed to choose from, the better their outcome – this supports the move towards patient preference having an influence upon the treatment offered.
