Stay on Your Feet Safety Walks Group

Group discussions on how to implement a participatory process in climate adaptation planning: a case study in Malaysia

The frequency and intensity of extreme climate events are increasing all around the world, due to climate change. Climate adaptation strategies are therefore needed, since mitigation strategies alone are not sufficient to avoid serious impacts of climate change. However, adaptation to climate change is not straightforward, as it is highly influenced by diverse and conflicting interests as well as epistemological (or scientific) uncertainties. Therefore, a minimum requirement for its success is the active participation of stakeholders and citizens in the adaptation policy cycle. This paper presents a case study on a participatory process involving civil servants from different municipalities in Malaysia, in Southeast Asia, with a view to considering the optimal level of engagement that is required for climate adaptation planning. The exercise consisted of a Focus Group session, where participants were asked to discuss the level of stakeholder and citizen participation that should be adopted within the Global Covenant of Mayors for Climate and Energy initiative. Contrary to authors' expectations, the participants tended to suggest medium to high levels of participation in the planning process. During the dialogues, a walking activity through the city, aimed at identifying hotspots of climate risks and defined as "safety walks", was one of the ideas proposed as a high-potential participatory method, spreading in the adaptation framework. Safety walks could complement climate modelling and enhance the robustness of climate risk assessments.

Behavioral Factors Contributing to Older Adults Falling in Public Places

Activity recall, in-depth interviews, and reenactment of the fall were used to elucidate the behavior patterns, actions, and habits that contribute to older adults falling in public places. The aim was to improve older adults' capacity to understand behavioral risks associated with falls and develop safe adaptive strategies so they can play an active role in minimizing falls and maintaining meaningful activity. Ten major themes were identified: not attending to the route ahead, lack of familiarity, pace, mobility behaviors, environmental influences, eyesight behaviors, health factors affecting physical abilities, lack of confidence, overexertion, and unnoticed environmental hazards. The findings add to knowledge about the extent and nature of behavioral factors that contribute to falls in public places and provide guidelines for some specific areas of focus for falls prevention. A recommendation is that fall prevention interventions with older adults employ strategies that actively engage them in critical reflective thinking.

Population-based interventions for the prevention of fall-related injuries in older people

BACKGROUND

Fall-related injuries are a significant cause of morbidity and mortality in the older population. Summary information about counter-measures that successfully address the risk factors for fall-related injuries in research settings has been widely disseminated. However, less available is evidence-based information about successful roll-out of these counter-measures in public health programmes in the wider community. Population-based interventions in the form of multi-strategy, multi-focused programmes are hypothesised to result in a reduction in population-wide injury rates. This review tests this hypothesis with regards to fall-related injuries among older people.

OBJECTIVES

To assess the effectiveness of population-based interventions, defined as coordinated, community-wide, multi-strategy initiatives, for reducing fall-related injuries among older people.

SEARCH STRATEGY

The search strategy was based on electronic searches, handsearches of selected journals and snowballing from reference lists of selected publications.

SELECTION CRITERIA

Studies were independently screened for inclusion by two reviewers. Included studies were those that reported changes in medically treated fall-related injuries among older people following the implementation of a controlled population-based intervention.

DATA COLLECTION AND ANALYSIS

Data were independently extracted by two reviewers. Meta-analysis was not appropriate, due to the heterogeneity of the included studies.

MAIN RESULTS

Out of 23 identified studies, five met the criteria for inclusion. There were no randomised controlled trials. Significant decreases or downward trends in fall-related injuries were reported in all five of the included studies with the relative reduction in fall-related injuries ranging from 6 to 33%.

AUTHORS' CONCLUSIONS

Despite methodological limitations of the evaluation studies reviewed, the consistency of reported reductions in fall-related injuries across all programmes support the preliminary claim that the population-based approach to the prevention of fall-related injury is effective and can form the basis of public health practice. Randomised, multiple community trials of population-based interventions are indicated to increase the level of evidence in support of the population-based approach. Research is also required to elucidate the barriers and facilitators in population-based interventions that influence the extent to which population programmes are effective.