2025/11/28 by Manuel Montero‐Odasso, Lotta J Seppala, Nathalie van der Velde +2 · 1 voice
Social Sciences · Health Professions · #Human Rights and Development #Health, psychology, and well-being #School Health and Nursing Education
paper · doi:10.1093/ageing/afaf366
openalex publication_date 2025/11/28 · openalex created_date 2025/12/23 · openalex updated_date 2026/07/29
Editorial to accompany: Implementing the World Falls Guidelines (WFG) in Sweden: Implications for a Knowledge Support tool and practice Organisational meso-level of leadership and alignment with local champions bridge the gap between policy and practice Co-created knowledge support tools increase relevance, usability and sustainability Integration across digital and organisational systems is essential to make fall prevention evidence truly actionable The WFG can only achieve its potential if implementation is treated as an ongoing process rather than a time-limited project The World Falls Guidelines (WFG) were developed to provide a unified, evidence-based framework for preventing and managing falls in older adults worldwide [1]. Since their publication in 2022, the question has shifted from what works to how we make it work. In other words, how can systems translate the WFG recommendations into daily clinical and public health practice? The study by Arkkukangas et al. in this issue of Age and Ageing provides one of the first real-world answers [2]. Their experience implementing the WFG in Sweden underscores a crucial insight: implementation lives or dies at the meso (organisational) level, where leadership, structure and context meet. Using a participatory research design across primary care, hospitals, homecare, and community settings, the Swedish team co-created a knowledge support tool based on the WFG’s recommendations, aiming to embed falls prevention into routine workflows. Their findings reveal that whilst commitment existed at both the macro (policy) and micro (clinical) levels, the organisational middle and intermediate management, emerged as the bottleneck. They found that managers often perceived implementation as a project rather than a process of change, risking early enthusiasm without long-term sustainability. This ‘bottleneck’ phenomenon, common in complex system change, highlights a blind spot in implementation efforts globally [3, 4]. One of the strongest messages from the Swedish experience is that evidence-based guidelines can only succeed if implementation is understood as a continuous process, not as a discrete project with a beginning and end. Short-term pilots and temporary funding create enthusiasm and initiate changes but fail to modify culture or practice in a sustainable manner. Long-term anchoring, through policies, accountability, and resources, is essential for the implementation of the WFG to move from aspiration to routine care. Research in knowledge mobilisation and implementation science have recognised the three above mentioned interconnected levels: macro (policy), meso (organisational) and micro (individual) [3]. Most guidelines’ implementation efforts focus on either the macro (national policies) or the micro (clinician behaviour), overlooking the meso level where coordination and resourcing occur. The Swedish findings confirm that intermediate management, including department heads, unit directors, and care coordinators are the true gatekeepers of change. Without their active engagement, decisions made at the top rarely translate into daily practice. In other words, the meso level seems to be the organisational heartbeat of change. The Swedish study also emphasises that local champions and supportive leadership are pivotal for sustaining new working methods. Local champions bridge the gap between the guideline’s recommendations and the front health workers, fostering trust, motivation and contextual adaptation. Their leadership and work should aim to transform guidelines from external mandates into locally owned tools. This aligns with our earlier observations regarding the WFG implementation globally: every successful falls prevention initiative features at least one visible and empowered champion driving it forward [4, 5]. Local champions and supportive leadership are indispensable for implementation. A key innovation of the Swedish project was the co-creation of a web-based knowledge support tool tailored to both professionals and older adults. The tool translated the WFG algorithm into actionable modules, integrating assessment instruments, educational videos and brochures. The participatory approach, where researchers, practitioners and people with lived experience jointly shaped content, ensured relevance and co-ownership. Co-creation moves beyond traditional dissemination, turning passive ‘users’ into active partners and increasing the likelihood of sustained use. Knowledge translation and support resources must be co-created, not just disseminated. Despite progress, the barriers remain familiar and willful, including fragmented documentation systems, limited digital literacy, and communication silos between health and social care [2]. These challenges illustrate that implementing falls prevention and management recommendations is not simply a matter of training clinicians: it requires system integration [6]. A recent study [5] examining the progress of WFG implementation highlighted that adapting the WFG to diverse healthcare systems and integrating fall prevention into national policies through context-sensitive strategies is crucial for sustainable global adoption. Importantly, shared documentation platforms, interoperable data, and consistent terminology are the infrastructure of sustainable falls prevention programmes. The Swedish experience shows that when systems remain disconnected, even the best evidence cannot achieve integration across systems making it imperative that we try and break silos and harmonise documentation. A global call to action. As adoption of the WFG advances across Europe, Asia, Australasia, and the Americas, the Swedish experience offers valuable lessons for all health systems. Implementing complex, multifactorial guidelines like the WFG demands investment in leadership training, middle-management engagement, and digital infrastructure. We must recognise that evidence alone does not change practice, while implementing systems embed in customary and cultural grounded workflow, do [7, 8]. At the same time, we should also acknowledge that implementation of fall prevention guidelines in health services is still generally poor. Therefore, the Swedish model of participatory co-creation provides a roadmap for others by anchoring the WFG initiative at the political and managerial level, by co-creating tools that fit local realities, and by sustaining engagement through leadership at every level. Without this alignment, WFG implementation risks simply remaining a well-intentioned aspiration rather than a clinical and public health achievement. The road to deception is paved with well-intentioned aspirations, but to defeat deception and achieve real change, we need collective commitment, empowered leadership, and the courage to turn evidence into sustained actions. M.M.O. is Past-President and member of the executive of the Canadian Geriatrics Society, member of the Advisory Board of the CIHR Institute of Aging, member of the Executive Committee of World Falls Prevention and Associate Editor of the Journal of Alzheimer’s Disease, the Journal Gerontology Medical Sciences, and Geriatrics. L.S. has no disclosures. N.vdV. is Academic Director of the Executive Board of the European Geriatric Medicine Society, member of the Executive Committee of World Falls Prevention and Deputy Editor-in-Chief of Age and Ageing. J.R. is a member of the Executive Committee of World Falls Prevention Society and Academic Board member of the European Geriatric Medicine Society. T.M. is President Elect and member of the Executive Board of the European Geriatric Medicine Society and member of the Executive Committee of World Falls Prevention. None declared.