As the first chapter of this book clearly sets out, falls are a major problem for older people and for society. Every year in the United Kingdom, around one-in-three people aged over 65 years fall, and about one-third of people in this age group are seen in hospital accident-and-emergency departments as the result of a fall. The incidence of fall-related injuries is increasing faster than would be expected given demographic changes, and while the costs of falls were nearly £1 billion in 1999, they are expected to triple by 2050. It is therefore unsurprising that, even though it is only six years since the first edition of this book was published and very positively received, over the last few years there has been a rapid increase in research on the topic. The authors note that this research has already generated important new knowledge; for example, they highlight the growing awareness that hip protectors may prove an ineffective means of reducing fracture rates from falls, because there is accumulating evidence that older people are reluctant to wear them consistently.

The book is extremely easy for readers to use, whatever their needs. It is very well written, readable and logically structured: Part I overviews risk factors, which provides a foundation for the discussion of prevention strategies in Part II. Each chapter reviews the evidence relating to a particular sub-topic, for example ‘Medications as risk factors’ and ‘Assistive devices and falls prevention’, and ends with a paragraph that summarises the conclusions from the review of the evidence. For the reader who is in a hurry, or has only a peripheral interest in a topic, these summaries convey concisely the up-to-date, expert opinions. Readers who wish for more extensive understanding of the evidence-base for these conclusions will find, however, that each chapter critically reviews a wealth of relevant papers, pointing out the complexities of the issues covered and the methodological limitations of existing research. For example, the chapter on ‘Sensory and neuromuscular risk factors for falls’ notes that links between falling and visual, proprioceptive and vestibular (balance) deficiencies may have been under-estimated because of limitations in the way that sensory function has been assessed. A case in point is vestibular function, which is especially difficult to assess accurately; new preliminary evidence suggests that there may be a previously undetected association between falls and poor vestibular function. The authors also observe that the effects of sensory deficits may interact. For instance, those with poor vestibular function may be obliged to rely more on vision to balance; this will only then result in falling if they also have poor vision.

Complex interactions between risk factors are a recurrent theme of the book, and draw the reader's attention to the need to appreciate the relationship between the individual and their environment. The authors suggest that the distinction between ‘intrinsic’ and ‘extrinsic’ risk factors is a false dichotomy. To continue the illustration given above; an individual with poor vestibular function but good vision may not be at risk of falling when they can see their surroundings well, but may fall in poor light. Moreover, people's behaviour can modify potential risk factors – the risk of falling may not be significantly elevated by their poor vestibular function if the individual concerned is aware that their balance is poor in the dark, ensures that there is good lighting at home, and walks carefully when the light is poor.

The introduction to Part II notes that since risk factors are heterogeneous and complex, there can be no single, simple solution to falls prevention. Chapter 10, which is co-authored with Julie Whitney, nevertheless makes a valiant attempt to identify the characteristics that discriminate effective from ineffective exercise-based falls prevention interventions. Although the evidence does not yet permit any firm conclusions to be drawn as to the ideal characteristics of such interventions, the authors make suggestions for necessary ingredients, based on their extensive clinical experience and an interpretation of the mixed findings from clinical trials.

The final section of the book considers directions for future research, but useful indicators of areas of ignorance requiring further investigation are provided throughout by the critical literature reviews. For instance, in reviewing psychological risk factors the authors note that depression can increase the risk of falling by an odds ratio of 7.5, but the reason for this greatly increased risk is unclear. Perhaps older people who are depressed are much less active and therefore have reduced muscle strength? Maybe use of antidepressants contributes to their increased risk of falling? While readers will learn much from this book, whether they are novice or experienced in the field, the book also makes the reader acutely aware of how much more we need to understand if we are to achieve significant reductions in the rate of falling. An inevitable limitation of any attempt to review such a large literature is that conclusions can rapidly become out of date, and so while this second edition provides a valuable update of an excellent resource, it can only be hoped that advances in our knowledge will soon make it necessary to embark on a third edition.