Aims: To gain new knowledge about barriers to participation in hospital-based falls assessment. Methods: Semi-structured

interviews with 20 older people referred to falls assessment at a hospital-based clinic were conducted. A convenience sample

of 10 refusers and 10 accepters was collected. Those who refused referral were recruited in relation to a systematic falls

screening programme performed by preventive home visitors. Accepters were selected among 72 participants successively

completing the falls assessment clinic programme. The time between the interviews was 12 months; different levels of

knowledge were expected, owing to accepters' participation in the programme. Interview transcriptions were thematically

analysed. The analysis was directed towards identification of barriers to falls assessment. Results: Barriers to participation

were categorized as being either within or outside the falls clinic, and included administration, time, communication,

attitudes to fall prevention, and expected future costs. Accepters completing the programme expressed a feeling of being

‘‘met'' in the system and maintaining authority over their own life, while the refusers expressed concern about the healthcare

system taking over their life. Conclusions: This study indicates that older at-risk patients acknowledge their falls

problem, but refuse to participate in hospital-based assessment programmes because they expect to lose their

authority and to be caught up in the healthcare system. In order to transformthe findings of this study to a public

health message, we have to consider moving the focus of falls prevention strategies from disease control to the

domain of health promotion in order to engage older adults in preventive healthcare.