The study, published in PLOS One, examined data collected between 2002 and 2023 through waves 1–10 of the English Longitudinal Study of Ageing, a large research programme that tracks the health, finances and living conditions of people in England as they grow older. Participants reported whether they had experienced falls and whether their homes had problems such as defective plumbing or electrical systems, insufficient space and inadequate lighting. The researchers then assessed how these housing conditions were related to falls and to falls that resulted in healthcare use.

Falls are among the most consequential health events affecting older adults who live independently. In England, about one in three people aged 65 and over experiences at least one fall each year. Although some falls cause little physical harm, others result in fractures, head injuries, hospital admissions and long-term disability. A fall can also trigger a loss of confidence, leading people to reduce their activity, become socially isolated or require additional assistance with daily tasks. For health systems, the consequences can extend far beyond the initial injury.

The strongest association in the study involved electrical or plumbing problems. Older adults living in homes with these defects had a 10.8 percent higher probability of reporting a fall than those without such problems. These conditions were also associated with falls requiring healthcare. The mechanisms may be both direct and indirect: leaking pipes can create slippery surfaces, damaged electrical systems may limit safe lighting or heating, and temporary repairs, clutter or exposed fixtures can create obstacles. Housing disrepair may also signal broader environmental risks that were not fully captured by the survey.

A lack of space was associated with a 3.3 percent increase in the probability of falling. In cramped homes, furniture and personal belongings can narrow walking routes, making it harder for residents to turn, use mobility aids or move safely between rooms. Limited space may also increase the need to step around obstacles or climb over items placed on the floor. These risks can be especially important for people with reduced balance, weakened muscles, impaired vision or conditions such as arthritis and Parkinson’s disease.

Poor lighting was particularly linked to falls that resulted in healthcare use, with a reported 9.3 percent increase in fall probability. Vision naturally changes with age, often reducing the ability to detect contrasts, judge distances and identify hazards in dim conditions. Shadows, glare and abrupt changes between bright and dark areas can make steps, loose rugs and uneven flooring difficult to see. Adequate illumination is therefore not simply a matter of comfort. It is an environmental factor that can influence how the nervous system detects obstacles and how quickly a person can adjust their movement.

Using the observed relationships and estimates from earlier research, the investigators modelled the financial consequences of housing-related falls. They calculated that poor housing could be responsible for approximately £440 million in healthcare costs and £778 million in formal care costs annually, producing a combined estimate of £1.2 billion. Healthcare costs may include emergency treatment, hospital care and follow-up services, while formal care costs can arise when people need professional assistance after an injury reduces their independence. The estimate does not mean that every fall in a defective home was caused solely by the housing condition, but it indicates the potential scale of preventable expenditure.

The findings support a shift in the way falls prevention is designed. Current strategies often focus on clinical interventions such as exercise programmes, medication reviews, vision checks and assessments of bone health. Those measures remain important, but they may be less effective if a person returns to a hazardous home environment. Repairs to plumbing and electrical systems, improvements in lighting, removal of unnecessary obstacles and modifications that create more usable space could complement medical and rehabilitation services. Treating housing improvement as part of integrated public health policy could help reduce injuries while allowing older people to remain independent for longer.

The researchers caution that the study cannot prove that housing problems directly caused the reported falls. Both falls and housing conditions were self-reported, which means that participants may have forgotten events, interpreted questions differently or underreported problems. The cost estimates also depend on assumptions drawn from previous literature, and the analysis may not capture every relevant factor, such as the design of staircases, flooring surfaces, footwear, medication use, muscle strength or the availability of informal family support. Even with these limitations, the results point to a modifiable source of risk. If poor housing contributes to falls on the scale suggested, improving homes could protect older residents while reducing pressure on already stretched health and care systems.

Subject of Research: People

Article Title: When home is a dangerous place: the cost of falls among older people living in the community

News Publication Date: 5 August 2026

Web References: https://doi.org/10.1371/journal.pone.0353755

References: Cartagena-Farías J, Fernández J-L, Silva-Ribeiro W, Brimblecombe N (2026) When home is a dangerous place: the cost of falls among older people living in the community. PLOS One 21(8): e0353755.

Image Credits: Anthony Lewis (www.anthony-lewis.com), PLOS, CC BY 4.0

Keywords: older adults, falls, housing conditions, poor lighting, home safety, healthcare costs, formal care, public health, England, PLOS One

Fragility fractures, often caused by low-impact traumas, and falls represent a significant hazard for adults over 60, threatening their healthy life expectancy. The etiology of such events is multifactorial, involving physiological changes, environmental exposures, lifestyle behaviors, and medication effects. Notably, the role of lifestyle factors—such as physical activity—and the influence of polypharmacy, defined as the concurrent use of multiple medications, have been hypothesized to impact fragility fracture and fall risk, yet definitive empirical evidence remains elusive due to limited comprehensive studies.

A groundbreaking observational study led by Dr. Masayoshi Iwamae at Osaka Metropolitan University’s Graduate School of Medicine aimed to elucidate these associations through rigorous cross-sectional analysis. The research team utilized data from 4,967 community-dwelling elders aged 60 years and older residing in Osaka Prefecture. Participants completed an online survey querying demographic information, history of fragility fractures and falls spanning five years, medication usage including polypharmacy status, unintentional weight loss, and physical activity levels.

The meticulous analysis uncovered several critical risk factors. Female participants exhibited a significantly higher likelihood of experiencing fragility fractures, consistent with the well-documented influence of postmenopausal bone density loss. Polypharmacy emerged as a robust independent predictor not only for fractures but also for falls, underscoring the detrimental cumulative side effects and drug interactions that often impair balance, cognition, and muscular function in older adults. Additionally, a history of previous falls strongly correlated with future fracture risk, reiterating the vulnerability cycle inherent in geriatric populations. Unintentional weight loss was another salient factor, likely reflecting underlying frailty, nutritional deficits, or undiagnosed illnesses compromising musculoskeletal integrity.

In a surprising finding, the researchers observed that physical activity status did not show a statistically significant association with either fragility fractures or falls within this cohort. This nuanced outcome challenges the conventional assumption that increased physical activity unequivocally reduces fracture and fall risk, suggesting that the nature, intensity, and context of physical exercise might mediate its protective effects more complexly than previously understood. While the role of physical activity remains a debated subject, the study highlights that exercise promotion should continue to focus on enhancing overall quality of life rather than solely fracture or fall prevention.

Medication optimization emerged as a paramount recommendation flowing from these findings. Given polypharmacy’s pronounced negative impact, comprehensive medication reviews to deprescribe unnecessary or high-risk drugs are vital. Health practitioners should prioritize tailoring pharmacotherapy regimens to minimize sedative load and cognitive impairment risks. Similarly, addressing unintentional weight loss through targeted nutritional interventions is crucial in fortifying bone strength and muscular resilience, thereby potentially mitigating fragility and fall susceptibility.

Beyond direct clinical applications, the study’s implications extend to public health policy. Developing integrated community-based initiatives that incorporate medication management guidelines, nutritional support programs, and adaptive physical activity schemes could enhance preventive outcomes at population levels. Such multidisciplinary approaches would recognize the multifaceted nature of fragility fractures and falls, moving beyond single-factor interventions towards holistic elder care.

Dr. Iwamae emphasized that the study’s cross-sectional design, while informative, warrants further longitudinal research to unravel causality and evaluate intervention efficacies over time. Future investigations could stratify physical activity modalities to determine which forms might confer protective benefits against fractures and falls. Additionally, exploring the biochemical and biomechanical pathways linking unintentional weight loss and polypharmacy to skeletal fragility could inspire novel therapeutic targets.

This research contributes substantial evidence supporting a paradigm shift in geriatric fracture and fall prevention strategies. While promoting physical activity remains essential for its broad health benefits, attention to medication burden and nutritional status emerges as equally critical components of comprehensive care models. Integration of such insights into clinical practice and public health frameworks promises to improve healthspan and autonomy among aging populations.

Published in the authoritative journal BMC Geriatrics, this study enriches the scientific dialogue surrounding age-associated injury risk factors and invites further exploration into optimizing elder health. As communities worldwide grapple with demographic aging, the actionable knowledge generated by Dr. Iwamae’s team underscores the urgency and potential of targeted interventions designed to mitigate the burdens of fragility fractures and falls.

Subject of Research: People
Article Title: Lifestyle factors, including physical activity status, associated with fragility fractures and falls: A cross-sectional study
News Publication Date: 24-Mar-2026
Web References: https://www.omu.ac.jp/en/
References: DOI: 10.1186/s12877-026-07344-7
Image Credits: Osaka Metropolitan University
Keywords: Fragility fractures, falls, elderly, polypharmacy, unintentional weight loss, physical activity, geriatric health, medication optimization, nutritional intervention, aging population, community-dwelling adults, fall prevention

Falls among older adults have long been recognized as a critical public health concern, often precipitating physical injury, loss of independence, and even mortality. While extensive research has explored physical factors such as muscle weakness, balance impairment, and environmental hazards, comparatively little attention has been paid to the psychological dimensions that modulate fall risk. This study meticulously bridges that gap by employing qualitative methodologies to capture the first-person experiences and internalized perceptions that older individuals harbor about their fall risk, shedding light on the subjective realities that shape their behavior and well-being.

Central to the research is the concept of “perceived control” — the degree to which individuals believe they can influence or prevent falls. Perceived control is not merely a passive belief but an active psychological mechanism that significantly impacts motivation, risk-taking behaviors, and adaptive strategies. Through nuanced interviews and thematic analysis, the authors reveal how older adults oscillate between feelings of empowerment and vulnerability, often influenced by past experiences, social support networks, and personal coping styles. This dynamic interplay underscores the importance of personalized approaches in fall prevention programs.

The qualitative design allowed participants to articulate their fears, strategies, and emotional responses in their own voices, revealing a spectrum of attitudes toward falling. Some expressed a resilient determination to maintain independence, employing mental rehearsal and environmental modifications as protective measures. Others conveyed a sense of resignation or anxiety that heightened their awareness of potential hazards but paradoxically could lead to reduced physical activity and increased fall risk. These psychological profiles suggest that interventions must be finely tuned to address individual cognitive-emotional states rather than adopting a one-size-fits-all model.

Moreover, the study highlights the role of identity and self-perception in shaping fall-related behaviors. Many older adults wrestle with the stigma of frailty and dependency associated with falling, which can erode self-esteem and foster social isolation. The perceived loss of control often extends beyond physical ability into existential domains, affecting overall mental health and quality of life. Recognizing these intertwined factors, the research advocates for holistic care frameworks that integrate psychological support with physical rehabilitation and environmental adjustments.

Importantly, the findings expose how information and communication from healthcare providers influence perceived control. Participants who reported clear, empathetic guidance and reassurance exhibited greater confidence and proactive engagement in fall prevention. Conversely, experiences of dismissal or inadequate communication exacerbated feelings of helplessness, underscoring the critical need for sensitive, patient-centered dialogue in clinical settings. This insight challenges medical professionals to refine their communication strategies to empower older adults effectively.

Technology also emerged as a double-edged sword in the perceptions of control. While assistive devices and monitoring systems offer tangible benefits, some participants articulated concerns about dependency, privacy, and the potential erosion of autonomy. This ambivalence illustrates the complexity of integrating technology into elder care, necessitating advancements that are not only functionally effective but also psychologically acceptable and customizable to individual preferences and values.

The research further elucidates the social dimensions underpinning perceived control. Strong social connections and community engagement were repeatedly linked to enhanced confidence in navigating fall risks. Emotional support and shared knowledge within social networks provided psychological buffering against fear and uncertainty. These findings affirm the value of fostering inclusive, socially supportive environments as a complement to clinical interventions, thereby promoting resilience and adaptive coping mechanisms in older populations.

Intriguingly, the study identifies cultural narratives and societal attitudes toward aging as influential factors in the construction of perceived control. Variations in beliefs about aging, independence, and risk-taking framed how participants internalized their fall concerns and strategies. This suggests that culturally tailored approaches may be necessary to effectively address fall-related fears globally, respecting diverse values and worldviews while encouraging empowerment and active engagement.

The psychological constructs investigated include not only perceived control but also related phenomena such as fear of falling, self-efficacy, anxiety, and locus of control. The integration of these constructs provides a comprehensive framework for understanding the multifaceted nature of fall risk perception. This theoretical advancement offers a scaffold for future empirical research and the development of psychometrically robust assessment tools to guide individualized care planning.

By bringing to light the complex psychological realities of older adults with fall concerns, this study challenges healthcare systems to rethink prevention paradigms. It argues convincingly for the adoption of multidisciplinary approaches that harmonize physical, psychological, social, and technological dimensions. Embedding these insights into policy and practice holds the potential to not only reduce fall incidences but also restore a sense of agency and dignity among aging populations.

In conclusion, the qualitative exploration by Tantrongphak, Suriyaamarit, and Anantapong represents a seminal contribution to geriatric medicine and psychological health. It underscores that perceived control over falling is a pivotal yet underappreciated determinant of outcomes in older adults. By interrogating the lived experiences behind fall concerns, the study paves the way for innovative, empathetic, and effective interventions that honor the whole person rather than merely addressing physical risk factors.

The urgency of this research cannot be overstated given the demographic shift toward an aging global population. As societies grapple with increasing demands on healthcare infrastructure, implementing the nuanced understanding of perceived control could transform fall prevention into a more successful, person-centered endeavor. This work serves as a clarion call for researchers, clinicians, and policymakers to embrace psychological insights as indispensable tools in the fight against fall-related morbidity and mortality.

Looking forward, the interdisciplinary collaboration inspired by these findings may lead to breakthroughs in digital health, community programming, and therapeutic techniques, all calibrated to optimize perceived control. This approach promises greater engagement by older adults in their own care, reducing fear, promoting adaptability, and ultimately improving safe mobility. With fall prevention poised at this crossroads of innovation and empathy, the future holds promise for truly enhancing the aging experience worldwide.

Subject of Research: Psychological aspects of perceived control over falling in older adults with fall concerns.

Article Title: Perceived control over falling: a qualitative study of psychological aspects in older adults with fall concerns.

Article References:
Tantrongphak, K., Suriyaamarit, D. & Anantapong, K. Perceived control over falling: a qualitative study of psychological aspects in older adults with fall concerns. BMC Geriatr (2026). https://doi.org/10.1186/s12877-026-07784-1

Image Credits: AI Generated

Falls are the leading cause of injury-related morbidity and mortality among adults aged 60 and above, exerting devastating effects on individuals and their families. Unlike their counterparts in high-income countries, older adults in low- and middle-income countries face distinct socio-economic and environmental risk factors that often exacerbate their vulnerability to falls. The scarcity of healthcare infrastructure and preventive services in these regions magnifies the urgency of deploying effective fall prevention measures that are both adaptable and feasible within resource-constrained settings.

This comprehensive meta-analysis scrutinizes an extensive body of literature, collating data from diverse interventions targeted at community-dwelling older adults in these economically varied terrains. The investigators meticulously evaluated randomized controlled trials and observational studies, encompassing multifaceted fall prevention strategies ranging from exercise programs and home modifications to multifactorial interventions integrating medical, social, and environmental components. By synthesizing evidence across numerous studies, the analysis not only quantifies the overall effectiveness of these interventions but also dissects their contextual relevance and implementation challenges.

Technically, the meta-analytical framework employed rigorous statistical methodologies including random-effects models to account for heterogeneity among study populations and intervention formats. The analysis also incorporated subgroup explorations to untangle nuances linked to intervention intensity, duration, and settings. Importantly, the researchers addressed potential publication biases and assessed the quality of evidence through recognized grading systems, providing a robust foundation for policy recommendations.

One of the quintessential revelations from the analysis underscores the significant reduction in fall rates and fall-related injuries among those who engaged in structured exercise regimens emphasizing balance, strength, and gait training. Such physically oriented programs wield profound physiological benefits, ameliorating muscular weakness and improving proprioceptive control, key contributors to fall risk. Crucially, these interventions demonstrated consistent efficacy even when adapted to community settings in LMICs, emphasizing the potential for scalable and culturally tailored exercise initiatives.

Home hazard modifications emerged as another critical domain, with interventions targeting environmental risk factors—such as inadequate lighting, slippery floors, and unstable furniture—showcasing tangible benefits in reducing fall incidents. The practical application of these modifications, often simple yet transformative alterations in living conditions, highlights the tangible intersection between environmental safety and geriatric health. The meta-analysis provides compelling evidence that even low-cost home safety strategies can yield significant public health dividends.

Multifactorial interventions, which synergize exercise, medication review, vision assessment, and social support, also featured prominently as a holistic approach. These multifaceted strategies address the intricate interplay of biological, psychological, and social determinants inherent in fall risk among older adults. However, the effectiveness of such complex interventions demonstrated variability, often contingent upon the availability of multidisciplinary teams and community engagement levels, factors frequently constrained in resource-limited settings.

A key technical consideration detailed in the study concerns the scalability and sustainability of these intervention programs. The meta-analysis revealed that community-based interventions facilitated by trained lay health workers or local volunteers showed promise, particularly when reinforced by culturally sensitive education and support mechanisms. This aligns with emerging public health paradigms advocating task-shifting and community empowerment to overcome healthcare workforce shortages endemic to LMICs.

The research also highlights the importance of contextualizing fall prevention within broader social determinants of health, including nutrition, chronic disease management, and mental health support. It becomes evident that integrating fall prevention with comprehensive geriatric care models could amplify benefits, addressing not only immediate risk factors but also underlying vulnerabilities contributing to falls.

Despite the promising outcomes, the study acknowledges several research gaps and methodological limitations intrinsic to existing literature. These include variability in outcome measurement, limited longitudinal data on intervention durability, and the paucity of cost-effectiveness analyses vital for policy prioritization. Such insights pave the way for a refined agenda focused on high-quality, culturally adapted randomized trials and implementation research within LMICs.

The global implications of these findings resonate far beyond the confines of individual nations. As the demographic profile shifts toward an increasing proportion of older adults in every sector of the world, the necessity for evidence-based, accessible fall prevention becomes a universal priority. This systematic review and meta-analysis offer an invaluable evidence base from which global health stakeholders, governments, and non-governmental organizations can craft impactful interventions tailored to the nuanced needs of older populations in economically diverse settings.

Technological advancements and digital health innovations also offer exciting prospects to augment traditional fall prevention methodologies. Telehealth platforms for remote exercise guidance, wearable sensors for real-time fall detection, and smartphone applications for home safety assessments could revolutionize intervention delivery, especially in LMICs where face-to-face resources are scarce. The study suggests future research avenues exploring such integrative technologies to bolster reach and fidelity.

Another fascinating dimension pertains to the psychosocial benefits of fall prevention programs observed within the analyzed literature. Older adults engaged in group exercises and community activities manifested improved mental health markers, social connectedness, and overall quality of life. These ancillary outcomes underscore the multidimensional value of fall prevention, extending well beyond physical safety to encompass holistic wellness and societal participation.

The ripple effects of fall prevention on healthcare economics are equally profound. Reducing fall-related injuries translates to fewer hospital admissions, diminished demand for rehabilitative services, and lower long-term care costs. These economic advantages are pivotal in LMICs where healthcare budgets are tightly constrained, positioning fall prevention as a cost-saving and health-promoting investment within geriatric care frameworks.

Nevertheless, the authors emphasize the crucial role of policy integration and multi-sectoral collaboration in actualizing the potential of these interventions. Effective fall prevention transcends clinical care, involving urban planning, social services, education, and community mobilization. Such cross-cutting approaches are indispensable for fostering environments conducive to healthy aging and injury prevention.

In conclusion, this landmark systematic review and meta-analysis shed critical light on fall prevention strategies tailored for older adults living in low- and middle-income countries. It presents a compelling, technically rigorous body of evidence affirming the efficacy of exercise, home modifications, and multifactorial programs while highlighting implementation challenges and research priorities. As global aging intensifies, harnessing these insights offers a transformative path to safeguarding older adults’ independence, dignity, and well-being across the diverse tapestry of LMICs.

Subject of Research: Effectiveness of fall prevention interventions for community-dwelling adults aged 60 years and above in low- and middle-income countries

Article Title: Effectiveness of fall prevention interventions for community-dwelling adults aged 60 years and above in low- and middle-income countries: a systematic review and meta-analysis

Article References:
Chellapillai, F.M.D., Dissanayaka, T.D., Weerasekara, I. et al. Effectiveness of fall prevention interventions for community-dwelling adults aged 60 years and above in low- and middle-income countries: a systematic review and meta-analysis. BMC Geriatr (2026). https://doi.org/10.1186/s12877-026-07319-8

Image Credits: AI Generated

The significance of this research lies not only in its potential to enhance the quality of life for the elderly but also in its capacity to alleviate burdens on healthcare systems worldwide. Sarcopenia affects an estimated 10% to 30% of older adults, leading to an increased risk of falls, diminished mobility, and ultimately, a decline in independence. The study aims to elucidate the specific ways in which sarcopenia influences postural stability, a key determinant of fall risk in the elderly population.

By employing a force platform, the researchers were able to quantitatively measure balance and stability parameters among older adults suffering from varying degrees of sarcopenia. This technology allowed for an unprecedented level of precision in assessing postural sway, which is known to increase the likelihood of falls. The research participants were subjected to a series of tests that analyzed their dynamic balance capabilities, creating a comprehensive picture of how muscle deterioration impacts their ability to maintain stability.

Moreover, the findings of the study underscore a critical aspect of rehabilitation and intervention strategies for older adults. With a clear understanding of how sarcopenia affects balance, healthcare providers can develop targeted programs that not only aim to improve muscle mass through resistance training but also enhance postural stability through balance exercises. This alignment of goals may significantly reduce the incidence of falls, thereby improving the overall quality of life for older adults.

The implications of this study extend beyond individual health; they reach into the broader context of public health policy. As governments grapple with the social and economic ramifications of an aging population, effective management of sarcopenia could play a pivotal role in minimizing healthcare costs associated with fall-related injuries. The study advocates for a proactive approach to sarcopenia screening and intervention, suggesting that early detection and treatment could delay the onset of debilitating conditions.

Interestingly, the researchers also noted that the impact of sarcopenia on balance may not solely be attributed to muscle mass loss. Factors such as neuromuscular function, proprioception, and even cognitive health come into play. This multi-dimensional perspective highlights the necessity for a holistic approach in addressing the challenges posed by aging, whereby both physical and mental health are integral to maintaining functionality and independence in older age.

While existing literature on sarcopenia has shed light on its physical ramifications, the present study takes a significant leap forward by correlating these physical changes with measurable outcomes in balance. This important linkage provides a foundation for future research aimed at exploring how interventions can be optimized to address the needs of older adults, particularly those at greater risk of mobility issues.

Additionally, the research emphasizes the need for a more nuanced understanding of the sarcopenic process. Instead of viewing sarcopenia as a uniform condition, the study recognizes the variation in its progression and effects among individuals. This variation calls for personalized approaches to treatment and management, thus enhancing the potential for effective outcomes across diverse populations.

In recognizing the broader implications of this study, it becomes clear that the urgency surrounding sarcopenia awareness and action cannot be overstated. Educational initiatives aimed at both healthcare providers and the public can foster a greater understanding of the importance of muscle health in aging populations. Awareness campaigns could empower older adults to engage in preventive measures, such as regular physical activity, nutrition focused on protein intake, and regular check-ups to monitor muscle health.

As researchers continue to explore the multifaceted impacts of sarcopenia, the integration of technology and innovative methodologies promises to yield further insights. Future studies may also incorporate longitudinal designs, allowing for the tracking of changes over time, which could illuminate the causal relationships between sarcopenia, balance, and fall risk more clearly.

In conclusion, the study conducted by Michel, Chorin, and Guerin represents a significant advancement in our understanding of sarcopenia and its impact on balance in older adults. By leveraging advanced tools and methodologies, the researchers have provided critical insights that will inform interventions aimed at mitigating the risks associated with muscle loss. The call to action for proactive screening, personalized treatment plans, and public health initiatives is clear, as our society moves forward in an era where addressing the complexities of aging is not merely beneficial but essential.

As the results of this study are disseminated, it is hoped that professionals in geriatric healthcare will prioritize strategies to combat sarcopenia and enhance balance, ultimately leading to healthier, more active lives for the aging population. The road ahead may be challenging, but with informed action driven by cutting-edge research, there is reason for optimism.

Subject of Research: The impact of sarcopenia on balance in elderly individuals.

Article Title: Assessing the impact of sarcopenia on balance in the elderly: an analysis using a force platform.

Article References:

Michel, E., Chorin, F., Guerin, O. et al. Assessing the impact of sarcopenia on balance in the elderly: an analysis using a force platform.
BMC Geriatr (2025). https://doi.org/10.1186/s12877-025-06755-2

Image Credits: AI Generated

DOI: 10.1186/s12877-025-06755-2

Keywords: sarcopenia, elderly, balance, force platform analysis, falls, healthcare, rehabilitation, muscle mass, public health, intervention strategies.