1. Why this article?
A fall rarely begins dramatically. Usually it is the edge of a rug, a step in poor light, getting up from the sofa too quickly, a swerve on the pavement. Seconds later you are on the floor and not quite sure how it happened.
What follows is often more far-reaching than the fall itself. Many people become careful. They walk less, avoid uneven ground, skip the outing. That is understandable – and it is exactly the wrong way. Whoever moves less loses strength and balance, and that raises the risk of the next fall.
The good news: few health problems in later life are as well researched and as modifiable as the risk of falling. There are international guidelines [1], there are large reviews with high-certainty evidence [2], and there is a fairly clear answer to the question of what works.
This article explains why people fall, how to judge your own risk and what is proven to help. It also says what does not help – that matters at least as much. All statements are backed by sources; the numbers in square brackets refer to the reference list at the end.
2. How common are falls?
The international guidelines assume that around 30 per cent of people over 65 fall at least once a year [1]. Depending on how carefully people are asked, the figure lies between a quarter and a third – some falls are simply never mentioned.
For Switzerland, the Swiss Council for Accident Prevention (BFU) gives the following orders of magnitude [18]:
- More than 290,000 people are injured in a fall each year.
- Around 16,000 of these falls are severe.
- More than 1700 people die each year as a result of a fall – 95 per cent of them are over 64.
- Among older adults, that amounts to roughly 1600 deaths and 7100 severe injuries a year.
- Almost two thirds of falls happen on the level – not off a ladder, but while walking.
For comparison: falls claim considerably more lives in Switzerland every year than road traffic does. It just makes the news less often, because a fall in one's own living room is not a headline.
A second point is easily overlooked: roughly one in eight people who fall then lie on the floor for more than an hour [1]. Among people over 90, up to 80 per cent cannot get up again by themselves after a fall [1]. Such long lies are medically dangerous – more on that below.
3. Why do people fall?
The commonest explanation after a fall is: «I wasn't paying attention.» That is almost never true. A fall is as a rule the result of several factors that happen to line up badly at the same time. This is not an academic nicety but the reason why single pieces of advice («get rid of that rug») achieve so little and why programmes that act on several fronts achieve so much [1].
3.1 Balance is teamwork
Your balance arises from three sources of information that the brain constantly cross-checks against each other:
- The eyes – they report where up is and how the surroundings are moving.
- The balance organ in the inner ear – it measures rotation and acceleration of the head.
- Proprioception – feedback from ankles, muscles and joints about how the body is currently positioned.
As long as all three sources deliver reliably, you notice nothing of this work. If one drops out, the others take over – up to a point. That is exactly why things get critical in the dark, on soft ground or with new glasses: several sources then fail at once or deliver contradictory information.
If you would like to try the interplay for yourself: in our Reaction Lab you can switch individual senses off in the sensory cockpit and watch what happens to balance.
3.2 Strength – and above all power
When you trip you have roughly a fifth of a second. In that time the standing leg has to take the full load and the other leg has to make a fast, long recovery step. For that you need not just strength but power: the ability to generate force very quickly.
And that is precisely what we lose first and fastest with age. In a large European study of more than 9000 people aged 60 and over, sit-to-stand power relative to body weight declined markedly from around the age of 50; below 2.1 watts per kilogram (women) and 2.6 watts per kilogram (men) the risk of mobility limitations rose clearly [17].
How muscle strength is lost in later life – and what to do about it – is covered in detail in our companion article Muscle weakness in older age.
3.3 Medication – the underrated factor
Certain medicines measurably increase the risk of falling. A European expert group developed a tool for this (STOPPFall) and compiled 14 medication classes in it – predominantly drugs acting on the nervous system [12]: sleeping pills, sedatives, certain antidepressants, antipsychotics, plus some cardiovascular medicines.
That does not mean these medicines are wrong. It means the list deserves regular review – particularly when things have been added over the years. The guidelines recommend a structured medication review as a fixed component of every falls programme [1].
Important: never stop anything yourself. Abruptly stopping sleeping pills or sedatives can be more dangerous than the drug. That is a conversation with your doctor or pharmacist.
3.4 Eyesight, feet, footwear
Eyesight. An untreated cataract is a substantial risk factor; operating on the first eye reduces the number of falls in studies [1]. Less well known: varifocal glasses are unfavourable outdoors. They distort exactly the lower field of view in which you judge kerbs and steps. For walks, single-vision distance glasses are the safer choice [1].
Feet and footwear. Painful feet change the way you walk, and a changed gait costs security. Unfavourable footwear includes slippers without a heel counter, smooth soles – and walking barefoot indoors, which is linked to falls more often than most people suspect [1].
3.5 Blood pressure, dizziness, the heart
Some falls are not a trip at all but a brief blackout. In an orthostatic blood pressure drop the blood pressure falls on standing up; vision goes dark for a moment. The guidelines therefore recommend measuring blood pressure lying down and then repeatedly while standing – not just once while seated [1].
Cardiac rhythm disturbances and brief faints (syncope) also hide behind «falls». One warning sign: you cannot remember the moment of the fall, or you fell for no discernible reason. That needs medical assessment [1].
And finally, dizziness. It has many causes, and a large share of them – benign paroxysmal positional vertigo, for example – respond well to physiotherapy.
3.6 The home
Trip hazards are real: loose rugs, cables, missing handrails, stairs that are too dark, the night-time route to the toilet without a light. How much removing them actually achieves is more nuanced than you might think – see section 6.2.
3.7 The fear itself
Fear of falling is not a side issue but a risk factor in its own right. It leads to more cautious walking, less activity, less strength – and therefore to more falls.
An Australian cohort study that compared measured and perceived fall risk is particularly instructive [11]. In many people the two did not match. There were people with good balance and great fear – in them, anxiety and depressive symptoms went along with it, and they restricted themselves unnecessarily. And there were people with poor balance and little concern – they went on to fall particularly often.
Both constellations are a reason to have the risk measured once rather than guessed.
4. How high is your risk?
4.1 The three questions
The international guidelines recommend a very simple starting point – three questions [1]:
- Have you fallen in the past year?
- Do you feel unsteady when standing or walking?
- Do you worry about falling?
If you answer yes to any of these, that is reason enough to have gait and balance looked at objectively [1].
Why three questions and not just the first? Because the question about falling on its own is highly specific but misses many of those affected. In 65- to 74-year-olds it identifies only around 43 per cent of future fallers, in the over-85s about 67 per cent [1]. On top of that, many people volunteer nothing about a fall. Among men, fewer than a third mention it unless asked directly [1].
These three questions, together with nine more, make up a short questionnaire you can fill in right here: Fall risk – the short self-check. It works everything out on your own device and stores nothing; at the end you can print a report or save it as a PDF and take it to your appointment.
4.2 What gets measured in practice
Simple, well-studied tests exist for this assessment. The Swiss versions of the forms are made freely available by the BFU in its StoppSturz portal [19].
Gait speed. The single test most strongly recommended by the guidelines. It is measured over four metres; a value of 0.8 metres per second or slower is regarded as a marker of increased risk [1].
Timed Up and Go (TUG). Stand up from a chair, walk three metres, turn around, come back, sit down. Cut-off: longer than 15 seconds [1].
Five times sit to stand (5xSTS). Standing up from a chair and sitting down again five times as fast as possible, arms folded across the chest. A measure of leg strength.
Mini-BESTest. A more detailed balance test that examines the different components of balance separately – among them how well you recover after being pushed.
FES-I. A questionnaire on fear of falling. The guidelines explicitly recommend capturing concerns about falling with a standardised instrument rather than asking about it in passing [1].
4.3 And now the honest appraisal
These tests are useful. But they are not fortune-telling, and that is worth knowing before a result is over-interpreted.
For the best known of them, the Timed Up and Go, a systematic review with meta-analysis examined the predictive value. The result: the TUG has only limited ability to predict falls in community-dwelling older people and should not be used in isolation to identify individuals at high risk [10]. The guidelines themselves are similarly cautious and rate the evidence for the TUG lower than for gait speed [1].
Translated, that means:
- An unremarkable test result is no guarantee. It does not rule out an increased risk.
- A remarkable result is not a verdict. It is a reason to look more closely.
A single test value almost never says as much as it appears to – why that is mathematically so is something you can play through yourself in our game A false sense of certainty.
That is why, when risk is increased, the guidelines call for what they term a multifactorial assessment: gait and balance, muscle strength, medication, standing blood pressure, vision and hearing, feet and footwear, memory and concentration, nutrition, continence, fear of falling and the home environment [1]. Not in order to produce a long list, but to find out at which two or three points the greatest leverage lies in your case.
5. What helps most: exercise
If you take only one section away from this article, take this one.
5.1 What the numbers say
The definitive review summarises 108 randomised trials with 23,407 people [2]. The findings:
- Exercise reduces the number of falls by 23 per cent (rate ratio 0.77; 95% confidence interval 0.71–0.83; 59 trials, 12,981 people) – with high certainty of evidence.
- The number of people who fall at all drops by 15 per cent (0.85; 0.81–0.89) – also high certainty.
- Balance and functional exercises reduce the rate of falls by 24 per cent (0.76; 0.70–0.81; 39 trials) – high certainty.
- Several types of exercise combined (usually balance plus strength) reduce it by 34 per cent (0.66; 0.50–0.88) – moderate certainty.
- Tai Chi reduces it by 19 per cent (0.81; 0.67–0.99) – low certainty.
- Fall-related fractures fell by 27 per cent (0.73; 0.56–0.95) and falls requiring medical attention by 39 per cent (0.61; 0.47–0.79) – both with low certainty.
A network meta-analysis of 192 trials arrives independently at very similar values: exercise as a single measure reduced the number of fallers by 17 per cent and the rate of falls by 21 per cent [6].
The phrase «high certainty» is rare in evidence appraisal and means: further studies are very unlikely to overturn the result. For a preventive measure that is a remarkably good evidence base.
On safety: in the 27 trials that recorded adverse events at all, practically all incidents were harmless and musculoskeletal in nature; serious events occurred in a single trial [2]. Exercise is not a risky intervention.
5.2 What makes a programme effective
And now the most important sentence of this chapter: not every kind of exercise works. The reviews show very clearly what matters [1] [2] [3]:
Balance has to be genuinely challenged. That is the core. What is meant are exercises in which the base of support becomes smaller (stride stance, tandem stance, single-leg stance), in which you shift your body weight under control, and in which you hold on as little as possible. Anyone holding on to the chair throughout the exercise is training their arms, not their balance.
Functional, not abstract. Standing up and sitting down, steps in every direction, turning, squats, climbing stairs. In other words, exactly the movements in which falls happen.
At least three times a week. The guidelines explicitly recommend three or more sessions weekly [1]. Programmes with a higher total dose – three hours a week was chosen as the boundary – and with challenging balance training achieved an estimated reduction of around 42 per cent in the analysis; this dose effect was, however, not statistically confirmed [3].
At least twelve weeks – and then keep going. The guidelines name twelve weeks as the lower limit and state: longer is better [1]. The flip side matters just as much: the benefit disappears once you stop. Fall prevention is therefore not a course you complete but something that stays in the weekly plan.
It has to get harder. A programme that still looks exactly the same after two years is no longer training but a habit. Progression is the active ingredient.
Individually adapted. In the successful trials the exercise was almost always adapted by trained professionals – physiotherapists or qualified exercise instructors [1]. Where risk is higher, the guidelines recommend closer supervision and smaller groups.
Group or at home? Both work – and the combination often works best, because it makes the necessary dose achievable and carries motivation over months [1].
5.3 Strength training alongside
Balance is the core, strength is the foundation. The guidelines recommend adding individually dosed, progressive resistance training wherever possible [1]. In the Cochrane analysis, programmes with several types of exercise also do better at 34 per cent than balance training alone [2].
Strength training on its own, however, is not enough: for strength work without a balance component the effect on falls is unclear [2]. The muscle is necessary, but the control decides.
One addition that pays off: power training – the upward movement brisk, the downward movement slow and controlled. A meta-analysis from our own circle found a small advantage for it over conventional strength training in everyday function in people over 60 [16]. The difference between the two forms of training is, however, smaller than the difference between «training» and «not training».
And one component that is often missing in practice: practising the reaction itself. In perturbation-based balance training, balance is disturbed in a controlled way – a push, a pull, a wobble board – so that the recovery steps become automatic. An early meta-analysis found a reduction in fall risk for this [13]; the number of trials available at the time of that analysis was still small, which is why we deliberately call this point promising rather than established.
5.4 Three programmes that have proved themselves
Otago. An individually prescribed home programme of strength and balance exercises plus a walking programme. The pooled analysis of four trials with 1016 people aged 65 to 97 – 80 per cent of them over 80 – showed around 35 per cent fewer falls and fall injuries [7]. What is remarkable is that it took place at home and still worked.
LiFE. Here the training is not scheduled as a session but built into daily life: standing in tandem stance at the kitchen counter while the coffee brews; standing on one leg while brushing your teeth; getting up from every chair without using your hands. In the randomised trial, the rate of falls fell by 31 per cent compared with the control group [8]. For people who do not want another «programme» in their life, this is often the more realistic route.
Tai Chi. In a trial of 670 people aged 70 and over at increased risk of falling, therapeutic Tai Chi twice a week over 24 weeks led to 58 per cent fewer falls than a stretching programme and 31 per cent fewer than a multimodal exercise programme [9]. The guidelines explicitly recommend Tai Chi where it is available [1]. In the Cochrane analysis across all trials the effect is smaller (19 per cent) and the certainty lower [2] – so the honest summary is: Tai Chi works, but probably not more dramatically than other good balance training.
5.5 Why walking is not enough
This is the commonest objection in practice: «But I go for an hour's walk every day.»
Walking is valuable – for the heart, circulation, bones, mood and sleep. As fall prevention it only goes so far. In the Cochrane review the effect of walking programmes alone on falls remains unclear, because too few trials are available [2]. The reason is obvious: walking straight ahead on level ground barely challenges balance. Whoever never goes to the limit never moves it either.
Walking and balance training are two different things. Both make sense. One simply does not replace the other.
6. What else works – and what does not
6.1 Reviewing medication
The guidelines recommend the structured review and, where justifiable, the gradual reduction of fall-risk-increasing drugs as a fixed component of a falls programme [1]. Tools such as STOPPFall help professionals to proceed systematically rather than by feel [12].
What you can contribute: bring a complete list – including over-the-counter remedies, sleep drops, herbal preparations and whatever has been taken «forever». And mention alcohol honestly, because it amplifies the side effects of several of these drugs [18].
6.2 Adapting the home
This is one of the most interesting findings in all of falls research. A Cochrane review examined home adaptations [5]:
- Across all trials, the rate of falls fell by 26 per cent (0.74; 0.61–0.91; 12 trials, 5293 people; moderate certainty).
- In people at increased risk of falling it fell by 38 per cent (0.62; 0.56–0.70; 9 trials; high certainty).
- In people without increased risk, no effect at all was detectable (1.05; 0.96–1.16; high certainty).
That is an unusually clear message: adapting the home is effective – but only where an increased risk actually exists. For a fit 68-year-old it makes more sense to invest in training than in removing the living-room rug.
In the effective trials, incidentally, a professional – frequently an occupational therapist – usually came to the house and looked at how the person actually moves around their home [5]. So it was not about ticking off a checklist but about the interplay of person and environment. For an initial self-assessment the BFU provides a digital home-safety checklist [19].
The most worthwhile points are almost always the same: light on the night-time route to the toilet, a handrail on every staircase (better on both sides), non-slip mats in the bathroom and shower, clear routes without cables, and everyday items within reach rather than on the top shelf.
6.3 Eyesight
Cataract surgery and avoiding varifocal glasses outdoors are among the established measures [1]. One important exception is worth knowing: new glasses raise the risk of falling in the short term, because the brain first has to get used to the changed optics [1]. The first weeks after a change of glasses are a good moment for extra attention – not for the first mountain path of the season.
What is not established is equally interesting: visual aids and vision counselling as a stand-alone measure showed no discernible effect on the rate of falls in the Cochrane review (1.12; 0.84–1.50) [5].
6.4 Vitamin D
Here the recommendation has reversed in recent years. The current guidelines state: general vitamin D supplementation to prevent falls is not supported [1]. It makes sense in people with a deficiency or an increased risk of one – for instance those who barely get outdoors, or care-home residents. For that group, 800 to 1000 international units per day is considered reasonable [1].
More is not better. In a trial of 200 people aged 70 and over who had already fallen, higher monthly doses led to more falls than the standard dose [14]. Vitamin D is not a harmless foodstuff but an active substance with a dose window.
6.5 Combining several components
Because a fall has several causes, the guidelines recommend multidomain measures where risk is high: at minimum strength and balance training, medication review, treatment of blood pressure and cardiac problems, optimising vision and hearing, feet and footwear, nutrition, continence, addressing fear of falling, individual education and home adaptation [1].
The figures behind this [4]: tailored multifactorial programmes reduced the rate of falls by 23 per cent (0.77; 0.67–0.87; low certainty); fixed multiple-component programmes, which usually include exercise, by 26 per cent (0.74; 0.60–0.91; moderate certainty) and the risk of falling at all by 18 per cent (0.82; 0.74–0.90).
An honest note on this: these values are no better than those for exercise alone, and the certainty is in part lower. The reason probably lies less in the concept than in the delivery – two large pragmatic trials in the United Kingdom and the United States were unable to reproduce the results of the research trials in routine care [1]. A programme only works if the intended dose actually arrives.
6.6 Fewer falls does not automatically mean fewer fractures
This is a point that is almost always missing from patient guides.
A 2026 review examined 17 trials with more than 25,000 people to see whether fall prevention programmes also prevent fractures [15]. The result is uncomfortable: falls declined markedly in 14 trials – but for fractures overall no reliable effect could be demonstrated (0.91; 0.72–1.14). For hip fractures only two analysable trials existed, both with a reduction that was not statistically confirmed. The certainty of these statements is very low.
What follows from that? Not that fall prevention is useless – fewer falls are in themselves a large gain in independence and quality of life. Rather: whether a fall leads to a fracture also depends on bone quality. Fall prevention and osteoporosis treatment are two topics, and anyone who takes one of them seriously should have the other assessed too. The guidelines make exactly this point [1].
7. The fear of falling
After a fall – sometimes without one – many people develop a persistent worry. They hold on more often, walk more slowly, cancel arrangements. Ironically this behaviour increases the risk: whoever walks less loses strength and balance.
The guidelines treat this explicitly as a domain of its own and recommend capturing fear of falling with a standardised instrument (FES-I or Short FES-I) and treating it actively – through exercise, cognitive behavioural therapy and/or occupational therapy [1].
From practice: what works best against this fear is usually not reassurance but experience. Someone who discovers in a safe setting that they can catch themselves after a push, that they can stand on one leg and that they can get up off the floor leaves the session differently from someone who has been told to worry less.
And the same holds in the other direction: if a measurement shows that balance is objectively worse than assumed, that too is useful – because in the cohort study it was precisely this combination of high risk and low concern that produced the most falls [11].
8. If you have had a fall
A fall is not a mishap to be shrugged off. It is the best available predictor of the next fall – and it is the moment when an assessment achieves most.
Report the fall. Even if nothing happened, even if it is embarrassing. Studies show that falls are systematically left unmentioned [1]. A professional can do something with that information; without it, the trigger for everything else is missing.
High risk means [1]: an injury that required treatment; two or more falls in the past year; known frailty; being unable to get up unaided; or a fall with possible brief loss of consciousness. In these cases a multifactorial assessment is indicated – not a single piece of advice.
Practise getting up from the floor. This point is nearly always forgotten and is one of the most important. Lying on the floor for a long time after a fall leads to dehydration, kidney damage, hypothermia, pneumonia and pressure damage to the skin [1]. Getting up can be learnt, and best in individual steps built up backwards – you start with the last step of the chain and work forwards [1]. This is a standard physiotherapy task and takes a few sessions.
Make sure you have a way to call for help if you live alone: an alarm watch, a pendant alarm or a phone you actually carry on you – not one lying on the sideboard [1].
9. A week that holds up
This is what a week containing all the effective components might look like. It is meant as orientation, not as a prescription – adapting it to your situation belongs in physiotherapy.
- Balance training three times a week, 20 to 30 minutes each: stride stance, tandem stance, single-leg stance, weight shifts, steps in every direction, walking with head turns, turning in a small space. Always so that it just works – with a kitchen counter within reach, but without holding on.
- Strength work two to three times a week for legs and trunk: standing up from a chair without using your hands, squats to whatever depth is available, heel raises, stepping up onto a stair. Briskly up, slowly down. Dosed so that after 8 to 12 repetitions two to four more would still have been possible – and increased over time.
- A few minutes daily, in passing, along LiFE lines [8]: standing in tandem stance while the coffee brews; on one leg while brushing your teeth; every stand-up without using your hands.
- Brisk walking for heart, circulation and bones – as a supplement, not as a substitute for balance training.
- Once a year: go through the medication list, have your eyes checked, have your blood pressure measured while standing.
That is not an hour a day. It is a good two to three hours a week – the order of magnitude at which the reviews found the clearest effects [3].
10. Six common misunderstandings
«Falls are part of getting old.»
They are common, but they are not a law of nature. A quarter to a third of people over 65 fall each year – which also means: two thirds to three quarters do not [1]. And the rate of falls can be reduced by around a quarter through exercise, with high certainty of evidence [2].
«I just need to be more careful.»
Caution alone makes the problem bigger. Less movement means less strength and less balance, and both raise the risk. The evidence-based answer is not restraint but training – challenging and supervised [1] [2].
«I walk every day, that's enough.»
For walking programmes on their own the effect on falls is unclear [2]. Walking barely challenges balance. It is a good supplement, but not a substitute.
«A walking frame protects against falls.»
A walking aid can provide security and make journeys possible in the first place. But it does not replace training, and a badly adjusted or incorrectly used aid is itself a risk. The guidelines therefore recommend checking walking aids for fit and handling as part of the assessment [1].
«Vitamin D prevents falls.»
Only in deficiency or an increased risk of deficiency. General supplementation is not supported, and high doses led to more falls in one trial [1] [14].
«I'm only 68 and fit, this doesn't concern me.»
True enough: home adaptations will indeed do nothing for you [5]. The reverse conclusion is false. Power declines measurably from the age of 50 onwards [17], and training works most favourably while there is still a lot to preserve. The best time for balance training is before you need it.
11. When should you see a professional?
Raise the subject if one or more of these statements apply:
- You have fallen in the past year – even without an injury
- You feel unsteady when standing or walking
- You worry about falling, or avoid activities because of it
- You have recently started holding on to handrails or furniture
- Your vision goes dark briefly when you stand up, or you feel dizzy
- You would not be able to get up from the floor unaided
- Your medication list has grown longer over the years
- You have osteoporosis, or have already had a fracture after a minor fall
What to expect in physiotherapy: a conversation about the circumstances and frequency of your falls, measurement of gait speed, a sit-to-stand test and balance testing (among others with the Mini-BESTest), assessment of fear of falling with the FES-I, and a look at footwear, walking aids and living situation. Out of this comes a training programme with clear progression steps – as individual therapy or in a group – and a home programme that you carry out yourself between appointments.
How we work: where fall prevention has been medically prescribed, we deliver StoppSturz, the BFU programme for Swiss healthcare: identify, assess and reduce the risk of falling [19]. Where a patient is suspected of being at increased risk of falling, we follow the international guidelines even without such a prescription [1]. The reason is simple: we always treat the functional deficits that are present – and balance, strength and gait security are among them, regardless of what the prescription says.
What needs medical assessment: falls with no remembered cause, brief loss of consciousness, newly occurring dizziness, a blood pressure drop on standing, unintentional weight loss, suspected osteoporosis, and a review of medication. In older people a fall is sometimes the first sign of an acute illness – pneumonia, for example, or a heart attack without chest pain [1].
In our practice you will find the corresponding services Assess your fall risk, Fall prevention as individual therapy and Fall prevention in a group.
12. In summary
Falls are common, consequential – and modifiable to a degree that is rare in medicine.
The core is exercise, and a particular kind of it: balance work that genuinely takes you to your limit, combined with strength, at least three times a week, over at least twelve weeks, with progression – and then continued, because the benefit disappears when you stop.
Around that lie the components that matter to differing degrees from person to person: the medication list, standing blood pressure, the eyes, the shoes, the home, the bones, the fear.
And one sentence that sets the direction: security does not come from doing less, but from being able to do more. A balance system that is never challenged does not get better – it gets worse. That is true at 65 and it is true at 90.
One limitation at the end, for honesty's sake: nearly all the evidence summarised here comes from high-income countries. A 2026 review of low- and middle-income countries did find a clear improvement in balance from exercise, but because of the small number and size of the trials it could reach no reliable conclusion about falls themselves [20]. For Switzerland the evidence transfers well – one should simply know what it rests on.
References
All Digital Object Identifiers (DOIs) were checked against the publisher's page and the Crossref register. The links in the reference list lead via the DOI service to the publishers' pages. Some of these are located outside Switzerland and the EU. When you click them, your IP address is transmitted to the provider concerned – this does not happen on our own site. The two references to the BFU lead to Swiss pages.
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