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What works for falls prevention is different depending on which setting you are working in. This section looks at the evidence for what works to prevent falls in the community. This includes:
The World Health Organisation (WHO) strongly advocates that to reduce the dramatic increase in demand for health services as a result of falls, falls projects/programs need to focus on prevention rather than treatment [78]. WHO encourages projects/programs to reduce the future rates of falls through a community or population health response [118].
Community or population based projects/programs to reduce falls have shown a relative reduction of 6 to 33 per cent of falls related injury [77]. However, this approach needs to be integrated across the whole health continuum [119]. Interventions need to take a life course approach and address underlying health and social factors such as physical activity and nutrition [56, 73]. Projects/programs should not simply 'scale up' strategies that have been effective in addressing falls risk factors in individual trials [73, 119].
While falls prevention projects/programs need to show that they reduce falls, if there is less than two years of falls prevention activity in the community, a statistically significant reduction in falls is unlikely [29]. Impact evaluation is important for detecting other changes such as knowledge, attitudes and behaviour, improvements in balance, strength and quality of life.
Multi-factorial strategies are highly effective in reducing falls among older people living in the community when they are based on the results of risk factor assessments [31, 53, 71, 76, 78, 79, 120].
The following strategies should be included as a part of a successful multi-factorial approach:
Over time, a person is exposed to a range of risk factors that influence the development of chronic conditions and diseases in later life. To address the biological, social and psychological factors to build resilience to falls and fractures, action needs to occur across the life course [56, 120] for example: good nutrition and weight bearing exercise to build strong bones. This can be achieved by addressing the social determinants of health. For more information on using a life course approach, refer to the Deakin Report.
Healthy active ageing involves 'improving and preserving physical, social and mental wellness, independence and quality of life' [123].
Sixty and Better, Queensland
The Sixty and Better program sponsored by Queensland Health works to improve the health of older people by increasing their awareness of healthy lifestyle options, decreasing social isolation and improving linkages and information exchange with other health services.
Some local area programs have developed their own websites:
For more information on this program and for a program in your area, contact the Queensland Government, Department of Communities by calling 1300 132 654 or 07 3224 2625 or visiting the Sixty and Better Program.
Education or information alone will not reduce falls. Falls prevention programs need to include the participants taking part in actual interventions to build strength, balance and their confidence and belief that they are able to undertake certain activities of daily living without losing their balance and falling [71, 82]. Two program examples are Stepping On and Steady Steps.
There are a range of existing falls prevention programs operating in Australian communities, including Stepping On, Steady Steps, Stay on Your Feet® and Sixty and Better.
Stepping On, Sydney
The Stepping On program in Sydney shows how a multi-factorial educational community based program using small group learning has reduced falls by 31 per cent [122]. The Stepping On program is based on a randomised controlled trial held in 2004 which demonstrated a 31% decrease in the incidence of falls in the intervention group. i(i) Stepping On was designed by Lindy Clemson and Megan Swann as a multiple intervention, facilitator led, community based falls prevention program consisting of 7 X 2 hour weekly group sessions, a booster group session and 2 follow up telephone calls. The program targets community-residing people aged 65 or over, who have had a fall, or who have a fear of falling. The program draws upon the Otago Exercise Programme strength and balance exercises, along with ways to prevent and manage environmental falls risk and increase confidence for mobility, in a supportive adult group learning environment. Along with the group facilitator, the program engages local health professionals to conduct guest presentations as part of the educational and practical components of the program. Program topics include strength and balance exercises, home hazard reduction, safe footwear, community mobility, vision, bone health and medication management. Geust presenters usually include Physiotherapists, Occupational Therapists, Nurses, Dieticians, Pharmacists, Podiatrists, and experts in vision and safe community mobility.
1(i) Clemson L, Cumming R, Kendig H, Swann M, Heard R and Taylor K (2004): The Effectiveness of a Community-Based Program for Reducing the Incidence of Falls in the Elderly: A Randomized Trial. Journal of the American Geriatrics Society 52:1487-1494.
Steady Steps, Queensland
A program known as Steady Steps has been developed and implemented by Fitness Queensland. Results are encouraging not only in terms of physical activity but also social connectedness.
Stay on Your Feet®, Northern Rivers, New South Wales
The Stay on Your Feet® program was conducted in Northern Rivers, New South Wales, from 1992 to 1997. It was a multi-factorial community based program aimed at older people aged 60 years and over living in the community. The program included community education, medication workshops, gentle exercises, falls prevention advisors, home safety measures, health professional workshops and policy development [77]. The results showed a significant 20 per cent reduction in fall-related hospitalisations in the intervention group. The program had a significant reach, with 77 per cent of the population participating in at least part of the program [77].
For more recommendations on what works in the community, visit:
Queensland Stay On Your Feet® Community Good Practice Guidelines.
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