Queensland Stay on your Feet® - Falls prevention
What is falls prevention?
What is a fall?
What a fall is not
How do we prevent falls in older people?
Risk factors and falls
What is falls prevention?
Falls prevention is about eliminating or reducing the risk of physical and psychological harm associated with falls in older people, as well as promoting healthy active ageing.
It involves determining what the community as a whole can do and how all members can work together to make Queensland homes and communities safer for older people and their families.
By learning how to assist older people address the causative factors of falls, we can help them stay healthy, active and independent.
The following provides definitions of falls, injury prevention, healthy active ageing and safety promotion:
Falls prevention for older people has received this attention because:
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most falls are preventable
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of a strong burden of injury evidence
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of a demonstrated high cost to health system
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Queensland’s population is ageing
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there is a strong national and international evidence base of proven and promising interventions
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the benefits of prevention are considerable for individuals as well as health care organisations.
What is a fall?
The World Health Organisation defines a fall as "inadvertently coming to rest on the ground, floor or lower level, excluding intentional change in position to rest in furniture, wall or other objects" [31].
Falls in older people cover a wide range of events including:
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small trips on loose rugs or mats
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major tumbles down steps or stairs
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falling off a ladder or stepladder
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slipping in the bath or shower
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falling over in a shopping centre or while using public transport.
Falls have significant physical and emotional impacts on older people and the cumulative effect of the number of falls in our community has a major impact on our hospitals.
Queensland already spends more than twice as much on the treatment of falls in older people than on victims of road traffic crashes. And the issue of falls will only grow as the population ages.
We need to act now by taking a collaborative and coordinated approach to preventing falls. This can be achieved by building on the work already undertaken in the community, encouraging the uptake of physical activity, good nutrition [36] and a range of other protective strategies at a population and individual level.
What a fall is not
Falls in older people are not accidents.
The word 'accident' has several meanings including:
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"anything that happens by chance without an apparent cause" [32 ]
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"an event without apparent cause, unexpected event, chance, mishap" [33].
Falls in older people are not accidents. Similarly, falls are not an inevitable or unavoidable part of life. The causes of a fall can be identified and the sequence of events leading up to the fall can be foreseen.
Falls in older people can usually be predicted and should not be regarded as accidents.
How do we prevent falls in older people?
In order to stop older people from falling we need to know the following:
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what caused the fall (causative factors or risk factors)?
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what can be done to prevent or reduce falls from occurring (protective factors)?
In order to reduce the consequences of a fall, we need to consider:
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how to minimise any damage that may result from a fall (for example: hip protectors or softer flooring)?
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what is the best way to rehabilitate a person after a fall?
Risk factors and falls
Research has identified a number of identifiable risk factors that increase the chances of an older person falling.
These risk factors can be classified in a number of ways [56]. One of the well known methods is to classify the risk factors as either personal (intrinsic) or environmental (extrinsic).
Intrinsic or personal risk factors include the following [67]:
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deteriorated health, mobility and strength associated with ageing
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impaired gait and balance
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certain medical conditions eg. Parkinson's disease, dementia, depression, osteoporosis, osteoarthritis, sensory loss (vision - for example: cataracts, glaucoma; vestibular - for example: benign paroxysmal positional vertigo; somatosensory - for example: peripheral neuropathy), low blood pressure and incontinence
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acute medical conditions such as urinary tract infections, chest infections and pneumonia
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lack of physical activity, linked with poor muscle tone and strength and low bone density
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alcohol use
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medications or medication combinations that can affect balance, vision and alertness (for example: sedatives/ tranquillisers and hypnotics)
- fatigue
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inadequate nutrition and diet
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wandering behaviour that occurs in residential care settings
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impaired cognition or confusion.
Extrinsic or environmental risk factors include the following [67]:
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uneven or loose surfaces (for example: cracked footpaths, loose pebbles or leaf litter)
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inadequate lighting
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slippery floors
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time of day
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activities that have a high falls risk associated with them for the individual functional abilities
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being hospitalised for 19 days or more
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people traffic (for example: other people in the way or crowds)
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poor step and stairway design and repair
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chairs and beds that are too high or too low
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unfamiliar or changed environment, particularly for people with cognitive impairment
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unsecured floor coverings, rugs and cords
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inappropriate footwear
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inappropriate eyewear
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poorly designed housing and floor plan (for example: external toilet and laundry, steps and rooms which are too small for walking aids) [34].
To be successful in preventing falls in older people, work needs to be done to address the following issues:
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aspects that affect the general older population such as inactivity
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individual issues such as health conditions and behaviours
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the injury event
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the environment
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the health and social systems in our society.
There are a number of other theories and models that can be used in falls prevention, including:
- the Ottawa Charter for Health Promotion
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the Jakarta Declaration on Leading Health Promotion into the 21st Century
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the Bangkok Charter for Health Promotion in a Globalized World
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the E's of Injury Prevention
- the E's of injury prevention - Environment, Enforcement and Education
- Extra E's of injury prevention - Evaluation, Evidence, Engagement, Epidemiology and Economics -
the Ecological Model
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Social Determinants of Health
- Safe Communities
Effective falls prevention for older people using any of these theories or models still requires the use of a systematic project management approach. This will help to plan for quality implementation, including the identification of potential threats or risks that could jeopardise the success of the falls prevention program/project.
