New ground: Updated falls guidelines for residential aged care

In a landmark development for aged care, the Australian Commission on Safety and Quality in Health Care has released the 2025 Falls Guidelines, replacing the 2009 framework with a comprehensive, evidence-based approach to tackling falls in older Australians.

Developed with significant input from researchers at Neuroscience Research Australia (NeuRA), these guidelines target three key settings – residential aged care services (RACS), community care, and hospitals – offering tailored strategies to reduce the devastating impact of falls, which remain the leading cause of injury-related hospitalisations and deaths among older Australians.

Falls represent a critical public health issue, with profound human and economic consequences. In RACS, over one-third of falls result in injury, and one in five leads to hospitalisation.

More than half of fall-related injuries affect the upper or lower limbs, while over a third involve the head or face, often leading to extended hospital stays, increased care needs, fear of falling, loss of confidence, or even death.

The financial toll is staggering, with falls among Australians over 65 costing the health system upwards of $2.8 billion annually. The updated guidelines, informed by a systematic review and the 2022 World Falls Guidelines, aim to address this crisis through a person-centred, multifaceted approach grounded in the latest scientific evidence.

A shift towards implementation

Associate Professor Jasmine Menant, Senior Research Scientist at NeuRA’s Falls, Balance and Injury Research Centre, was part of the team that spent five years refining these guidelines. “Falls have a big impact on individuals and our economy,” she said.

“The 2025 Falls Guidelines combine research, community consultation, and expert opinion to deliver best-practice recommendations for preventing falls across diverse settings.”

Unlike the 2009 guidelines, which focused heavily on risk assessment, the updated version prioritises the implementation of interventions. “For all settings, there’s a stronger emphasis on delivering tailored interventions rather than just assessing risk,” Assoc Prof Menant explained. This shift reflects a growing body of evidence that proactive, individualised strategies are more effective in reducing fall rates and related injuries.

Key recommendations for residential aged care

The Falls Guidelines for RACS outline seven evidence-based recommendations, each supported by the modified GRADE system, which evaluates the strength and quality of evidence. These recommendations address both intrinsic (personal) and extrinsic (environmental) risk factors, ensuring a holistic approach to fall prevention:

• Multifaceted interventions (Level 1A): All residents should receive comprehensive fall prevention plans as part of routine care. This includes regular assessments of individual and facility-level risk factors, such as environmental hazards and medication reviews, alongside workforce education to embed fall prevention into daily practice. Tailored plans are developed based on each resident’s risk profile, ensuring interventions align with their needs and goals.
• Tailored exercise (Level 1B): Supervised exercise programs, designed by physiotherapists or trained instructors, are recommended for all residents who opt to participate. These programs focus on improving balance, strength, and mobility, which are often compromised in older adults, particularly those with frailty or cognitive impairment.
• Continued exercise (Level 1A): The benefits of exercise diminish over time if programs are discontinued. The guidelines stress the importance of ongoing exercise to sustain fall prevention outcomes, addressing the progressive decline in balance and strength common in RACS residents.
• Hip protectors (Level 2A): For residents at high risk of hip fractures—such as those with frequent falls, osteoporosis, or low body mass index—hip protectors are recommended to absorb or disperse impact forces. Education and workforce support are critical to ensure proper use and comfort.
• Dairy food provision (Level 1B): Menus should include at least 3.5 daily servings of dairy foods (milk, yoghurt, cheese) to meet protein and calcium requirements, which support muscle and bone health. Dietitians should be engaged to design menus that reflect residents’ preferences while addressing nutritional needs.
• Vitamin D supplements (Level 1A): Daily or weekly vitamin D supplements are recommended for all residents unless contraindicated, as low vitamin D levels increase the risk of hip fractures. The guidelines advise against monthly or yearly mega-doses, which can paradoxically increase fall risk (Level 2A).
• Osteoporosis medicines (Level 1A): Residents with diagnosed osteoporosis or a history of minimal trauma fractures should receive prescribed osteoporosis medications, such as bisphosphonates, to strengthen bones and reduce fracture risk.

Addressing diverse risk factors

The guidelines provide detailed good practice points to address a wide range of fall risk factors, ensuring a comprehensive approach to prevention. These include:

• Cognitive impairment: Cognitive conditions like dementia and delirium significantly increase fall risk. Regular cognitive assessments, delirium prevention strategies, and tailored interventions for residents with cognitive impairments are recommended, including dementia-enabling environmental adjustments and supported decision-making.
• Continence: Bladder and bowel issues can prompt rushed movements, increasing fall risk. The guidelines advocate for sensitive continence assessments, tailored toileting plans, and proactive management of nocturia to minimise risks.
• Footwear and foot health: Safe, well-fitting footwear with low heels and good tread is critical for stability. Podiatry assessments are encouraged to address foot pain or conditions that impair mobility.
• Vision and hearing: Annual eye and hearing assessments are advised to address sensory impairments, which double fall risk. Ensuring residents wear appropriate glasses and functioning hearing aids during mobility is emphasised.
• Environmental risks: Poor lighting, slippery floors, and clutter are common hazards in RACS. Regular environmental assessments by occupational therapists, combined with resident orientation to their surroundings, are recommended to enhance safety.
• Medication management: Certain medications, including sedatives, antidepressants, and cardiovascular drugs, increase fall risk. Regular medication reviews by medical practitioners or pharmacists are advised, with a focus on deprescribing where possible.
• Post-fall management: Every fall, even minor ones, requires immediate response, including vital-sign checks, neurological observations (if head trauma is suspected), and comprehensive assessments to identify underlying causes. Multidisciplinary care plans should be updated to prevent recurrence.

Person-centred care and dignity of risk

A key principle of the guidelines is partnering with residents to respect their autonomy and preferences, a concept known as dignity of risk.

This involves engaging residents, their carers, and families in shared decision-making to tailor interventions to individual goals, such as maintaining independence or participating in meaningful activities.

For example, residents may choose to forgo certain interventions if they perceive them as limiting their freedom, and the guidelines encourage supporting these choices while providing education on fall risks.

The guidelines also recognise the role of carers and families in fall prevention, advocating for their involvement to the extent desired by the resident. Effective communication with the multidisciplinary team, including nurses, physiotherapists, and general practitioners, is critical to ensure coordinated care and timely escalation of risks.

Implementation and workforce support

Implementing the guidelines requires a skilled and adequately staffed workforce. Safe staffing levels, ongoing education, and multidisciplinary collaboration are essential to deliver high-quality, person-centred care. 

The guidelines recommend regular training for RACS workers on fall prevention, post-fall management, and the safe use of equipment like mobility aids and hip protectors.

Monitoring and observation strategies, such as sighting charts and alerts, are encouraged to support residents at high risk of falling, particularly those with dementia or delirium.

However, these measures must balance safety with respect for residents’ autonomy and dignity. The guidelines also caution against using restrictive practices, such as physical or chemical restraints, except as a last resort and in compliance with strict Commonwealth regulations.

Broader implications

Assoc Prof Menant highlighted the transformative potential of the guidelines: “These recommendations build on decades of research at NeuRA’s Falls, Balance and Injury Research Centre, translating evidence into practical initiatives that can prevent falls and enhance quality of life.”

By embedding fall prevention into routine care, the guidelines align with the strengthened Aged Care Quality Standards, ensuring a nationally consistent approach to safety in RACS.

The guidelines also address systemic issues, such as the higher fall risk in respite care (three times higher than in permanent RACS) and post-hospital discharge periods, where deconditioning increases vulnerability.

Coordination between hospitals, general practitioners, and RACS is recommended to ensure continuity of care and effective risk management.

A call to action

The release of the 2025 Falls Guidelines marks a pivotal moment for aged care in Australia. By prioritising evidence-based interventions, person-centred care, and workforce education, the guidelines offer a roadmap to reduce the incidence and impact of falls, enabling older Australians to live safer, more independent lives.

For further details, including the full guidelines and resources, visit the Australian Commission on Safety and Quality in Health Care’s website.

As Assoc Prof Menant noted, “Falls can be life-changing, but with these updated guidelines, we have the tools to make a real difference in keeping older Australians safe and independent for longer.” This renewed focus on prevention, grounded in science and compassion, promises to reshape the landscape of aged care safety across the nation.