Prevention strategies achieve falls reduction success

With the number of Australians aged 65+ expected to increase by 31% over the next eight years, the number of fall-related deaths in the same population is projected to increase by one-third.

It’s a stark figure, especially when fall-related deaths are vastly overrepresented by older people – 94% occur in people who are 65+.

Australia’s last national falls prevention strategy, the National Injury Prevention and Safety Strategy, concluded in 2014. The National Falls Prevention for Older People Plan: 2004 Onwards has not received any attention or widespread focus since it was published as part of that Strategy in 2005.

Even though a new National Injury Prevention Strategy is being developed by the Federal Government, little information has been released since consultation began in 2020. 

As a result, there has been no uniform approach to reducing and preventing falls among older Australians in the past eight years. 

Aged care providers have had to take it upon themselves to research and implement new strategies to protect and support their residents through education and exercise. But they’re not alone in making – or calling for – changes. 

The Australian and New Zealand Falls Prevention Society (ANZFPS) is calling for a coordinated action plan by 2025, including the introduction of a National Falls Prevention Coordination Group.

The reinvigorated approach to falls is a positive sign and it suggests that aged care providers can be at the forefront of new falls prevention strategies and initiatives.

Focusing on new strategies

A recently released report by the ANZFPS, Why investing in falls prevention Australia can’t wait, highlighted the impact that the right type of exercise has had on preventing falls.

Research has found that, on average, exercise reduces the rate of falls by 23%. Three different exercise programs resulted in positive results with the combination of balance, functional and resistance training the most successful as fall rates were reduced by 28%.

Balance and functional exercises – excluding resistance training – reduced falls by 24% while Tai Chi reduced falls by 23%. The greatest impact for participants was felt when they had three or more balance and functional exercise sessions per week, as their fall rates dramatically dropped by 42%.

Based on reputable research and evidence of what works in falls prevention, aged care provider Brightwater invested in effective practices, introducing exercises like Tai Chi, boxing, and chair yoga, while they enhanced education services and functional exercise training.

The exercises were a part of Brightwater’s Falls Improvement Program which was recognised with a Team Excellence Award at the 2022 HESTA Excellence Awards ceremony in November. 

Allied Health Manager, Andrea King, said a multi-pronged approach to reducing falls and injuries was a worthwhile investment.

“Falls are our highest critical incident within the organisation and changing this is difficult, but we have to stop tolerating that falls are normal,” said Ms King

“We knew we needed to better understand why falls occurred and how to prevent them, and we knew of the evidence out there that shows what works and what does not.

“If we had a pill to prevent falls everyone would be taking it, but that pill happens to be exercise.”

“We introduced novel exercises like chair yoga and Tai Chi because that’s another way to get people moving which is safe and effective because of the balance, strength and endurance elements. 

“While it might seem easy and for pleasure, it’s also providing improvements to physical wellbeing.”

Investing in new exercise methods also proved to be cost-effective as the boxing equipment was affordable and accessible.

Ms King said residents enjoyed the opportunity to try new exercises and activities.

“For a lot of our older residents and clients who live at home, doing exercise for the sake of it is not a part of their lifestyle,” explained Ms King.

“We’re asking them to do something they haven’t done before so it has to be enjoyable and interesting. But it still has to be targeted otherwise it isn’t effective. 

“It has to cover their needs by having the resident up on their feet or completing enough repetitions of a movement to strengthen their muscles.”

The Falls Improvement Program also features a multidisciplinary approach where, for example, dietitians are involved to ensure residents have calcium and vitamin-rich diets.

Music therapists have also worked closely with physios to design exercise programs in the form of dance sessions and silent discos, further normalising movement and balance exercises into daily activities.

Coordinated action between teams

As a part of ANZPS’ key recommendations for a National Falls Prevention Strategy, they’re calling for a coordinated communication plan that can help share information, resources and new initiatives.

While this is intended for a national scale to keep providers informed, coordinated communication amongst staff and teams within a facility or workplace is essential.

Allied Health Manager for the SA Health’s Specialist Advanced Dementia Unit (SADU) and Repat Neuro-behavioural Unit (RNBU), Steve Flatman, was determined to highlight dangers and trends in high-risk falls patients. 

To achieve this, Mr Flatman crafted a calendar where data could easily be displayed and shared between staff throughout the day.

“Falls are very unpredictable so it’s about putting in additional resources that can help us understand what’s happening with the patient so we can develop a plan to address the causes of their falls,” said Mr Flatman.

“I noticed how we identify people who are at risk of falls through risk assessments and then how we document and display that information,” said Mr Flatman.

“I might come along and perform a physiotherapy assessment, and write down some key learnings and recommendations, but how do I know that the nurse or occupational therapist will review it?”

The incorporation of a visual system for falls identification is something that can easily be incorporated into shift handovers or medical visits, according to Mr Flatman. It provides a clear way to share information with care teams.

Using a traffic light system, residents who have not experienced a fall would have a specific day highlighted in green. If they had one fall, the date would be orange, while multiple falls would be red.

“It’s a really clear system for anyone coming in to pick up themes and trends over time, and as a team, we can then have a discussion about potential falls triggers.”

Meanwhile, Brightwater set up weekly safety falls huddles between their multidisciplinary team, a move that has helped reduce the rate of falls in one facility by 25%. 

Each week the team gathers where a fall has occurred, such as in the dining room or lounge, and dissects what occurred.

“Suddenly our team is more vigilant to falls, we’re having conversations about falls all the time, so our acceptance is no longer there,” explained Ms King.

“If someone’s had a fall, how do we get to the cause of it; what were they doing, how can we do better next time, and how can we be really brave and bold about those conversations? 

“We understand that things have to change to keep a resident out of a risky situation. It’s a mind shift to acknowledge that falls are everyones’ responsibility.”

A group discussion provides opportunities to work together and improve practices. The shared conversations build rapport within the team and highlight individual residents who may require additional supervision and supports due to changing needs.

What falls prevention initiatives have benefited your residents? Tell us in the comments below.