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Falls and older people Stepping into falls management. Working together to prevent falls. Developed by: Goulburn Valley Health Format: Booklet and PowerPoint presentation Availability: Download education booklet <PDF version> <Word version>

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Falls and older people

Falls and older people

Stepping into falls management

Working together to prevent falls

  • Developed by: Goulburn Valley Health

  • Format: Booklet and PowerPoint presentation

  • Availability: Download education booklet <PDF version> <Word version>

  • Download education presentation <PDF version> <Word version>

  • This staff education package (booklet and powerpoint presentation) was developed by Goulburn Valley Health for nursing and personal care staff in residential aged care facilities. It consists of a 4-hour module including training on:

    • the extent of the problem of falls

    • the definition of a fall

    • falls risks, and

    • strategies to address falls risks.

    • (Downloadable)

  • In 2009 the Department of Health funded Northern Health, in conjunction with National Ageing Research Institute, to review falls prevention resources for the Department of Health’s website. The materials used as the basis of this generic resource were developed by Goulburn Valley Health under a Service Agreement with the Department of Human Services, now the Department of Health. Other resources to maintain health and wellbeing of older people are available from www.health.vic.gov.au/agedcare

Falls and older people

Working together to prevent falls

Falls and older people

Stepping into falls management

What is a fall
What is a fall?

Kellogg, 1987

  • An unintentional event that results in a person coming to rest on the ground, or another lower level, not as a result of a major intrinsic event such as stroke or epilepsy) or an overwhelming hazard (such as being pushed).

The e xtent of the p roblem
The extent of the problem

  • An estimated one in three people aged 65+ suffer a fall at least once a year, about half of those suffer multiple falls

  • For people aged 75+, and those in residential care the figure increases to one in two people

The extent of the problem
The extent of the problem

  • Falls are the leading cause of unintentional injury and death among people aged 65 years and over

  • Health care costs for Australia for falls related injuries in 2001 was estimated to be $498 million dollars

  • Of those admitted to hospital following a fall about 50% will die within 12 months

Consequences of falls
Consequences of falls

  • Physical injury

  • Emotional trauma

  • Psychological problems

  • Social consequences

  • Financial impact

Consequences of falls1
Consequences of falls

  • 70% of falls result in an injury

  • One third of people who fall require medical treatment

  • Major injury such as dislocation or fracture occurs in 13% of falls

Consequences of falls2
Consequences of falls

  • Approximately 1-2% result in a fractured femur or hip

  • Of those who suffer fractured femurs 50% will not fully recover, and 30% will die within 12 months

People at risk of falls
People at risk of falls

  • Advanced age

  • Female

  • Those living alone

  • Those with one or more diseases

  • People with acute illness

  • People on multiple medications (4 or more)

  • People with walking (gait) problems

People at risk of falls1
People at risk of falls

  • People suffering increased postural sway

  • People with decreased mobility

  • Cognitively impaired people

  • Previous history of falls

  • Home bound

  • Decreased vision

When do falls occur
When do falls occur?

  • Statistics show that most falls occur in the daytime when people are more active, around 11am and between 4pm and 6pm

Where do people fall
Where do people fall?

  • 49% of falls take place in and around the home

  • 17% of falls take place in the urban environment

  • 14.8% occur in residential care environments

Areas where falls occur at home
Areas where falls occur at home


















Victorian Injury Surveillance System



Causes of falls
Causes of falls

An internal cause, such as a disease or condition that affects the person individually, eg vision impairment, or muscle disease

An external cause such as an unsafe environment

Risk taking behaviour such as climbing an unsafe ladder

Falls usually have more than one cause

Causes of falls1
Causes of falls

  • Chronic disease

  • Acute illness

  • 4 or more medications

  • Poor balance and gait

  • Impaired vision

  • Lack of physical activity

  • Hazards in the home and community

  • Foot disorders

  • Unsafe footwear

Falls chronic illness
Falls & chronic illness

Regular medical checkups, and referral to specialist services to:

  • Prevent worsening of the condition

  • Restore lost ability

  • Keep as well and active as possible

What you need to k now a bout your c hronic i llness
What you need to know about yourchronic illness

  • How your condition will affect you

  • What treatments are available

  • What assistance can be provided to you

  • The signs and symptoms of a flare-up

  • What to do if you suffer a flare-up

  • What can be done to reduce the risk of your condition/s causing a fall

Acute i llnesses
Acute illnesses


  • Chest infections

  • Urinary Tract infections

  • Diarrhoea

  • Surgical procedures

Acute illness in the community
Acute illness in the community

  • Seek medical treatment

  • Community services

  • Ask family, friends and neighbours to help out

  • Ensure adequate diet and fluids

  • Aids

Continence bladder problems

Incontinence (loss of bladder or bowel control)

Frequency (Needing to pass urine often)

Urgency (Needing to go in a hurry)

Nocturia (Needing to go to the toilet more than twice per night)

Urinary Tract infections

Continence & bladder problems

Urinary tract infections
Urinary Tract Infections


  • Mental confusion

  • Frequency

  • Urgency

  • Foul smelling urine

  • Incontinence

  • Burning or scalding when passing urine

Incontinence frequency urgency
Incontinence, frequency & urgency

These conditions may require referral to:

  • Doctor

  • Continence Clinic (for advice, continence aids, and exercises to help bladder control)

  • Physiotherapist (for exercises to help bladder control)

  • Urologist (for a specialist opinion)

Postural hypotension
Postural hypotension

A drop in blood pressure after standing up


  • Dehydration

  • Cardiac disease

  • Drug side affects

  • Prolonged bed rest

  • Dysfunction in the nervous system

  • Certain chronic & acute illness

How to get up safely
How to get up safely

  • Sit on the edge of the bed or chair with feet on the floor for a few minutes before getting up

  • Stand up slowly using both arms to push up for support

  • Make sure you have good balance and do not move off if you feel lightheaded or dizzy

  • Use support when bending down and stand back up slowly

Reducing falls from postural hypotension
Reducing falls from postural hypotension

  • Regular medication reviews

  • Inform doctor of any side affects from medications (prescribed or other)

  • Ensure adequate fluid intake

  • Treatment and control of associated diseases

Dizziness dizziness needs to be properly investigated by a doctor or specialist
DizzinessDizziness needs to be properly investigated by a doctor or specialist


  • Medications

  • Chronic disease

  • Acute illness

  • Psychological disorders

    If you are dizzy you need to get up safely

Strategies for preventing falls due to impaired vision
Strategies for preventing falls due to impaired vision

  • Annual check ups with optometrist

  • Specialist referral for eye problems

  • Ensure the environment is safe

  • Occupational therapy home assessment

  • Vision Australia referral

  • Colour contrasting

  • Adequate lighting

  • Glare reduction

Falls and older people

Seeing well

  • Keep your glasses in reach

  • Remember to wear your glasses

  • Turn your light on at night before you get up so that you can see where you are going

  • Bifocals are not recommended

Hearing problems
Hearing problems

  • Medical examination

  • Audiology referral

  • Hearing aids (Wear them!!!)

  • Specialist referral

  • Raise awareness of the problem amongst carers/family and friends


  • 80-90% of people over 65 use medications

  • Some medication can cause or contribute to falls

  • Older people can have altered sensitivity to medications

  • Side effects from drugs are greater when multiple medications are used

Medication risks
Medication risks

  • Multiple medications (4 or more)

  • Medication side affects

  • Use of medications associated with an increased risk for falls (eg sleeping tablets)

  • Difficulty taking medications/incorrect use

  • Lack of information or instructions

Falls management medications
Falls management & medications

  • Regular review of medications

  • Keep a medication list

  • Use of Webster packs or dosettes

  • Use the same doctor if possible

  • Assistance with medications e.g. District Nurse

  • Obtain information on side effects

  • Inform doctor of any side effects suffered

  • Inform doctor about herbal medications being taken

  • Discuss any medication changes with your doctor

Balance and gait disorders
Balance and gait disorders

  • Medical assessment

  • Physiotherapy

  • Prescribed walking aids

  • Ensure safe environment

  • Occupational therapy home assessment

  • Exercise

Falls and older people

Walking aids

  • If you have a walking aid, remember to use it (Correctly!!!!!)

  • Only used prescribed walking aids

  • Make sure you know how to use your walking aid

  • Have your walking aid within reach at all times

Lack of physical exercise
Lack of physical exercise

Reduced activity leads to:

  • Reduced muscle tone and bone density

  • Loss of strength

  • Poor balance and coordination

  • Reduce mobility

  • Increased frailty

  • Reduced quality of life

Staying active exercise t raining
Staying activeexercise & training

  • Strength and Balance training

  • Hydrotherapy/water exercise

  • Exercise programs

  • Tai Chi

  • Walking for 30 minutes most days of the week

  • Dancing

  • Ask you doctor or physiotherapist for an exercise program that is suitable for you

Reducing falls from foot disorders
Reducing falls from foot disorders

  • Purchase of properly fitting shoes

  • Referral to podiatrist for treatment of foot disorders

  • Referral to podiatrist for advice on purchasing of shoes

  • Referral to a specialist for treatment of foot disorders

Reducing falls from unsafe shoes
Reducing falls from unsafe shoes

Purchase safe footwear:

  • Flat sole

  • Broad rounded heel

  • Flexible sole

  • Good grip

  • Lace ups if possible or velcro fasteners

  • Shoes that are enclosed at the front and back

  • Avoid scuffs, thongs, high heels, and sling backs

  • Don’t wear socks without shoes

Shoe sole to ground contact
Shoe sole to ground contact

Flat Shoe

Court Shoe

Shoes with greater ground contact help to reduce the risk of falls

Nutrition and falls
Nutrition and falls

Optimal nutrition is important to reduce

the risk of falling and to enhance recovery

if a fall occurs. The incidence of falls has

been linked to:

  • Vitamin deficiencies

  • Protein-calorie deficiencies

Nutrition and falls1
Nutrition and falls

Effects from under-nutrition include:

  • Reduced muscle mass

  • Weight loss

  • Iron deficiency (aenemia)

  • Balance and gait abnormalities

  • Vision disorders

  • Hypotension

  • Decrease in folic acid can lead to confusion

Falls and older people

Eating and drinking

  • It is important to have enough diet and fluids, especially in hot weather

  • Make sure that you eat and drink enough according to your doctor’s or dietitian’s advice

  • If you are having problems with chewing, swallowing, or with your appetite, tell your doctor or dietitian

Strategies to reduce nutrition related falls
Strategies to reduce nutrition related falls

  • Referral to dietician

  • Medical review

  • Assistance with shopping

  • Assistance with meals eg Meals on Wheels

Vitamin d and calcium
Vitamin D and calcium

  • Vitamin D and calcium deficiencies are common in nursing home, hostel and house bound older people

  • Vitamin D and calcium are essential for healthy bones

Vitamin d and calcium1
Vitamin D and calcium

  • A diet with 1200-1500mg of calcium per day is recommended

  • 20 minutes of direct sun exposure 4-6 times per week to the face and hands is required to absorb adequate vitamin D (Vitamin D cannot be absorbed through a window). Avoid peak heat times (10.00am-3.00pm)

  • Supplements are advised for people not receiving adequate amounts

Fear of falling
Fear of falling

  • 50% of people who fall will suffer fear of further falls

  • Fear of falling causes people to restrict their activities

    Strategies for fear of falling

  • Seek help from doctor, social worker or physiotherapist

Treatment of fear for falling
Treatment of fear for falling

  • Assessment of medical condition

  • Identification of fears

  • Counseling and education

  • Physiotherapy

  • Behaviour modification and treatment of fears and phobias

Hazards in the home
Hazards in the home

  • Rugs & mats

  • Slippery & damaged floors

  • Electrical cords

  • Poor lighting

  • Unsafe bathrooms

  • Steps and stairs

  • Hazardous gardens and paths

  • Furniture

  • Ladders

Hazards in the home1
Hazards in the home

  • Home Safety Checklist to identify areas that need to be addressed

  • Occupational therapy home assessment to identify and advise on changes needed to optimise home safety

  • Home maintenance assistance

Risk taking behaviour
Risk taking behaviour

  • Store things you need at a good height to reduce the need to use step ladders or chairs to reach things

  • Avoid risky activities

Hazards in the community
Hazards in the community

  • Footpaths

  • Gutters and kerbing

  • Stairs and steps

  • Floors and flooring material

  • Slips involving fruit and vegetables on floors

  • Concrete and other man made surfaces

  • Elevators and lifts

  • Supermarkets and shopping centres

  • Alcohol

Hazards in the community1
Hazards in the community

  • Use footpaths

  • Avoid rough or uneven surfaces

  • Report hazards in the community

  • Allow enough time to cross intersections

  • Use pedestrian crossings if possible

  • Wear a hat and sunglasses to reduce glare

  • Be alert, watch for hazards

  • Ask the bus driver to wait until passengers are seated before taking off

Falls and older people

Hip protectors

  • Hip protectors can be used to protect people who have weak bones, and people who have many falls

  • Hip protectors are plastic shields that slip into pockets in specially made underwear

  • If you want more information about hip protectors ask your nurse or physiotherapist

Falls and older people

What to do if you fall

  • Stay calm

  • Decide if you will try to get up

  • If you can’t get up try to keep warm

  • Make a loud noise to get help

  • Always tell someone if you have had a fall even if you don’t hurt yourself

Falls and balance clinics
Falls and Balance Clinics

Falls and Balance Clinics are specialist clinics

which provide assessment for falls.

A typical team would include:

  • Nurse

  • Physiotherapist

  • Occupational therapist

  • Geriatrician or Rehabilitation specialist


In 2005 the Department of Human Services funded the National Ageing Research Institute to review and recommend a set of falls prevention resources for general use. The materials used as the basis for this generic resource were developed by the Goulburn Valley Health Service under a Service Agreement with the Department of Human Services. This and other falls prevention resources are available from the department’s Aged Care website at: http://www.health.vic.gov.au/agedcare.