Preventing Falls and Harm is an Australian National Safety Standard but Are We Really Following Best Practice or Just Current Practice?

Falls are a notable health issue in Australia since 30% of people aged over 65 have at least one fall per year. In 2012-13, around 100,000 people aged 65 and older were hospitalised because of a fall and this is likely to increase as the proportion of people aged over 65 is expected to increase by 23% by 2050. The number of older Australians falling and hurting themselves has been increasing by 3% per year between 2002-3 and 2012-13. Most of the falls (72%) happen either at home or in a residential facility for the aged. A lot of injuries are caused by these falls, with 26% of the injuries (the largest) happening in the hip, 22% in the head and various other injuries.

Apparently falls contribute 40% of injury-related deaths in Australia. Due to advanced age, frailty and pre-existing illnesses, older people do not easily recover from their fall injuries. According to a study done at the University of Mississippi in the US, people aged 70 years and over have a three-fold increase in the risk of death after a fall compared to people who are aged below 69 years. Statistics at the Center for Disease Control in the US show that of the people who died from falls in 2010, 41% were due to trauma to the brain. However, it’s not just head injuries that kill. Those with broken bones also have complications caused by treatment and their prognosis is poor. For example, hip fractures often necessitate surgery (which is traumatic) that requires sedation. The combination of sedation and the trauma of surgery can endanger an elderly person’s life.

For those who survive the fall, the quality of life is generally low. A person who was independent before a fall may be completely unable to take care of himself after the fall, needing to move to a care facility. It’s a huge blow to a person’s pride to suddenly be unable to look after himself and require assistance to get up, move, toilet, bath and get dressed. It can be very depressing. Not to mention the depression that can arise because the now dependent elderly person has to move away from family and friends to live in a facility with complete strangers. It is quite possible for a person to lose interest in life after that and simply decline and die earlier than should be the case.

Other people might still be able to live at home after surviving a fall but tend to move less because they are afraid of falling again. The resulting lack of activity makes them weaker. The weaker the elderly person becomes, the higher the risk of another fall. The impact on mental health is quite hard and a person can become depressed by their new condition of immobility and dependence.

Falls are costly for the nation as the elderly people need health care and, most likely, hospitalisation after a fall. They tend to stay in hospital twice as long as people who suffer from other illnesses, increasing the demand for beds. The long hospital stay increases the risk of contracting infections such as pneumonia, sepsis and catheter-related urinary tract infections which may lead to death. So, in addition to the surgery and nursing care, they will need antibiotics for the infections that arise out of hospitalisation. That is another cost. After hospitalisation the elderly people may need to live in an aged care home to be rehabilitated till they are well enough to move back home. That too is a cost. Home modifications might become necessary to make mobility easier and safer for the fall survivor. That is an added cost. The cost of falls is expected to rise to about $1.4 billion by 2051.

Yet falls are preventable and Australia must get better at falls prevention. With the increase in the number of people aged 65 or over, there are not enough aged care facilities for everyone. With encouragement from government, more people are opting to stay in their homes long instead of living in a residential care facility, therefore the issue of fall prevention needs a closer look. The elderly people will have assistance at home but they can’t have that assistance 24 hours per day. While they are alone mishaps may lead to falls. If growing old in the home is going to succeed, then Australia needs fall prevention programs like those found in the USA which:

·        Provide the elderly people with physical education to improve muscle strength and balance.

·        Train the elderly how to accomplish certain tasks without falling.

·        Recommend home modifications that are client-specific that make mobility safer and easier.

The evidence-based fall prevention programs in the USA have proven to be a success because they were created after studying how and why old people were falling. After going through any of the training programme, old people are stronger, have better balance and they are more confident of themselves. As a result, they stay active without the fear of falling, and they participate fully in life. They can go shopping, go for a walk, clean the house, do some gardening and visit with friends. With an all-round participation in life, they are happier and healthier. We need such programs in Australia to help our old people to regain their confidence, strength and independence and fall less than they are doing now.

One of the challenges that elderly people face is disability which requires the home to be modified with ramps, rails and bars to make mobility and bathing safe. It is good that the NDIS has a home modification benefit for the disabled that makes the home safer for its beneficiaries. My Aged Care should consider adopting the same approach because the elderly, even if they are not disabled, find mobility a challenge as they become weaker. Better still, maybe the NDIS and My Aged Care should consider merging their play books, and the combined program can offer safety training, physical training and home modification as benefits. That should reduce the rate of falls for both the aged and the elderly.

It is obvious that any organisation that is in the aged care industry should examine its practices and policies. They can start by reviewing each fall incident to find out what caused it, whether it could have been prevented and what could have been done to prevent it. The information gathered can then be used to design fall prevention programs that are evidence based and effective. Alternatively, they can copy the evidence-based fall prevention programs that are run in the US. Once they implement the programs, they should monitor any falls and make adjustments to their policies and procedures till the number of falls decline.

Organisations can read more about falls and fall prevention in the following resources:

·        Preventing Falls and Harm from Falls Standard 10.

·        Evidence based practice and research for falls prevention.

·        My Aged Care: Preventing falls in the elderly.

·        Preventing Falls in the Geriatric Population.

·        Preventing Falls and Harm from Falls in Older People.

·        Falls prevention resources.

·        Best-practice recommendations for physical activity to prevent falls in older adults: a rapid review.

·        Falls prevention in older adults: Assessment and management.

·        Fall prevention.