New fall prevention guidelines have landed

5 minute read


The first update since 2009 moves away from a numerical fall risk score and instead focuses on individualised, evidence-based prevention.


New fall prevention guidelines emphasise tailored management and collaboration between individuals and their family and healthcare team.

The Australian Commission on Safety and Quality in Healthcare recommendations are the first update since 2009, and advise GPs to screen all older people annually using a validated falls risk assessment tool.

Doctors can then identify what patients’ goals of care are, while focusing on maintaining independence and quality of life.

The guidelines also recommend carer and family involvement, to the extent that the older person chooses, as well as shared decision making on fall prevention interventions.

It was also important to evaluate the patient’s health literacy to ensure education and discussions were tailored to individual.

Reducing risks of alcohol-related harm, facilitating meal support and dietician access, and supporting the use of telehealth and virtual care (where appropriate and available) were also listed as key recommendations.

Individuals were considered low risk for falls if they had fewer than one fall a year. They were at increased risk if they had one or more fall per year and were high risk if they had two or more falls per year.

It was estimated that less than half of all falls were reported to health professionals, and half of falls happen at home or close to home.

It was strongly stated that regardless of a lack of injury or harm, every fall needed to be reported and reviewed.

Strong recommendations for supporting individuals living in the community and in residential care

  • Providing regular fall risk assessment and personalised multifactorial prevention interventions. This includes exercise plans, referral to podiatry, vision assessment, assistive devices, medication reviews, education of and engagement with carers, and other tailored strategies to address fall concerns.
  • Tailored exercise should be designed and delivered by appropriate professionals such as physiotherapists. The guidance states that positive impacts of exercise diminish following cessation, and a focus on ongoing support to undertake two to three hours of exercise per week should be adopted. All older individuals with a low risk of falls should be encouraged to exercise at home or in the community, while those living in aged care or at high risk of falls should undertake supervised exercise programs. The focus should be on balance, mobility and strength training.
  • Osteoporosis medicines should be prescribed to anyone diagnosed with osteoporosis or with a history of minimal trauma fractures, unless contraindicated.
  • Adequate dairy intake should be encouraged. Menus should have 3.5 servings daily of milk, yogurt, cheese and similar foods to maintain calcium, which may require assistance from dieticians to tailor it to the patient’s preferences.
  • Facilitation of timely referral for cataract surgery for older people with clinically significant visual impairment primarily due to cataracts, unless contraindicated.
  • Tailored home safety interventions should be provided following home risk assessment by an occupational therapist for individuals living in the community. Those with severe visual impairment, who have fallen in the past year, who need help with everyday activities, have mobility impairment/use a mobility aid or who have recently been discharged from hospital are at increased risk of falls and require this home assessment. Regular risk assessment of aged care, ensuring facilities remain appropriate for an older person’s changing needs, should also be undertaken.
  • Vitamin D supplementation should be prescribed daily or weekly for older people living in the community with known deficiency or little sunlight exposure (less than 5-15 mins at least four times per week) unless contraindicated. Large monthly or yearly doses should be avoided as they can increase fall risk. There is weaker evidence to suggest that vitamin D supplementation should be considered for all individuals living in aged care and was listed as a conditional recommendation.

Other conditional recommendations based on weaker evidence

  • Consideration of the use of hip protectors for older people living in aged care to reduce the risk of fall-related hip fractures.
  • Advising older people living in the community to use single-lens distance glasses as opposed to bifocal, multifocal or progressive lenses when engaging in outdoor activities. Also, limiting the change in prescription where possible.
  • Facilitating the treatment of diagnosed cardio inhibitory form of carotid sinus hypersensitivity with dual-chamber cardiac pacemakers.
  • Minimising the use of psychotropic medicines and other medicines that increase risk of falls.

The guidance was designed for individuals aged 65 years and older, or 50 and above for Aboriginal and Torres Strait Islander peoples. The recommendations were also relevant to people outside these age groups at an increased risk of falls due to disability, conditions that alter functional ability or a history of falls.

The guidelines stated that the incidence of falls in Australia have been increasing and are expected to increase further as the population ages. Given that falls are a common reason for older people to present to the emergency department and to commence residential care, the incorporation of new research evidence was an essential update.

The complete guidelines are available here.

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