Falls in older adults are often serious, resulting in functional decline, reduced quality of life, loss of independence and in severe cases, even death (Rubenstein 2019).
According to the Royal Commission into Aged Care Quality and Safety (2021), 10.5% of aged care residents were admitted to the hospital or emergency department due to a fall in 2018/2019.
Despite these alarming statistics, most falls are preventable.
What is a Fall?
A fall can be defined as ‘an event that results in a person coming to rest inadvertently on the ground or floor or other lower level’ (DoH 2021).
Most falls occur due to a combination of both intrinsic (personal) and extrinsic (environmental) factors. The more risk factors that are present, the more likely the person is to fall (Clay, Yap & Melder 2018). Some common risk factors include:
Intrinsic risk factors
Extrinsic risk factors
Prior history of falls
Acute or chronic illness
Delirium, disorientation or confusion
Use of mobility assistance
Fear of falling
Bathroom location and accessibility
Cords and tubing
Lack of communication with staff
Unfamiliarity with environment
Time of day
(Clay, Yap & Melder 2018; ACSQHC 2009; Canadian Patient Safety Institute 2015)
Older Adults and Falls
Changes to the body due to the normal ageing process can worsen existing risk factors or cause new ones to arise. Inadequate physical fitness, nutrition or hydration, and illnesses or other conditions may compound this risk further (Healthdirect 2020).
Older adults are 12 times more likely to fall than have a motor vehicle or pedestrian accident (Better Health Channel 2016). Falls are the biggest cause of unintentional injury in older adults over 65, accounting for about 75% of injury-related hospitalisations (Healthdirect 2020; Roo, Johnston & Petersen 2015).
Overall, about one-third of older adults fall every year (Healthdirect 2020).
Risk factors associated with age include:
Balance issues and unsteadiness
Muscle weakness and joint stiffness
Medication side effects
Slower reaction time
New health problems (e.g. incontinence or dementia).
(Healthdirect 2020; Better Health Channel 2016)
Consequences of Falling
Even in cases where an injury does not occur, the resident may develop a fear of falling that reduces their confidence and independence. This, in turn, only increases their risk of falling again in the future, as reduced physical activity can lead to poor balance, muscle weakness and stiff joints (Rubenstein 2019; Healthdirect 2020).
Falls can lead to a variety of physical, emotional, social, short-term and long-term consequences including:
Bruises, sprained ligaments, strained muscles and other minor injuries
Stiff joints and weak muscles due to lack of activity
Increased risk of future falls
(Rubenstein 2019; Better Health Channel 2016; Healthdirect 2020)
Preventing Falls in Aged Care
Preventing falls requires a multifactorial approach that addresses each resident’s modifiable risk factors (Clay, Yap & Melder 2018).
Using a validated falls risk assessment tool, vulnerable clients should be identified and appropriate interventions should be put into place. It is likely that multiple solutions will need to be implemented in order to target several individual risk factors (Clay, Yap & Melder 2018).
The following are some universal precautions that aged care staff can take to prevent falls:
Ensure effective communication between staff
Ensure the resident is familiar with their environment
Ensure the resident knows how to use any call lights or alert devices
Ensure personal belongings such as glasses are in reach
Answer call lights as soon as possible so that the resident does not need to ambulate unnecessarily
Remove debris from outdoor walkways (e.g. moss, slime, leaves)
Repair any broken, uneven or damaged flooring
Ensure tables and benches do not have sharp corners
Keep the floors clean, dry and free of clutter, and clean any spills as soon as possible
Remove or tape down electrical cords
Mark changes in the floor level with a bright colour
Use non-slip mats in wet areas (e.g. bathroom, kitchen) and non-slip flooring
Implement handrails, seats or handheld nozzles in the shower and bath
Secure mats and rugs with adhesive strips; remove any that are torn or wrinkled
Use bright lighting and nightlights to increase visibility, and ensure lights are switched on
Use curtains or blinds to reduce glare
Change lights if they are not bright enough
Encourage the resident to wear non-slip footwear
Keep the resident’s bed at an appropriate height (their feet should be able to touch the floor with their hips, knees and ankles at a 90-degree angle) and lower it while they are resting
Keep bed and chair brakes on
Mobilise the resident at least two times per day
Ensure residents know how to use mobility and assistive devices
Avoid restrictive practices where possible
Establish a bowel and bladder function care plan
Consider frequent vital sign observations
Ensure residents and staff are properly informed about any medicines, including instructions, dosage and any side effects
Ensure the resident is not taking unnecessary medicines.
(Performance Health 2019; ACSQHC 2009; Canadian Patient Safety Institute 2015; Healthdirect 2020; Better Health Channel 2016)
Depending on their individual risk factors, residents may require specific interventions in addition to universal precautions. Some examples include:
Modifiable risk factor
Fear of falling
Encourage the resident to verbalise their feelings
Encourage the resident about their capabilities and strengthen their self-efficacy for ambulation
Regularly monitor the resident’s cognitive status
Implement a behavioural approach
Strength or balance impairment
Strength and balance training
Provide assessment and referral if necessary
Ensure aids or devices are being used and are suitable
Ensure frequently-used items are in a consistent place
Incontinence and toileting issues
Individual bladder/bowel management plan
Encourage adequate fluids and fibre
Laxatives, if required
Urinal bottle or commode chair
Poor hydration or nutrition
Referral to dietitian
Address reasons for poor food or fluid intake
Modify medicines if necessary (upon review)
Switch, decrease or stop medicines if necessary (upon review)
Modify or remove hazards
Review bed rails
Adjust bed and bedside table height
Provide clocks or calendars
Use personal belongings to make the resident’s space familiar
(Canadian Patient Safety Institute 2015; WA DoH 2018)
Falls can result in functional decline, reduced quality of life, loss of independence and in severe cases, even death (Rubenstein 2019).
Addressing and managing potential risk factors in aged care facilities is essential in preventing falls and their associated complications, and ensuring residents are able to maintain their confidence and independence.