Falls in older people are often serious, resulting in functional decline, reduced quality of life, loss of independence and, in severe cases, even death (Stefanacci & Wilkinson 2025).

The Australian Institute of Health and Welfare (2025) identified falls as the leading cause of injury-related deaths in 2022-23, as well as the leading cause of injury hospitalisations in 2023-24. In that same period, Australians aged 65 and over were twelve times more likely to require hospitalisation following a fall compared to adults aged 25-44. The financial burden of these fall-related injuries on the Australian health system was estimated at over $5 billion during the 2023–24 period (AIHW 2025).

Despite these alarming statistics, most falls are preventable.

What is a Fall?

A fall is ‘an event that results in a person coming to rest inadvertently on the ground or floor or other lower level’ (DoHaAC 2025).

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 (WA DoH 2024).

Some common risk factors include:

Intrinsic risk factors	Extrinsic risk factors
Prior history of falls Age Comorbidity Acute or chronic illness Cognitive impairment Delirium, disorientation or confusion Incontinence Impaired mobility Balance issues Muscle weakness Medications Fear of falling Being female Depression Reduced reaction time Physical inactivity Vision impairment	Tripping hazards Poor lighting Bathroom location and accessibility Slippery or uneven floor surfaces Doors Cords and tubing Room layout Noise (e.g. alarms that impair sleep) Furniture Staffing Poor staff communication Footwear Unfamiliar environments Language barriers Lack of contrast marking Time of day Lack of accessibility (e.g. no ramps or handrails)

(WA DoH 2024; Queensland Health 2026; Clay et al. 2018)

Older People 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, poor nutrition or hydration, illnesses and other conditions may compound this risk further (Healthdirect 2025).

In Australia, approximately 1 in 4 people aged over 65 will experience at least one fall a year (ACQSC 2026).Falls are the biggest cause of unintentional injury in older people over 65 (Healthdirect 2025).

Risk factors associated with age include:

Balance issues and unsteadiness
Muscle weakness and joint stiffness
Poorer sensation in legs and feet
Poorer eyesight
Medication side effects
Slower reaction times
Memory difficulties
Poor diet and dehydration
Low levels of calcium
New health problems (e.g. incontinence or dementia).

(Healthdirect 2025; Better Health Channel 2026)

Consequences of Falling

Even in cases where an injury does not occur, the person 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 (Stefanacci & Wilkinson 2025; Healthdirect 2025).

Falls can lead to a variety of physical, emotional, social, short-term and long-term consequences, including:

Bruises, sprained ligaments, strained muscles and soft tissue injuries
Hip fractures (the most common injury caused by falls)
Dislocations
Broken bones
Torn ligaments
Deep cuts
Respiratory infections
Organ damage
Loss of consciousness
Head injury
Impaired mobility
Social isolation
Loss of confidence and independence
Embarrassment and low self-esteem
Functional decline
Hypothermia
Family and carer stress
Stiff joints and weak muscles due to lack of activity
Increased risk of future falls
Death.

(Stefanacci & Wilkinson 2025; Better Health Channel 2026; Healthdirect 2025; Horta Reis da Silva 2024)

Falls Prevention Under the Strengthened Aged Care Quality Standards

Standard 5: Clinical Care - Outcome 5.5: Safety of clinical care services under the Strengthened Aged Care Quality Standards (Action 5.5.4) advises aged care providers to establish processes for reducing falls and harm from falls by:

Optimising older people’s mobility to reduce functional decline
Providing appropriate and timely care after an older person has fallen
Assessing fall and injury events to determine why they occurred and what the consequences were.

(DoHDA 2025)

Preventing Falls in Aged Care

Preventing falls requires a multifactorial approach that addresses each person’s modifiable risk factors (Clay et al. 2018).

Vulnerable people should be identified using a validated falls risk assessment tool, and appropriate interventions should be implemented. Multiple solutions will likely need to be implemented to target several individual risk factors (Clay et al. 2018).

Universal Precautions

The following are some universal precautions that aged care staff can take to prevent falls:

Ensure effective communication between staff
Ensure the person is familiar with their environment
Ensure the person knows how to use any call lights or alert devices
Ensure personal belongings (e.g. glasses, hearing aids) are within reach
Answer call lights as soon as possible so that the person does not need to ambulate unnecessarily
Remove debris from outdoor walkways (e.g. moss, slime, leaves)
Repair any broken, uneven or damaged flooring
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 the lights if they are not bright enough
Encourage the person to wear non-slip footwear
Keep the older person’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
Ensure older people know how to use mobility and assistive devices
Avoid restrictive practices where possible
Establish a bowel and bladder function care plan
Ensure older people and staff are properly informed about any medicines that may increase the risk of falls.

(Performance Health 2019; ACSQHC 2025; Healthdirect 2025; Better Health Channel 2026)

Conclusion

Falls represent one of the most significant and costly challenges in aged care, yet with the right knowledge and a proactive approach, many can be prevented. By understanding the intrinsic and extrinsic risk factors that contribute to falls, identifying vulnerable individuals early, and implementing both universal precautions and targeted interventions, aged care providers can meaningfully reduce the frequency and severity of falls in their care settings.

Ultimately, fall prevention is about more than avoiding injury - it is about supporting older people to live with confidence, independence and dignity.