Falls are the leading cause of unintentional injury in older Australians. As well as physical injury, falls can cause loss of confidence and fear of falling, so over time, older people may become less active, which may increase their risk of falling.
Evidence suggests falls can be prevented by exercising, modifying the environment (particularly at home) and reducing some medications. Vitamin D and calcium supplements can also reduce fall-related fractures.
Victorian health care providers and services can use a range of resources to assess the risks associated with falls, and then identify ways of addressing those risks.
Definition of a fall
The department endorses the World Health Organization’s definition of a fall: an event that results in a person coming to rest inadvertently on the ground or floor or other lower level.
Falls are the leading cause of unintentional injury of older Australians. In 2011‑12, 96,385 people aged 65 years and older had a fall that required a hospital stay (Tovell, Harrison & Pointer 2014). In Victoria, falls accounted for almost three-quarters (72%) of injury related hospital admissions and more than half (53%) of injury related emergency department presentations (Clapperton & Fernando 2014).
More than twice as many women were hospitalised as men, and fractures were the most common type of injury associated with a fall (Victorian Injury Surveillance Unit 2013)
Falls can cause loss of confidence and fear of falling, so older people become less active over time, which increases their risk of falling. Older people are encouraged to discuss all falls (including ones that didn’t cause injury) with their general practitioners or other health care provider, to make it easier to identify and address contributory factors.
Evidence suggests falls can be prevented. Randomised controlled trials (Cochrane Collaboration 2013) show interventions can reduce falls among older people living in their own home. Effective approaches include exercise (home exercise programs or group exercise programs targeting balance and strength, and tai chi), reducing psychotropic medications, cataract surgery, home assessment and behavioural modification by occupational therapists, and multi-factorial interventions. Further, research suggests vitamin D and calcium supplements can reduce fall-related fractures.
Falls prevention tools
Falls risk for older people: community setting (FROP-Com)
Health care providers and services can use the FROP-Com assessment tool in community settings. It involves rating 13 risk factors, usually on a scale of 0-3.
The FROP-Com Guidelines comprise two sections:
- Section 1 contains definitions and scoring options.
- Section 2 lists possible intervention to consider for identified risk factors.
FROP-Com Screen uses the three items that best predict falls risk in a 12 month period. It has high retest and inter-rater reliability, and a moderate ability to predict falls in older people presenting to an emergency department after a fall.
For more information on FROP-Com, please contact the National Ageing Research Institute (NARI) on (03) 8387 2305.
Falls Risk Assessment Tool (FRAT)
The Falls Risk Assessment Tool (FRAT) comprises three parts:
- Part 1 - falls risk status (can be used as a falls risk screen)
- Part 2 - risk factor checklist
- Part 3 - action plan.
The FRAT pack includes:
- validated risk assessment tool (FRAT) and guidelines
- multidisciplinary intervention strategies to reduce falls and falls injury
- staff development and training information and material
- a range of other material related to quality improvement, guidelines for prescribing medication, an incident form, environmental checklists, brochures, and additional resources and recommended reading etc.
The FRAT is a validated tool, so we do not recommend using the changes to Part 1. Validation of the FRAT resource was reported in September 2009: Four-item fall risk screening tool for subacute and residential aged care.
The cognitive status question in Part 1 refers to the Abbreviated Mental Test Score (AMTS).
The Peninsula Health Falls Prevention Service developed the FRAT tool in 1999.
The complete FRAT Pack and Facilitators Guide is available fromPeninsula Health Falls Prevention for a charge.
Please call (03) 9788 1260
Community Falls Prevention Program sustainability guidelines
The Community Falls Prevention Program sustainability guidelines help agencies to plan program sustainability, so falls prevention programs are effective over the longer term. Effective long term programs may help reduce rates of falls and injuries in Victoria.
The guidelines were developed as part of a National Health and Medical Research Council (NHMRC) Partnership Grant: Reducing falls among older people in Victoria: better evidence, better targeting, better outcomes.
Australian Commission on Safety and Quality in Healthcare
The Australian Commission on Safety and Quality in Health Care (ACSQH) has several initiatives to help health services to reduce falls, and the resulting patient harm.
- Falls prevention resources contains best practice guides and fact sheets for preventing falls in community care, residential aged care and hospitals
- National Safety and Quality Health Service (NSQHS) Standards improve the quality of health care in Australia. Standard 10 covers preventing falls and harm from falls.
- The Safety and quality improvement guide for Standard 10: preventing falls and harm from falls can help agencies implement Standard 10.
For more information visit the commission .
Falls prevention evidence and resources
The following sites contain evidence, research and resources about preventing falls.
- Interventions for preventing falls in older people living in the : Cochrane reviewed healthcare literature to identify effective ways to prevent falls for people living in the community.
- Interventions for preventing falls in older people in care facilities and : Cochrane reviewed healthcare literature to identify effective ways to prevent falls for people in care facilities and hospitals.
- The Australian and New Zealand Falls Prevention promotes multidisciplinary study and implementation of falls prevention in older people.
- The NSW Clinical Excellence has several useful falls prevention resources for health professionals.
- NSW Falls Prevention shares knowledge, expertise and management information for the public, health professional, general practitioners and carers.
- Active and Healthy has falls related information for professionals
- Stay on Your Feet Western has information for health professionals.
- Stay on Your Feet has information for health professionals.
- is a Centre Disease Control United States resource focusing on preventing elderly accidents, deaths and injuries due to falls. It provides resources for health professionals and older people to help prevent falls.
Reference texts
Tovell A, Harrison JE and Pointer S 2014. Hospitalised injuries in older Australians, 2011-2012, Injury research and statistics series no. 90, cat. no. INJCAT 166, AIHW, Canberra.
Clapperton A and Fernando T 2014, Unintentional (accidental) hospital-treated injury in Victoria, 2012‑13, E bulletin edition 10, Victorian Injury Surveillance Unit, Monash Injury Research Institute, Melbourne.
Victorian Injury Surveillance Unit 2013, Hazard 76 – a settings-based analysis of injury data in Victoria, Monash Injury Research Institute, Melbourne.
Cochrane Collaboration 2013, Interventions for preventing falls in older people living in the community
Reviewed 05 August 2024