Despite the best efforts of aged and community care providers, falls rates are simply not coming down because randomised studies are ignoring the practicalities of implementation, an expert said.

Professor of Allied Health at Northern Health and La Trobe University (Melbourne), Keith Hill, explained that although several local-level falls initiatives have worked well to reduce rates for the older population, these “pockets” of success have failed to make an overall difference.

Although he admits that “falls prevention has come a long way in the last 15 years, from the time the first randomised trial was published…over that same time however, the key indicators like hospitalisation rates due to falls have not changed”.

He said that this will become increasingly problematic as the nation’s population ages. If falls rates remain the same in the future, Professor Hill expects that there will be greater numbers of people who will present to hospital because of a fall.

“The bottom line is that we need to see a substantial reduction in rates to see a real decline in falls.”

The big question of course is why? Professor Hill also puts it down to lack of government funding and a host of other reasons: “The translation of research into practice. It’s not just a matter of a good research study that works but how can that be applied in a real life situation.”
 
Community health centres face a whole range of “real life issues”, including long waiting lists, which are not incorporated into the many randomized trials on falls. The same goes with residential care, as falls initiatives “do not necessarily translate into real life”.

Hope has not been lost though as Professor Hill believes that the situation can be turned around if researchers pay greater attention to the realities associated with implementing falls initiatives in an aged care environment or community health setting.

“You either need researchers that fall in both camps as practitioners and researchers, or you need to engage practitioners in research.

“They will then very quickly be able to tell us what won’t work as they have worked in the stretched system. We need to get the researchers and practitioners together to work a out a way to implement randomized trial evidence.”

Facilities should also put their hand up and get involved in research, be it either in primary research for a randomized trial or on the implementation side.

“Just to be willing [to be involved] is a good starting point.

The most important thing that an aged care provider can do, according to Professor Hill, is to get the message out, to health professionals, residents and their families, that falls rates can actually be reduced.

“In community care, people also need to be able to recognise that the early signs that may cause a fall, like if someone feels unsteady or a changing activity level as these things are not just a normal part of ageing.

"[The older person] should get checked out, particularly if they have had a fall and find out what you can do to reduce the risk in future.

 “We also need to work harder to [translate research into practice] and look at what works in a randomized trial, what the barriers are and how to address them.”

Professor Hill will explore why fall rates are not coming down despite all of the evidence surrounding the topic, at the 4th National Ageing Research Institute (NARI) Biennial Seminar on Active Ageing tomorrow in Melbourne.