Help solve the problem of falls in care homes
Dr Suzanne Dyer discusses the updated Australian guidelines for falls prevention for older Australians living in aged care homes and the importance for all stakeholders to follow the recommendations.
Every year, 144,000 older Australians are hospitalised because of a fall and 6,000 die. Twenty-six thousand Australians hospitalised for a fall every year are residents of aged care homes.
A new update of the Australian national falls prevention guidelines released today shows what Australians aged 65 and over in the community, hospitals and care homes can do to prevent potentially fatal falls.
These updated guidelines draw on evidence from a Cochrane Collaboration review update expected to be published later this year. Preliminary findings published by the NHMRC funded Centre for Research Excellence for Prevention of Falls Prevention Injuries have also provided clearer guidance on how to prevent falls in this vulnerable population (here, here and here).
How to prevent falls in care homes
Residents of care homes have the highest rate of deaths from falls. Their falls can be prevented by:
- regularly assessing both resident and care home level fall risk factors, including assessment for environmental interventions and medication review to develop a tailored falls prevention plan for each resident, and providing education and engaging the workforce about falls prevention and harm from falls. Such personalised falls prevention approaches should consider the individual needs of the residents, so, for example, if they have dementia, consider if they need additional support to use mobility aids, or keep track of their glasses.
- exercise – providing tailored, supervised exercise to all older residents who choose to participate. Health professionals, such as physiotherapists, exercise physiologists or appropriately trained instructors should design and deliver the exercise programs. The exercise should be moderate intensity, tailored to the individual and include strength and balance exercises. The exercise programs should be ongoing as the falls prevention benefit of exercise programs won’t be maintained after programs end.
- vitamin D supplementation – care home residents generally get outdoors infrequently so are usually vitamin D deficient. Recommended doses of vitamin D should be provided as daily or weekly supplements. Vitamin D can improve muscle function as well as bone health so can help prevent falls and fractures.
- increasing dairy foods in residents’ diet to meet dietary guidelines for protein and calcium intake through dietitian assistance with menu design. Menus should have at least 3.5 servings of dairy foods – milk, yoghurt, cheese – daily. Increasing dairy foods in the diet can reduce the number of falls and hip fractures.
Why haven’t we been doing enough to prevent falls before?
Falls are often a serious event after which an older person’s quality of life and health declines. One third to almost half of care home residents die within a year of hip fracture. In addition, injuries from falls are costly, with treatment of falls injuries in older people costing more than $2.3 billion annually.
However, one reason that not enough has been done to prevent falls in the past is in part because the true rate of falls among older Australians in care homes has not been known until recently. Falls became a National Aged Care Mandatory Quality Indicator in July 2021 following recommendations from the Australian Aged Care Royal Commission.
What now?
We need everyone – families, older people, care home managers and staff and politicians – to support the provision of these effective falls prevention approaches in aged care homes, as recommended in the newly updated guidelines, through awareness, opportunities and funding to help maintain the independence and dignity of older Australians.
Click on the following to access the best practice guidelines for residential aged care services and fact sheet for preventing falls in residential aged care.
Dr Suzanne Dyer is a senior research fellow at the Flinders Health and Medical Research Institute, Flinders University, funded by the Centre of Research Excellence in the Prevention of Fall-related Injuries
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