Whilst falls in residential aged care facilities are common, they are not inevitable. Regular training about falls risk and the introduction of various interventions can make a significant difference, an expert tells Australian Ageing Agenda.
“People assume that as you get older, you’re bound to fall,” said Professor Joseph Ibrahim – head of the Health Law and Ageing Research Unit at Monash University and editor of the Residential Aged Care Communique. “So people consider it natural. And when they start to think about things being natural, they think there is nothing you can do about it,” Professor Ibrahim told Australian Ageing Agenda.
“And as staff members or clinicians, you tend to get reinforcement because you see the people that fall … so you think you can’t fix it,” he said.
However, there are interventions to reduce the risk of falls including strength and balance exercise programs, vitamin D supplements and improved diet, said Professor Jacqueline Close, clinical director at the NeuRA Falls, Balance and Injury Research Centre. In the latest Residential Aged Care Communique – which focuses on a single theme relevant to clinicians and care staff in the aged care sector – Professor Close offers tips and techniques to reduce the risk of falls in aged care facilities.
“A very recent study undertaken in Australia has shown that increasing dairy and protein intake of residents in the form of milk, cheese and yogurt can reduce both falls and fractures,” said Professor Close.
The reality is a lot of these interventions stop people from falling, said Professor Ibrahim. “But you never see that success. I’m not saying that you can eliminate falls altogether, because we know they’re common, but we can certainly continue to work towards reducing the risk.”
According to Professor Keith Hill, director of the Rehabilitation Ageing and Independent Living Research Centre at Monash University, around 50 percent of aged care residents experience one or more falls in a 12-month period. This rate increases to 80 percent in dementia-specific facilities.
Two levels of preventative action
Also contributing to the communique, Professor Hill said that falls risk management involves two levels of action. The first is at an organisational level, “which focuses on facility wide practices that aim to reduce the risk of falls generically for all residents.” This includes implementing measures such as appropriate lighting, ensuring surfaces are level and introducing adequate spacing of seating for residents who tire and need to rest.
The second focus “should be individualised, based on each resident’s falls risk factors.” These could include medication reviews, physiotherapy programs, nutrition reviews and continence management to minimise the risk of residents rushing to the toilet – a common circumstance of falls in residential care.
“Falls prevention is everyone’s responsibility,” said Professor Hill. “A cleaner or a personal care worker may be the first to note new clutter or a new environmental hazard that needs to be remedied – so they have a role and a responsibility to report and ensure appropriate actions are implemented to remove the risk.”
Asked whether there are enough preventative measures in place to protect people from falling in aged care homes, Professor Ibrahim said: “The general answer is probably not.” However, he added that it’s hard to generalise across the whole sector. “You have people who have diseases that increases their risk of fall, those with Parkinson’s for example. It’s a hard topic to be definitive on because it’s so broad.”
The reason for the focus on falls management, said Professor Ibrahim, was to convey to staff and families there’s a lot of simple things that you can do that can reduce falls. “It’s not like you have to go and do something terribly dramatic or expensive, and you can still achieve a better health status.”
Professor Close acknowledges that achieving a goal of zero falls is “aspirational and probably unrealistic”. But she said there are undoubtedly falls that can be prevented. “Every fall, every fracture, every head injury causes suffering and pain – every fall counts and we can do more to stop our older residents from falling.”