Fall Injury Prevention in Older People Policy

The revised policy aims at improving the risk screening methods so as to effectively detect patients who are vulnerable to injuries caused due to fall. The policy further aims to educate the professionals about providing a positive patient-centred holistic care in order to provide assistance to the suffering patient as well as the concerned family members.

NAME OF DOCUMENT Fall injury prevention in Older People Policy
TYPE OF DOCUMENT Policy
DOCUMENT NUMBER PHAA150922
DATE OF PUBLICATION September 2015
RISK RATING The elderly population base at Australia are
exposed to a high incidence of fall and other
related injuries.
REVIEW DATE
Documents are to be reviewed a
maximum of three years from date
of issue
October 2018
FORMER REFERENCE(S)
Documents that are replaced by
this one
PD2011_029
EXECUTIVE SPONSOR or
EXECUTIVE CLINICAL
SPONSOR
Ministry of Health, NSW and Administrative
post holders of health care organizations
AUTHOR
Position responsible for the
document including email address
Richard Franklin & Lyndal Bugeja, Co-
Convenors, Injury Prevention SIG –
[e-mail];
[e-mail]
KEY TERMS Old age, fall, injury
SUMMARY
Brief summary of the contents of
the document
The alarming incidences of accidents caused
due to fall in the elderly patients predicted a
three-fold hike in the medical cost expenditure
related to fall intervention. However, injuries
related to fall can be prevented and predicted
to a significant extent. In order to effectively
implement fall prevention strategies it is
important to work in a coordinated manner with
the health care professionals across different
organization and compliance with the national
standard. This policy aims to enhance the
effectiveness of the prevention policies through

effective education and training of the
professionals.
Name of Policy: Advanced Fall Injury prevention in older people
1. POLICY STATEMENT: Incidences of fall and associated injury among the
elderly people can be prevented. The revised policy aims at improving the risk
screening methods so as to effectively detect patients who are vulnerable to injuries
caused due to fall. Further, the policy would access the readiness of the care givers
in providing care to the injured patients based upon their level of awareness in
administering effective intervention strategies.
2. AIMS: The revised policy aims at educating the nursing professionals and
other associated health care professionals to effectively deal with elderly patients
who have been injured and also promote their psychological well being. The policy
further aims to educate the professionals about providing a positive patient-centred
holistic care in order to provide assistance to the suffering patient as well as the
concerned family members. The policy also aims to empower the patients about self-
management strategies so that they can take the ownership of their medical
condition and cooperate with the nursing care plan for a speedy recovery.
3. TARGET AUDIENCE Old age patients, high risk old age patients, registered
nurses, health care professionals managing the geriatric unit
4. RESPONSIBILITIES The policy aims to create awareness campaigns in
collaboration with the following administrative bodies at the national, local as well as
the district level. The administrative bodies include:
The NSW Health Department, The Local Healthcare welfare Ministry, The clinical
excellence department and The private health care organizations

5. DEFINITIONS
Geriartic: Related to old people and health care issues
Elderly: People aged 65 years and above
Fall: The momentary disturbance of the balance that causes the body to
collapse to the ground
Holistic care: Providence of complete care based on physical as well as
mental wellness
6. DOCUMENTATION
Preventing falls and harm for falls in older people in Australia
National Safety and Quality Health Service Standard
7. REFERENCES
O'Rourke, M. (2007). the australian Commission on Safety and Quality in Health Care agenda for
improvement and implementation. Asia Pacific Journal of Health Management, 2(2), 21.
8. REVISION & APPROVAL HISTORY
Date Revision No. Author and Approval
September
2015
150922_PHAA Co-Convenors, Injury Prevention

Background:
With an advancing age the human body is said to lose the ability to maintain
equilibrium. This is the primary reason why incidences of fall are extremely common
among the elderly people. According to studies, it has been mentioned that, 30% of
the elderly people are injured on account of fall. Further statistical evidences state
that the incidence of fall related injury is on the rise in people aged 65 and above.
Studies further reveal that on an average 20% of the elderly people visit hospital
because of sustaining injuries due to fall (Bird et al., 2013). ‘Fall’ has been defined as
a procedure that leads to imbalance and loss of body control resulting in complete
collapse. It is a serious concern and must be addressed on immediate basis. The
NSW policy on fall prevention in elderly people aims at designing strategies to deal
with problem effectively (Gelbard et al., 2014). It should be critically noted here that
Australia hosts a major segment of the old age population. In close association with
the population census ratio as evaluated in the year 2014, it was stated that 15% of
the total population was aged 65 years old and above. Further, the ratio is expected
to rise up to 19% by 203 (Haines et al., 2013)1. A wide range of risk factors has
been associated with incidences of fall with the advancing age. Some of the factors
include depression, dementia, dizziness, vertigo, improper home environment,
blurred vision and inappropriate footwear (Jeon et al., 2014). In accordance to the
statistical evidences, it should be noted that between the time span of 2010-2011,
92,150 cases of elderly fall and injury were reported that required hospitalization.
The annual medical expense involved for the treatment was calculated equivalent to
$ 600 million (Kaminska et al., 2015). Hence, it can be said that there is an alarming
need to formulate policies so as to address the issue of fall prevention among the
elderly in an effective manner. Most of the cases of fall and injury have been
reported within home care settings. However, it should be noted that a high
prevalence of fall related injuries among the old age patients have also been
observed within the hospital settings. Hence, it can be stated that injury related to
accidental fall is preventable to a significant extent. Effective planning and
coordinated working at the national level in collaboration with the health care
professionals can help in the reduction of the rate of accidents to a great extent. This
report aims to review the existing policies and suggest reforms so as to deliver
effective care to the elderly segment of the Australian population susceptible to fall.
Overview:
The risk associated with the hike in incidences of fall injury in the old age patients
can be controlled to a significant extent. In this regard it must be stated that research
studies have suggested a wide range of therapeutic interventions that can be applied
on the elderly patients so as to prevent injuries related to accidental falls.
Administration of minimal muscle strengthening exercise activities have been
reported to be effective for the old people (Lee et al., 2013). Other therapeutic
interventions for the treatment and prevention of fall include, administration of
occupational therapy in high risk population aged 70 and above, providence of hip-
guards or hip-protectors, treatment of blurred vision or cataract, concise geriatric
assessment and multidisciplinary assessment in high risk populations. In addition to
this, awareness strategies to educate care givers and nursing professionals to
engage in a patient-centred care process can also help in minimising the probability
of fall. It should be noted that the older people have the right to live in an
independent manner free from any possible accidental injury arising due to falls
(Lovarini et al., 2013). The Australian Commission on Safety and Quality in health

care emphasises on designing strategies so as to educate the health care
professionals about the mandatory guidelines that must be followed so as to reduce
risks associated with fall within a hospital setting. However it is important to
review the existing policies and incorporate reforms so as to strengthen the system
of care for the geriatric group. At the same time, it should also be noted that proper
integration of the revised policy into the health care network and working in
collaboration with the national level can help in enhancing the quality of the care
framework. The proposed reform in the existing policy would deal with two important
factors. The first being the ability to impart sufficient training to the professionals in
order to enhance the level of care provided to the patients injured because of fall.
The second factor would deal with empowering the patient to practice self
management and take ownership of the medical condition in order to cooperate and
speed up the process of recovery. In this context, it can be stated that the old age
people have often been associated as moody and non-cooperative at a hospital
setting. Healthcare professionals have primarily revealed these two characteristics
as the major obstacles that hinder with the successful implementation of a care plan.
Hence, the revised policy through awareness schemes and education would aim to
educate the professionals in administering a holistic patient centred care plan. It is
expected that it would lead to an accelerated and complete recovery. As old age has
been often compared to a second childhood, it is important to for the care givers to
be sensitive while dealing with the patients (Mitchell et al., 2013). Further, the
patients should also be administered a complete care which would not only focus on
improving the physical health but would also promote mental and emotional
wellness. It can be expected that on successful implementation of the proposed
strategy the incidence of injuries related to fall can be controlled to a great extent
which would also reduce the combined medical expenditure related to fall prevention
in future.
Awareness Strategies:
It has been seen that despite the application of the fall prevention strategy by the
public health association of Australia, majority of the care facilities are unable to care
for older adults as the rate of fall has increased. Therefore, for this purpose, there
should be some changes or improvements in the existing policy or regulations is that
with the existing policies or regulations the changes can be visible on the rates and
stats of falling related to older people in care homes as well as healthcare facilities
(Lord & Washington, 2018).
The first changes or improvement which will be included in the policy related to care
strategies will be providing awareness in the care facilities and nursing professionals
so that while caring for the patient or older adults in the care home they can utilize
the evidence-based practice to prevent fall in the care homes or hospitals. Further,
they should be provided with training and educational program so that their
healthcare professionals can understand the strategies and activities which can
prevent fall episodes in older people prone for falling (Hempel et al., 2013).
The third action which can be implemented or changes in the policy will be including
the care quality improvement checklist which will be provided to the healthcare or
care homes so that they can evaluate the loopholes and lacks present in their
process (Lord & Washington, 2018). This will increase the sense of evaluation of their
own care process and they will be responsible for their action while caring for older

patients admitted in their care facility. Besides these the other care interventions
which will be implemented to improve or change the existing policy about fall
prevention in Australia will be providing a fall alert strategy to all the high-risk fallers
in the healthcare facility (Hempel et al., 2013). All the patients who are highly prone to
fall, they will be provided with a specific strap with color coding on their hand so that
by watching them, the professionals can understand the type of care will need in the
care process (Goodwin et al., 2014). Further, the patients will also be provided with
educational facility so that they can understand the need and self-efficacy so that
they can prevent their fall episode on their own, if any care professionals are not
around them. These are therefore, the care improvement strategy or plan which can
be implemented in the care process so that while caring for care process so that
while caring for patients with fall risks, the care professionals can understand the
strategy using which they can prevent falls in them (Hempel et al., 2013).
Review of the new policy:
There are research processes that determine that these changes or improvement
can be critically important for the process using which fall prevention can be
strengthened and prevented in the care homes and healthcare facilities. In this
context the research article of Maetzler et al. (2013) should be discussed in which the
primary aim of the care facilities was to provide educational training to the care
professionals so that while caring for the older adults, the professionals can use
specific theories and strategies mentioned in the communication and educatable
intervention to make the process helpful for the patients and prevent their fall. It was
evident from the article results that maximum of the strategic and educational
planning was provided to the healthcare or care professionals using educational or
skilled training due to which they were able to use those skills and educational
concepts in the care process so that while caring for older adults prone to fall, the
proper care can be implemented in the process (Maetzler et al., 2013).
The second article chosen for this section is the article by Goodwin et al. (2014) in
which, the primary aim of the researchers was to identify the process using which the
care facility identifies the fall prone patients whom they provided specific training and
education so that they can themselves care for their fall prevention strategies. In this
process, the researchers carried out survey and interview to more than 10
healthcare facilities and finally it was proven that the care facilities primarily used
color coordination strategy to mark the patients while are majority affected with fall
risks and prone to affect their health due to their risks for fall. Further, it is the duty of
the care facilities to determine that the colour coordination cannot be mixed a each
of the patient is tagged differently as per their own risk related to falls and hence, the
primary role of the care facilities was to identify the issues in patients an as per their
severity tag them with a marker so that whenever the patients are at risk, the care
professionals can solve their pain and fall related issue (Goodwin et al., 2014).
Implementation strategies of the new policy:
There is very less amount of evidences which determines that these changes or
implementation in the fall prevention policies has been used in the care facility as

practical practice so that while caring for older adults it can be implemented for their
fall related risk prevention. In an article, by Silva, Eslick and Duque (2013)
researchers mentioned several guidance or strategies using which these factors can
be implemented in the care process. They mentioned that, to make the training and
educational section successful, it is important that the care professionals understand
the severity level of these processes and falls in the older adults in Australia so that
while relating to the tragedy and risk, they can take active part in the educational
facility (Silva, Eslick & Duque, 2013). Further, it will also allow them to understand the
positives and negatives of the process and therefore, providing them with education
should be done after explaining the complete process and risk for their complete
support and efficiency in the process. Therefore, this researcher completely focused
on the importance of active participations of healthcare facilities professionals and
care home carers in the successful implementation of the proposed changes in the
existing care policy for fall prevention (Silva, Eslick & Duque, 2013). Secondly,
another research article was about the care facility and the importance of including
the patient in the fall preventing intervention (Siris et al., 2014). This is important as
they are an important prat of care process and if they are aware of their steps, they
will be prone to les fall events and injuries. Hence, the researchers identified the
need of care process ab patient involvement and found that the care intervention
achieved success when the patients supported them for the care process hence, it
was evident that the care process is more successful in the presence and support of
patients and hence, involvement pf patient and related intervention was important
(Siris et al., 2014).
Recommendations for evaluation:
There are several evaluation methods which can be used to determine the
effectiveness of the modified care process and then it can be used to identify the
most effective care process using which the care professionals can identify the
process which can be used for fall prevention in patients with major fall risks in old
age care homes of healthcare facilities (Hempel et al., 2013).
The first evaluation process will the FRS, which is one of the most effective validated
tools which is used in the evaluation of the care process for older adults an this
determines that the older adults are able to understand the main preventive and
interventions which is important for the care process and improvement of the older
adults prone to risk of fall (Lord & Washington, 2018). This is an important care
evaluation and hence, it will be used to identify the effectiveness of the care process.
The second intervention will be the mobility assessment, in which the patient mobility
will be assessed and depending on the care process of the older adult and its
effectiveness will be judged. It is an important care evaluation as it is directly
associated with mobility, which is affected after falls in majority of the older adults
(Maetzler et al., 2013). Therefore, is the patient is able to carry out mobility, then the
intervention is bale to provide proper care to the patient and hence, intervention will
be successful. these are the way using which care process will be evaluated
(Goodwin et al., 2014).

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