Preventing Falls in Residential Aged Care Settings: Policy Direction and Stakeholder Engagement

This article discusses the policy direction for preventing falls in residential aged care settings, including stakeholder engagement and preventative strategies. It also highlights the importance of engaging stakeholders such as facility administration, care managers, clinical educators, quality assurance personnel, registered nurses, care workers, general practitioners, patients and their families, and government authorities.

Running head: Ageing health and human services
Ageing Health & Human Services
Name of the Student
Name of the University
Author Note

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Contents
Policy area in the ageing field I would like to investigate.........................................................2
Why I am interested in this policy area......................................................................................2
My preferred policy direction....................................................................................................2
Outline of the policy direction that I would like to recommend................................................2
The stakeholders who needs to be engaged and reasons for doing so.......................................4
Based on the pros and cons, a possible scenario of its implementation.....................................5
Different Scenarios of implementing preventative strategies................................................5
Preventative Strategies that can be used in the scenarios above:...........................................7
Recommendation on an implementation strategy......................................................................9
Key steps of evaluation of the policy after implementation....................................................10
References:...............................................................................................................................14

2Ageing health and human services
Policy area in the ageing field I would like to investigate
In this assignment I would like to investigate policies Of Falls Prevention in
Residential Aged Care Settings of the NSW government (Cec.health.nsw.gov.au 2018). I
would also like to contrast it with the policies outlined in Standard 10 of preventing falls and
harm from falls (Falls prevention :: SA Health 2018)
Why I am interested in this policy area
Injuries related to falls are more common among elderly people and is one of the
major contributors of pain, disabilities, loss of independency as well as death. Every year,
approximately 28% to 35% elderly people above 65 years of age experiences falls, the risk of
falls further increases to 32%to 42% for individuals 70 years or older. Furthermore, the health
system cost per injury due to fall for individuals 65 years or older in Australia is about AU$
6500, as of 2001-2002 (Falls Prevention in Older Age 2018). In South Australia, 22,576
people were hospitalised after a fall, 65% of whom were individuals 65 years or above, and
caused 400 deaths among older people (sahealth.sa.gov.au 2018).
My preferred policy direction
Standard 10, Preventing Falls and Harm from Falls, Safety and Quality Improvement
guide (2012) outlined criteria to prevent falls and harm from falls such as: governance
systems, screening and assessment, preventative strategies and communication, which
focuses on improvement on safety as well as quality of care for elderly residents
(safetyandquality.gov.au, 2018).
Outline of the policy direction that I would like to recommend

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I would like to recommend the strategic outline as proposed in the Standard 10 of
Preventing Falls and Harm from fall, which includes strategies for governance, screening and
assessment, fall prevention and communication. The outline is given below:
 Ensuring policies, protocols and procedures which are consistent with the best
practice guidelines are used (wherever possible) and utilise screening and assessment
tools.
 Regular monitoring of the use of procedures, policies and protocols to prevent and
reduce risk of falls
 Ensuring regular reporting, investigating and monitoring incidents of falls is utilised
 The frequency and severity of falls in the healthcare facility are monitored and
investigated using administrative and clinical data
 Data on falls are reported to the top levels of governance in the organization
 Taking actions to reduce the frequency as well as severity of falls in the care setup
 Preventing falls and reducing harm to resident through quality improvement
 Ensuring that devices and equipments are available to implement preventative
strategies and management plans to prevent and reduce the harm from falling
 Using screening tools from best practice to identify the risk of falling among older
residents
 Monitoring the use of screening tools in order to identify the proportion of residents at
risk who were screened for falls
 Taking proper action to improve the number of residents being screened for fall risks
during admission as well as upon presentation of an incident of fall
 Using best practice assessment tool for the assessment of residents at risk of falling
 Monitoring the use of assessment tools to identify the proportion of residents who
completed fall assessment

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 Ensuring participation of patients and caregivers while developing or amending
prevention plans.
 Taking proper actions to improve the number of residents undergoing complete
assessment of fall risk
 Using best practice for minimisation of harm and multifactorial prevention of falls,
and recording them in the clinical records of the patient
 Regular monitoring of falls prevention and harm reduction strategies for their
efficiency, appropriateness and effectiveness.
 Taking action to reduce the risk of falls and reduce harm for residents at risk of falling
 Referrals to appropriate service provided upon discharge (wherever possible)
 Information on falls and their prevention strategies are given to the patients as well as
their caregivers in a simple, meaningful and understandable format.
 Developing fall prevention plan in partnership with the patients and caregivers
(safetyandquality.gov.au, 2018).
The stakeholders who needs to be engaged and reasons for doing so
Stakeholders are individuals who are involved or have interest in the aged care system
and include beneficiaries, providers and funders (DefinedTerm: Stakeholders, 2018)
The stakeholders who needs to be engaged in the policies for the prevention and
reduction of injuries due to falls among elderly residents and patients includes: Facility
administration, Care Manager/Director of Nursing, clinical educator, quality assurance
personnel, registered nurses, Care workers, general practitioners, patients and their families,
and government authorities (caresearch.com.au, 2018; Poulton et al. 2017)
The facility administration’s involvement would include vital strategies like planning
and implementation of preventative strategies, and addressing concerns identified by risk

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assessment. They have the overall responsibility of the wellbeing of the residents, ensuring
safety in the care facility, and also monitoring and investigating reports of falls. The
administration can also facilitate the implementation of change processes, outline standards
of best practice, and ensure compliance to preventative practices (Myers et al. 2016).
The care manager can be involved in a more personalized approach of fall prevention
and minimization of harm from falls. They can be involved in the care planning of the
patients, ensuring adequate screening for risks and monitoring of screening efficiency. The
care manager can also overlook the treatment given to the patients. Care managers are often
form the front lines of leadership and are responsible for the day to day operations including
managing and recruiting staff, managing budgets and ensuring the quality of care meets the
national standards of care (Huber, 2017).
Clinical educators or nursing professional development specialists can be involved in
the training of nurses and healthcare professionals. They can ensure that the nurses have the
necessary skills and training to conduct their responsibilities efficiently and effectively. This
also requires coordination with the facility administration to identify training needs as per the
care goals of the organization. The educators can formulate plans and implement training on
strategies to prevent and reduce the risks of falling among the elderly residents (Myer et al.,
2017).
Quality assurance team can be involved to ensure maintenance of standard quality of
care and constantly review the efficacy of the care provided by the organization. They can
also monitor the usage of screening tools and preventative strategies, ensuring their optimum
usage at maximum efficiency (Puri et al. 2018).
Registered nurse can be involved in the provision of specialized care for the elderly
residents, which can reduce the risks of falling. They have specialization in geriatric care, and

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are able to assess both physical and mental ailments of the patents. They also can be involved
in providing basic care as well as monitor the patient conditions, assess their health, reporting
to physicians and also providing medications whenever needed.
Care workers are important support groups that bridge the gap between the healthcare
professionals and the patient and their families. They can ensure continuation of care given to
the patients. They can be involved in patient’s follow-up and ensure safety and wellbeing of
the patients after discharge.
General physician’s involvement is also vital since they have the necessary expertise
in the treatment of the patients, as well as ensuring proper assessment of the risks of falling.
Government Authorities’ involvement can also be recommended since the incidents
of fall are closely associated with significant rates of disability and death among elderly
patients, and therefore is a public health concern apart from the cost burden on the healthcare
industry (in the form of insurance coverage).
Based on the pros and cons, a possible scenario of its implementation
Different Scenarios of implementing preventative strategies
The process of developing, implementing and reviewing procedures and protocols
related to fall prevention and reduction of risks from falls can be implemented an aged care
setting under various scenarios. In an aged care centre, residents often suffer from long term
or chronic disabilities which increase their risks of falling like cognitive deficit, lack of
balance or mobility, vision impairments, physical disabilities (Bunn et al., 2014).
Additionally, environmental risks and medications can also increase the risk. Some of the
scenarios are discussed below:

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Patients with poor balance or mobility are unable to maintain their balance very well,
and have difficulties in movement. This increases their risk of falling due to a reduced
musculoskeletal and motor coordination. Patients can be regularly assessed for such aspects
to identify individuals with reduced ability to move and balance themselves (Caetano et al.,
2018; Merryweather et al., 2015). Such patients can be given support to reduce their risks of
falling as an effective preventative measure.
Patients with cognitive impairments due to neurodegenerative conditions like
dementia, alzhimers or Parkinson have a reduced ability to remember things, and also affect
their motor coordination skills. Such patients also show postural instability as well as an
inability to understand environmental hazards of falling (Amar et al., 2015). Assessment of
environmental risks as well as their cognitive performance can be important to minimise the
risks of falling. Additionally, assessment of their postural stability can be done to understand
patients at risk (Jabelli et al., 2016). Using memory aids like notes, alarms and visual cues
can also be considered to aid their cognition, and help them to remember things (Migo et al.,
2015).
Patients with incontinence as one of the geriatric symptoms are at risks of falling due
to the effect of their impairment on multiple organ systems. The associations of the
impairments are mostly related to visual and audio impairments as well as anxiety, depression
and lower limb impairment (Pahwa et al., 2016). This also increases their risks of falling
further, due to which it is important to assess their health condition as well as the risks of
falling.
Issues with feet and footwear can increase the risks of falling among older people.
Health issues like diabetic foot ulcers can be caused due to the degeneration of neurons of the
lower extremities like feet due to diabetes, which reduced the sensations of the foot,

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increasing the risks of falling, and injury to the foot. Patients with diabetes therefore should
be checked for foot ulceration and the quality of footwear they use for identifying any risks of
falling (Al-Rubeaan et al., 2015).
Patients who are at the risks of syncope /fainting are also at high risks of falling. The
risks are because of a reduced blood flow to the brain which results in blackouts. Sudden
fainting therefore can highly increase the risks of falling among the patients (de Vries et al.,
2018). It is therefore important to analyse patients at risks of syncope, and recommend
treatment to prevent accidental blackouts.
Patients with Dizziness and vertigo also can face problems with balance and
maintenance of posture. This can increase their risks of falling and accidental injury
(Matarese et al., 2015). Treatment of the symptoms of dizziness and vertigo therefore is very
crucial for the prevention and reduction of harm from falling among such patients.
Medication issues can also lead to musculo-motor impairments and lead to symptoms
like dizziness, vertigo and reductions in motor shills which can increase their risks of falling
(de Vries et al., 2018). Patients with physical disabilities like visual impairments can also
have higher risks of falling due to the inability to identify environmental risks of falling, and
tripping hazards.
Preventative Strategies that can be used in the scenarios above:
The first strategy for high risk individuals is a thorough assessment of the risks of
falling among the individuals through understanding their physical conditions and ailments
and how they affect their risks of falling. A significant strategy for the prevention of the risk
of falling includes understanding of any environmental risks that can increase tripping and
falling hazards in the aged care centre and then eliminating them. Another strategy is for the

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improvement of the motor coordination and musculoskeletal skills among the patients
(Goodwin et al., 2014).
The sense of balance as well as musculoskeletal and motor coordination can be
improved through various physical exercise routines that are aimed to improve the sense of
balance among the elderly residents. For example, specialised aerobics programs, tai-chi
training, yoga therapy, gardening, outdoor walks, and games can be utilised in the care setup
for the various residents to help them gain their sense of balance and thereby reducing the
risks of falling (Canning et al., 2015; Schoene et al., 2017; Wayne et al., 2015). Studies have
shown that routines like yoga therapy, tai-chi and physical exercise can help to improve the
motor coordination of the residents, and reduce their risks of falling (Altenburger et al., 2016;
Saravanakumar et al., 2014). Routines like yoga therapy and tai-chi also can help the
residents to improve the posture of the patients, as well as help them to practice breathing
Saravanakumar et al., 2014).
The advantage of using interventions like exercise, tai-chi and yoga is that it can help
the patients to develop their motor skills and reduce their risks of falling and it can also have
a therapeutic effect on the mental and emotional well being of the patients (Canning et al.,
2015; Schoene et al., 2017; Wayne et al., 2015). However a major disadvantage is that such
interventions cannot be utilised equally for every residents. Being involved in physical
activities can be challenging for many patients with physical disabilities or advanced stages
of musculoskeletal, neuromuscular, cognitive and motor skill deficits, due to which they
might experience challenges in following the instructions of the trainers (Benjamin et al.,
2014). In such scenarios, it is important to tailor the interventions based on the specific
condition each resident is suffering from, and utilising strategies best fit for such scenarios. It
can be helpful to categorise the patients based on the levels and types of physical activity that

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the patients can be engaged in, keeping into consideration any physical symptoms and
disabilities of the patients.
Activities like gardening or taking a stroll can also help residents with limited
mobility to improve their sense of balance and also instil in them confidence of moving
independently (Nelson et al., 2017). This is a significant strategy for patients who cannot be
involved in other physical exercises, but have the potential to take part in them after some
recovery.
In the aged care centre, long term program can be included which incorporates the
strategies above, encouraging voluntary participation of residents as well as through referrals
from nurses, general physicians and care workers in the intervention and rehabilitation
programs to regain their balance. The patients can be systematically trained to be able to take
care of themselves through self care strategies, and also foster independence among them. AT
the same time, regular monitoring of the preventative strategies can help the providers to
assess the utilization of the intervention, their effectiveness in reducing the risks of falling
and also help the healthcare professionals to identify potential areas of development of
consideration that should be addressed (Bentley et al., 2015).
Recommendation on an implementation strategy
Gschwind et al. (2013) discussed the best practices for fall prevention exercise
programs that can be used to impro0ve balance, strength, power and psychosocial health
among the elderly residents. The study focuses on managing the effects of sarcopenia or
neuromuscular deficit, which increases the risks of falling. The recommended preventative
strategy can follow the key testing and assessment protocols like static and dynamic steady
state balance (using Sharpened Romberg Test and instrumented gait analysis), proactive
balance assessment (using Functional Reach Test and Timed Up and Go Test), reactive

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balance assessment ( using perturbation test during bipedal stance and Push and Release
Test), strength assessment ( using hand grip strength test and Chair Stand Test) (Gras et al.,
2017; Schülein et al., 2017)). Also, the body composition of the residents can be analyzed by
bioelectrical impedance analysis systems. This can help to identify patients with frail and
poor body mass composition which can adversely affect their ability to be involved in
physical activities. Quationnai9res can also be used in order to assess the psychosocial state
of the patients. Questionnaires such as World Health Organisation Quality of Life
Assessment-Brief can be utilized for the psychosocial assessment. Cognitive performance can
be examined through mini mental scale exam, which can help to identify symptoms of
cognitive deficits of the patients (Kaur et al., 2016; Paul et al., 2014). Fall efficacy scale can
be used to assess the determinants that can increase the risks of falling among the patients.
The residents after their assessment can participate in intervention groups, where balance,
power and strength training programs can be conducted for 12 weeks, done 3 times every
week for an average time of 30 minutes. The residents will also be frequently monitored to
assess any change in their gait, posture, balance and well as their power and strength
(Gschwind et al., 2013;
Key steps of evaluation of the policy after implementation
After the implementation of the policies for the prevention and reduction of risks of
harm from falling, it is necessary to put in place effective evaluation, monitoring, reporting
and investigative strategies. This can help to show the effectiveness of the preventative
strategies in the reduction of risks of falling among elderly patients in the care facility. The
strategies are outlined following the Standard 10 protocol (safetyandquality.gov.au, 2018).
These evaluation strategies include:

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 Implementing and reviewing incident management systems in order to collect data
related to incidents of falling, adverse events and also near misses
 Preparing reports on incidents of falls to allow monitoring and assess the safety of the
patients and help to develop quality improvement initiatives
 Identification and adoption of dataset from clinical and administrative sources in
order to determine the frequency as well as severity of falls
o Using reporting template, documentation process for highlighting the data
o Using Audit reports for the assessment of frequency and severity of falls
o Using regular reporting systems to identify trends in the fall related incidents
 Using a strong organisation wide reporting system and investigate change
management to address incidents of falls
o Using documentation from meetings and committees on falls and harm from
falls
o Using annual reports which contains incidents of fall data
o Using trend reports for showing the preventative changes and actions taken in
the organisation
o Reports on clinical performance shared with the governance group
o Using medication review
o Using registry of environmental and equipment hazards related to falls
o Clinical records of the patients audited to understand continued management
of environmental risk factors for individuals
o Providing evaluation results to clinical staff
 Ensuring quality improvement activities
o Using safety and quality indicators and data report

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o Using risk registers or logs which also contains activates that can address the
risks of falling
o Preparing organizational agendas, meetings or reports that show improvement
through the strategies implemented
o Including quality improvement plans, their implementation and evaluation
strategies
o Using brochures, fact sheets and posters for the workforce as residents
 For evaluation of falls prevention program:
o Evaluation of previous device and equipments and their effectiveness
o Outlining the types of support devices needed in the care facility and options
for accessing these equipments
o Reviews of fall incident reports to identify the role of the equipment in the
incident
o Preparing inventory of equipment and auditing its clinical use
o Maintaining register log for use of devices and equipments
o Implementing systems for review and procurement of devices and equipments
o Patient environment reviews (like safety assessment and hazard removal)
 Using best practice tools for screening of patients upon presentation as well as
admission when indicated at risk for falls
o Pre admission screening tools
o Audit of patients records
o Observational audit of the screening process
o Risk register and logs that contains actions to address the risks of falling
o Evaluating patient safety and quality of care improvement plans

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 Ensuring comprehensive risk assessment
o Using policies, procedures and protocols to0 describe how risks due to falls
can be assessed
o Ensuring training and education process for the staff as well as the residents
are oriented towards the reduction of falls
o Recording the outcomes of the falls assessment for reviews
o Providing the reports to relevant committees informing on the number of
patients screened for risk of falling, and have undergone assessment for fall
risk factors
(safetyandquality.gov.au, 2018).

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References:
Al-Rubeaan, K., Al Derwish, M., Ouizi, S., Youssef, A. M., Subhani, S. N., Ibrahim, H. M.,
& Alamri, B. N. (2015). Diabetic foot complications and their risk factors from a
large retrospective cohort study. PloS one, 10(5), e0124446.
Altenburger, P. A., Schmid, A. A., Puymbroeck, V. M., & Miller, K. K. (2016). Impact of
Yoga on Postural Stability in Stroke. Int J Neurorehabilitation, 3(195), 2376-0281.
Amar, K., Stack, E., Fitton, C., Ashburn, A., & Roberts, H. C. (2015). Fall frequency,
predicting falls and participating in falls research: similarities among people with
Parkinson's disease with and without cognitive impairment. Parkinsonism & related
disorders, 21(1), 55-60.
Benjamin, K., Edwards, N., Ploeg, J., & Legault, F. (2014). Barriers to physical activity and
restorative care for residents in long-term care: a review of the literature. Journal of
aging and physical activity, 22(1), 154-165
Bentley, M., Minstrell, M., Bucher, H., Sproule, L., Robinson, A., & Stirling, C. (2015).
Aged care nurse practitioners working in general practice. Journal of clinical
nursing, 24(23-24), 3745-3747.
Bunn, F., Dickinson, A., Simpson, C., Narayanan, V., Humphrey, D., Griffiths, C., ... &
Victor, C. (2014). Preventing falls among older people with mental health problems: a
systematic review. BMC nursing, 13(1), 4.
Caetano, M. J. D., Lord, S. R., Allen, N. E., Brodie, M. A., Song, J., Paul, S. S., ... & Menant,
J. C. (2018). Stepping reaction time and gait adaptability are significantly impaired in
people with Parkinson's disease: Implications for fall risk. Parkinsonism & related
disorders, 47, 32-38.

16Ageing health and human services
Canning, C. G., Sherrington, C., Lord, S. R., Close, J. C., Heritier, S., Heller, G. Z., ... &
O'Rourke, S. D. (2015). Exercise for falls prevention in Parkinson disease A
randomized controlled trial. Neurology, 84(3), 304-312.
caresearch.com.au. (2018). Stakeholder Assessment. Caresearch.com.au. Retrieved 6 April
2018, from
https://www.caresearch.com.au/Caresearch/Portals/0/Documents/WhatisPalliativeCar
e/Other%20National/Cebparac/cebparac-Appendix5_StakeholderAssessment.pdf
Cec.health.nsw.gov.au. (2018). Clinical Excellence Commission - Residential Aged
Care. Cec.health.nsw.gov.au. Retrieved 6 April 2018, from
http://www.cec.health.nsw.gov.au/patient-safety-programs/adult-patient-safety/falls-
prevention/residential-aged-care
de Vries, M., Seppala, L. J., Daams, J. G., van de Glind, E. M., Masud, T., van der Velde, N.,
... & van der Cammen, T. (2018). Fall-Risk-Increasing Drugs: A Systematic Review
and Meta-Analysis: I. Cardiovascular Drugs. Journal of the American Medical
Directors Association.
DefinedTerm: Stakeholders (in aged care). (2018). Defined Term. Retrieved 6 April 2018,
from https://definedterm.com/a/definition/153809
Falls prevention :: SA Health. (2018). Sahealth.sa.gov.au. Retrieved 6 April 2018, from
http://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/
clinical+resources/cli
Falls Prevention in Older Age. (2018). World Health Organization. Retrieved 6 April 2018,
from http://www.who.int/ageing/projects/falls_prevention_older_age/en/

17Ageing health and human services
Falls prevention. (2018). Health.nsw.gov.au. Retrieved 6 April 2018, from
http://www.health.nsw.gov.au/falls/Pages/default.aspx
Goodwin, V. A., Abbott, R. A., Whear, R., Bethel, A., Ukoumunne, O. C., Thompson-Coon,
J., & Stein, K. (2014). Multiple component interventions for preventing falls and fall-
related injuries among older people: systematic review and meta-analysis. BMC
geriatrics, 14(1), 15.
Gras, L. Z., Pohl, P. S., Epidy, J., Godin, B., & Hoessle, N. (2017). Use of the Sharpened
Romberg as a Screening for Fall Risk: A Pilot Study. Topics in Geriatric
Rehabilitation, 33(2), 113-117.
Gschwind, Y., Kressig, R., Lacroix, A., Muehlbauer, T., Pfenninger, B., & Granacher, U.
(2013). A best practice fall prevention exercise program to improve balance, strength /
power, and psychosocial health in older adults: study protocol for a randomized
controlled trial. BMC Geriatrics, 13(1). http://dx.doi.org/10.1186/1471-2318-13-105
Huber, D. (2017). Leadership and Nursing Care Management-E-Book. Elsevier Health
Sciences.
Jebelli, H., Ahn, C. R., & Stentz, T. L. (2016). Fall risk analysis of construction workers
using inertial measurement units: Validating the usefulness of the postural stability
metrics in construction. Safety science, 84, 161-170.
Kaur, G., Kaur, D., & Verma, P. (2016). Elderly Women's Quality of Life in A Conflict
Border Area of India. International Journal of Advanced Research in Management
and Social Sciences, 5(1), 149-156.

18Ageing health and human services
Matarese, M., Ivziku, D., Bartolozzi, F., Piredda, M., & De Marinis, M. G. (2015).
Systematic review of fall risk screening tools for older patients in acute
hospitals. Journal of advanced nursing, 71(6), 1198-1209.
Merryweather, A., Hunt, M., Smith, L., Foreman, B., & Minor, M. (2015, August). Gait
alterations on irregular terrain in older adults with and without Parkinson disease: Fall
risk implications. In Proc. 19th Triennial Congr. IEA (p. 14).
Meyer, I. S., Louw, A., & Ernstzen, D. (2017). Physiotherapy students’ perceptions of the
dual role of the clinical educator as mentor and assessor: Influence on the teaching–
learning relationship. South African Journal of Physiotherapy, 73(1), 1-8.
Migo, E. M., Haynes, B. I., Harris, L., Friedner, K., Humphreys, K., & Kopelman, M. D.
(2015). mHealth and memory aids: levels of smartphone ownership in
patients. Journal of Mental Health, 24(5), 266-270.
Myers, D. R., Rogers, R., LeCrone, H. H., Kelley, K., & Scott, J. H. (2016). Work life stress
and career resilience of licensed nursing facility administrators. Journal of Applied
Gerontology, 0733464816665207.
Nelson, K., Tomyn, A., Hampton, I., & McCabe, M. (2017). How can we improve quality of
life for aged care residents?. Australian Ageing Agenda, (Nov/Dec 2017), 20.
Pahwa, A. K., Andy, U. U., Newman, D. K., Stambakio, H., Schmitz, K. H., & Arya, L. A.
(2016). Noctural enuresis as a risk factor for falls in older community dwelling
women with urinary incontinence. The Journal of urology, 195(5), 1512-1516.
Paul, S. S., Sherrington, C., Canning, C. G., Fung, V. S., Close, J. C., & Lord, S. R. (2014).
The relative contribution of physical and cognitive fall risk factors in people with

19Ageing health and human services
Parkinson’s disease: a large prospective cohort study. Neurorehabilitation and neural
repair, 28(3), 282-290.
Poulton, E., Barnes, L., & Clarke, F. (2017). Disclosure and Reporting of Governance
Practices by Australian Residential Aged Care Providers: Accountability to
Stakeholders.
Puri, N., & Spevetz, A. (2018). QUALITY ASSURANCE AND PATIENT SAFETY IN
THE INTENSIVE CARE UNIT. Critical Care Secrets E-Book, 71.
safetyandquality.gov.au. (2018). Standard 10-Preventing Falls and Harm from Falls- Safety
and Quality improvement guide. Safetyandquality.gov.au. Retrieved 6 April 2018,
from
https://www.safetyandquality.gov.au/wp-content/uploads/2012/10/Standard10_Oct_2
012_WEB.pdf
sahealth.sa.gov.au. (2018). Sahealth.sa.gov.au. Retrieved 6 April 2018, from
http://www.sahealth.sa.gov.au/wps/wcm/connect/dbb7840047d3aef8a1d6a5fc651ee2
b2/2018+Falls+Month+STATE+STAFF+Infographic.pdf?
MOD=AJPERES&CACHEID=ROOTWORKSPACE-
dbb7840047d3aef8a1d6a5fc651ee2b2-m9gfocW
Saravanakumar, P., Johanna Higgins, I., Jane van der Riet, P., Marquez, J., & Sibbritt, D.
(2014). The influence of tai chi and yoga on balance and falls in a residential care
setting: a randomised controlled trial. Contemporary nurse, 48(1), 76-87.
Schoene, D., Kiesswetter, E., & Lord, S. R. (2017). Comment on Tai Chi for Risk of Falls. A
meta‐analysis. Journal of the American Geriatrics Society, 65(12), 2746-2748.

20Ageing health and human services
Schülein, S., Barth, J., Rampp, A., Rupprecht, R., Eskofier, B. M., Winkler, J., ... & Klucken,
J. (2017). Instrumented gait analysis: a measure of gait improvement by a wheeled
walker in hospitalized geriatric patients. Journal of neuroengineering and
rehabilitation, 14(1), 18.
Wayne, P. M., Hausdorff, J. M., Lough, M., Gow, B. J., Lipsitz, L., Novak, V., ... & Manor,
B. (2015). Tai chi training may reduce dual task gait variability, a potential mediator
of fall risk, in healthy older adults: cross-sectional and randomized trial
studies. Frontiers in human neuroscience, 9, 332.