Falls Prevention Among Elderly Individuals: PHAA Policy and Strategies

This report focuses on falls prevention among elderly individuals, examining the Public Health Association of Australia (PHAA) policy and related strategies. It begins by defining falls and highlighting the associated risks and statistics, including those from the World Health Organization (WHO). The report then delves into the PHAA's policy, outlining its principles, recommendations, and actions to reduce fall-related injuries. Key areas covered include prevention strategies in various settings (hospitals, residential, and home/community), implementation plans, and evaluation methods. The document emphasizes the importance of a coordinated national response, evidence-based approaches, and collaborative efforts across healthcare disciplines to address the growing challenges of an aging population and the associated costs of falls. The report also suggests updates to the PHAA guidelines for more effective implementation of fall prevention strategies.

Running head: Falls Prevention Among Elderly Individuals
Falls prevention among elderly individuals
Name of the Student
Name of the University
Author Note

1Falls Prevention among elderly individuals
Contents
Background:...............................................................................................................................5
PHAA: Fall Injury Prevention in Older People Policy..........................................................7
Policy Statement:.......................................................................................................................7
PHAA Principles:.......................................................................................................................8
PHAA Recommendations for Strategies:...................................................................................9
PHAA recommendations for Actions:.....................................................................................11
Recommended Updates:...........................................................................................................12
In A Hospital Setting:...........................................................................................................13
Prevention Strategies:.......................................................................................................13
Education Strategies:........................................................................................................14
Intervention Strategies:....................................................................................................14
Residential Settings:.............................................................................................................15
Education Strategies:........................................................................................................15
Intervention Strategies:....................................................................................................16
Home and Community Setting:............................................................................................16
Prevention strategy:..........................................................................................................16
Education Strategy:..........................................................................................................17
Intervention Strategies:....................................................................................................17
Interface Settings:.............................................................................................................17
Implementation Plan:...........................................................................................................17

2Falls Prevention among elderly individuals
Evaluation and Monitoring Strategies:.................................................................................18
Documentation:....................................................................................................................18
References:...............................................................................................................................20

3Falls Prevention among elderly individuals
NAME OF DOCUMENT Fall Injury Prevention in Older People Policy
TYPE OF DOCUMENT Policy
DOCUMENT NUMBER NA
DATE OF PUBLICATION 1991
RISK RATING High
REVIEW DATE
Documents are to be reviewed a
maximum of three years from date of
issue
2015
FORMER REFERENCE(S)
Documents that are replaced by this one
NA
EXECUTIVE SPONSOR or
EXECUTIVE CLINICAL
SPONSOR
Public Health Association of Australia
AUTHOR Richard Franklin & Lyndal Bugeja, Co-Convenors,

4Falls Prevention among elderly individuals
Position responsible for the document
including email address
Injury Prevention SIG –
[e-mail];
[e-mail]
KEY TERMS Falls, prevention, fall injury, elderly patients, fall
risk, policy
SUMMARY
Brief summary of the contents of the
document
The policy outlines the objectives and goals of the
Public Health Association of Australia in the
prevention of injury related to falls for elderly people
in Australia. The document provides various
strategies which can be used to reduced, minimized
or prevented the risk of falls among the target
population, supporting the strategies from evidences
from research. The document also outlines the
guidelines set by Australian Commission on Safety
and Quality in Health Care (ACSQHC) Falls Best
Practice Guidelines (2009). Based on these
supporting evidences, the document outlines the
steps and actions that can be used to reduce or
prevent the risks due to falling among the elderly
people.
The document follows the best policy guidelines of
ACSQHC
https://www.safetyandquality.gov.au/wp-content/

5Falls Prevention among elderly individuals
uploads/2012/01/Guidelines-COMM.pdf
Background:
A fall can be understood as an incident which causes an individual coming at rest
accidentally on the ground, floor or a lower level, according to the definition by the World
Health Organization (WHO). The WHO statistics shows that every year 646,000 people die
due to injuries caused by falling. Adults who are 65 years or older are at the highest risk of
falling, and receiving a fatal injury due to it. Moreover, every year there are 37.3 million
incidents of falls, which require medical attention. The WHO recommends that preventative
strategies should focus on education, training and developing safe environments as well as on
studies on fall and fall prevention and devise effective policies to alleviate the risk of falling
(who.int 2018). The risks of falling also increases with age, which is supported by the
Canadian Community Health Survey in Canada on people above 65 years of age. The
statistics (published by WHO) shows that the risk for fall related injuries increased
progressively among the age groups 65-69 (35 cases), 70-74 (46 cases), 75-79 (66 cases) and
above 80 (76 cases). The statistics also showed comparatively higher risks of injuries related
to falls among women, compared to men (who.int, 2018).

6Falls Prevention among elderly individuals
Figure 1 Statistics on falls related injury rate: source (who.int 2018)
The statistics also analysed the location of these falls, showing the most of the falls
occur outside home (56%), while the next most significant location is on level surfaces
(26%), and indoor locations include shower or bath (6%), stairs (6%), getting out of bed (3%)
and chairs or ladders (3%).
Figure 2: Locations of injury due to falls. source (who.int 2018)

7Falls Prevention among elderly individuals
PHAA: Fall Injury Prevention in Older People Policy
According to the Public Health Association of Australia, there is an increasing trend
in the ageing population in Australia. According to their estimates the percentage of
population aged 65years and above will reach 19% by 2031 (from 15% as of 2014), with
even a greater increase in the population aged 85 years and above. The risk factors that
increases the chances of falling and injuries related falling have been identified as: age,
gender, balance and gait, strength, vision, vertigo/dizziness, heart diseases, dementia,
depression and even due to medications, wrong footwear and the environment at home.
PHAA also points out that the risk of falling increases with age (more than 1 in three people
of age 65 or older, in community dwelling setup fall every year and between 2010 and 2011,
more than 92,150 cases of injuries related to falls have been recorded, which needed
hospitalisation. The annual costs incurred due to such injuries amounts to about 600 million
dollars (towards hospital expenses). Also, with the improvement in the life expectancies
among Indigenous Australians (aboriginals and Torres Strait islanders), it is important to
focus on reducing the risks of fall related injuries in the population aged 45 years and older
(workingwitholderpeople.edu.au 2018; phaa.net.au 2018).
Policy Statement:
The policy suggests that risks of falling as well as the injuries caused by them can be
reduced or even prevented through exercise routines that improves balance and strengthens
muscles. Activities such as high level balance exercise in group or home setup can be useful
to achieve that objective. The policy also outlines few other strategies that can be useful to
reduce the risk of falling and injuries due to it:
 Applying occupational therapy interventions for populations at high risk of falling
 A speedier surgery for cataract removal

8Falls Prevention among elderly individuals
 Withdrawing the administration of psychoactive medicines
 Assessment of cardiovascular ailments
 Involving a multidisciplinary and intensive assessment for populations at high risk
 Comprehensive geriatric assessment in residential care setup
 Targeted hospital based intervention and education of patients and their care givers.
 Using hip protection for population at high risks (in home care setup)
 In home assessment and modifications to home environment (to reduce fall risks and
environmental hazards) for people at high risk of falling
(workingwitholderpeople.edu.au 2018; safetyandquality.gov.au 2018)
PHAA Principles:
The PHAA outlines the following principles on which preventative strategies can be
developed:
 An exponential rise in the incidence and expenses related to fall related injuries are
likely to occur in absence of a nationally coordinated response, especially due to the
‘baby-boomer’ generation reaching the retirement age. Since the injuries related to
falls result in prolonged hospital stays, it results in a high financial burden.
Estimations from 2003 showed that without proper interventions and preventative
strategies, the healthcare expenses related to fall related injuries can increase by 3
times to reach about 1375 million dollars and 1.17 million bed days each year. Also,
the rate of hospital falls also increased by 1.8% from 1999 to 2009, which shows that
without proper preventative measures, the rate is likely to increase further.
 Risk of falling also is increased due to a fear of further falling by people to suffered
falls earlier, which reduces their confidence towards movement, which further affects
their socialization process. Older people who had been hospitalized before due to fall

9Falls Prevention among elderly individuals
related injuries have increased challenges towards independent living, due to which
residential care might be needed for such individuals.
 Even though there is a decreasing trend in the hospitalization rates for hip fractures, it
still remains one of the most significant injuries related to falls (17,000 cases each
year). The burden is also significant in the context of mortality, morbidity, costs of
care and hospitalisation as well as the loss of independent living ability.
 Injuries related to fall is both preventable as is predictable. Also, it is of a high priority
to reduce the risks of falling among the older people for health promotion initiatives at
national and local (state and territory) levels. Effective strategies need actions which
spans a variety of healthcare setups as well as community based and population
specific strategies.
 Even with an increasing base of evidence for strategies on fall prevention, more
investigation is still required in older to develop more effective strategies for older
population suffering from cognitive decline and impairment, to understand the
function of physical activity, supporting individuals in residential care setup and for
individuals from whom English is a second language as well as individuals living in
remote places. Also, prescribing vitamin D can also help to reduce the risks of falling
among residents in care setups.
 Additional studies are also needed to understand the efficacy of fall prevention
strategies among the indigenous populations, with focus on the cultural and social
differences and community orientations among the Torres Strait islander and
aboriginal communities in Australia.
PHAA Recommendations for Strategies:
The PHAA recommends the following steps which can be undertaken to prevent and
minimize the risks due to falls, such as:

10Falls Prevention among elderly individuals
1. Developing a nationwide approach to use ACSQHC falls best policy guidelines in
order to provide the following advantages to the prevention of fall and fall related
injuries among the older population:
o In a community setup, promotion of the health and wellbeing, removing the
fear of falling, improving independence and maintaining the community
involvement in care.
o For healthcare services, a safer healthcare delivery, improving healthcare
savings, increasing productivity and reducing aged care and acute service
demands
2. Funding the AIHW National Injury Surveillance Unit (NISU) to partake in studies to
understand factors related to fall related injuries among older populations
3. Improving the participation and partnerships in order to develop collaborative efforts
that spans across different disciplines of healthcare as well as other disciplines and
involves communities in order to reduce the risks of falling and fall related injuries
among older people.
4. Using evidence base approaches to develop effective strategies that can be used to
reduce the risks and also support healthy active living and ageing process and create a
low risk population.
5. Understanding the local government’s role in the development and maintenance of
safety in the environment, and implementing physical activity routines for older
adults, as well as improving accessibility towards those services.
6. Promoting the development of best practice guidelines as well as collaborative
strategies to design frameworks that can eliminate the hazards of falling, which can be
utilized by architects and designers to understand the needs of elderly people, which
can then be used in the design, development and building of buildings and other civil

11Falls Prevention among elderly individuals
structures or architectures or to upgrade them. This can also help to create an
environment that fosters physical activity among the target group and also improve
the sense of security to partake in both planned and unplanned activities.
PHAA recommendations for Actions:
The PHAA outlines the following actions which has been resolved to reduce and
prevent the risks of falling and fall related Injuries. These actions can be applied by the board
and branches of healthcare organizations supported by advice from Injury Prevention Special
Interest Group, and include the following actions:
1. Supporting strategies to prevent injuries due to falling as a national health priority, which
aims to reduce the risks of falling, reduce injuries related to falling and its adverse effects
on elderly people using updated policy information which includes a strategy for policy
implementation.
2. Developing lobbies to increase funding in order to support health interventions, capacity
development to improve access to interventions based on evidences on fall prevention.
3. Supporting a systematic and multifaceted method of investment which can be used to
reduce the injuries related to falls, using evidence based strategies in order to foster
independent living for elderly people and also reduce future expenses and demands for
healthcare services.
4. Supporting strategies that foster collaboration between educators, researchers and policy
makers in order to develop research based on available evidence and the unmet needs,
and also to translate evidences based of literature into professional practice and to prevent
or reduce the risk of fall and fall related injury
5. Developing lobbies for resourcing in order to implement and fund the guidelines.
Recommended Updates:

12Falls Prevention among elderly individuals
Certain changes to the PHAA guidelines can also be suggested, which can help in the
implementation of the strategies to reduce the risks of falling and fall related injuries among
elderly people.
The Falls Policy for Older Western Australians outlines several important aspects in
the fall prevention strategy, such as the risk factors (intrinsic and extrinsic) which increases
the risks of falling and factors which increases the costs of care due to injuries related to falls
(Hendrie et al., 2004; health.wa.gov.au 2018). The policy outlines their objectives as:
 Focus on the quality of life and independence for individuals 65 years and
older
 Set up principles based on best practices to be adopted by hospitals, residential
care facilities and also in home or community care setup
 Design methods to develop awareness of falls and improve intervention
strategies
 Reduce duplication by improved coordination of services
 Improving networks and partnerships between the stakeholders
 Strengthen and support collaboration between the healthcare partnerships and
networks
The policy is moreover based upon 4 key principles, which can be implemented in the
recommended policy updates to the PHAA strategies. These principles include:
 Promoting independence among the selected population, helping them to achieve
positive and healthy living as much as possible so that they are able to continue
residing in the community
 Preventing risks and reducing the risks of falling
 Education and interventions to reduce risks of falling and injuries caused due to it

13Falls Prevention among elderly individuals
 Ensure continuous improvement in the provision of services across the various target
healthcare setups.
(Hendrie et al., 2004; health.wa.gov.au 2018)
The policy outlines the following target settings which can be focused on in the
implementation strategies such as: hospitals, residential care, home and community based
care, and the various interfaces with the hospital and health services. These interfaces have
been identified as: primary care, emergency department, falls clinics, day hospitals and
outpatient clinics. The strategies on fall prevention and risk mitigation can be implemented in
these settings.
The Falls Policy for Older Western Australians differentiates the strategies addressing the
risks of falling and fall related injuries into three categories: Prevention Strategies, Education
Strategies and Intervention Strategies, which can be incorporated into the PHAA guidelines:
In A Hospital Setting:
Prevention Strategies:
 Multidisciplinary and multifactorial approach:
o Increasing awareness of the staff, patients and their caregivers about risk
factors of falling and fall related injuries
o Individual assessments of fall risk which can include neurological, visual and
cardiovascular assessments
o Developing and implementing clinical pathways and plans for the prevention
of falls
o Review of the environment, medications and footwear
o Involving exercise routines for the target population to improve balance,
strength and mobility

14Falls Prevention among elderly individuals
o Management of continence
o Review and management of the patient’s dietary status and diagnosis of
osteoporosis
o Supporting and facilitating the use of hip protection for high risk individuals
 Protocols for referrals to other services for prevention strategies already in progress:
Education Strategies:
 Self training and education
 Education of patient/caregiver and family
 Posters and information packages
Intervention Strategies:
 Multidisciplinary, multifactor individual strategies of interventions:
o Developing and implementing intervention plan and clinical pathways
o Reducing the individual risk factors for falling
o Review of environment, medication and footwear
o Exercise routines that are tailored to meet individual needs to improve
balance, strength and mobility
o Continence management
o Review of diet and risks of osteoporosis
o Supporting the use of hip protection
 Coordinating discharge plans
 Protocols for referrals and transfers for continued intervention approaches
Residential Settings:
Prevention Strategies:

15Falls Prevention among elderly individuals
 Multidisciplinary and multifactor approach:
o Increasing awareness of the staff, residents as well as their families towards
the risk factors
o Risk assessments done individually including review of visual and
cardiovascular status
o Developing and implementing fall prevention plan and clinical pathways
o Review and modification of the environment, footwear and medications
o Exercise routines to develop strength, balance and mobility
o Continence management
o Review of diet status and signs of osteoporosis
o Ensuring minimal usage of restraints
o Supporting and fostering the usage of hip protection in high risk individuals
 Referral and transfer protocols to other services for ongoing strategies
Education Strategies:
 Education and training of staff
 Education of residents, their families or caregivers
 Posters and information packages
 Increasing awareness of the communities towards fall prevention strategies and
intervention services available
Intervention Strategies:
 Multifactor approach for intervention and assessments
o Develop and implement intervention strategies and clinical pathways
o Reducing individual risks for falling
o Review and modification of medication, environment and footwear

16Falls Prevention among elderly individuals
o Exercise routines tailored to individual needs to improve balance, strength and
mobility
o Continence management
o Review of dietary status and signs of osteoporosis
o Minimal restraint use
o Supporting the use of hip protection
 Referral and transfer protocols to other services to support ongoing strategies of
intervention
Home and Community Setting:
Prevention strategy:
 Encourage and support to healthy lifestyle choices and improving attendance of
exercise programs for elderly people
 Improving the awareness of the clients to the risk factors, which can include:
o Medication, environment and footwear
o Visual reviews and modifications
o Continence management
o Review of dietary status and signs of osteoporosis
o Assessment of deteriorating health
 Client review done regularly with primary care provider, and include cardiovascular
and visual review
Education Strategy:
 Education of the client, family and caregiver
 Review of brochures and posters of information on falls prevention strategies

17Falls Prevention among elderly individuals
 Developing community awareness on fall prevention strategy and intervention
services.
Intervention Strategies:
 Multifactor approach:
o Reducing individual risk factors
o Review and modification of medication, environment and footwear
o Exercise routines tailored to individual needs to improve balance, strength and
mobility
o Continence management
o Review and management of diet and signs of osteoporosis
o Support the use of hip protection
 Reviews done with primary care providers regularly and involve cardiovascular and
visual reviews.
Interface Settings:
For interface settings, the same strategies for prevention, education and intervention
can be utilized, as outlined above.
Implementation Plan:
Setting Implementation Plan
Hospital Developing fall risk assessment tool
Developing fall care pathway
Developing education package
Deliver education
Interface and
Community
Adding falls identification tag to EDIS
database
Automatic sharing of falls information to GP
RMO education and referrals to fall clinics
Fallscreen analysis
Community Fallscreen analysis

18Falls Prevention among elderly individuals
Implementation of education
Residential Care incident reporting systems developed
Evaluation and Monitoring Strategies:
The ACHS standards can be utilized for the evaluation and quality improvement
strategies. The standards evaluate the outcomes based on 5 groups: LA- Little Achievement,
SA- Some Achievement, MA- Moderate Achievement, WA- Extensive Achievement and
OA- Outstanding achievement (fallsnetwork.neura.edu.au 2018).
The Falls Policy for Older Western Australians also identifies The Statewide Falls
Policy Group Executive Committee in the evaluation and monitoring of clinical practices
annually utilizing formative, impacts and outcomes as well as economic analysis in
collaboration with Injury Research Centre. This can also be implemented for the suggested
methods for monitoring the performance of the preventative strategies.
Documentation:
1. ACSQHC falls best policy guidelines
2. AIHW National Injury Surveillance Unit reports
3. Clinical pathways and plans for the prevention of falls
4. Review of diet
5. Review of signs of osteoporosis
6. Risk assessment tool
7. Education package
8. Fall identification tag added to EDIS database
9. Fallscreen analysis

19Falls Prevention among elderly individuals
References:
Hendrie, D., Hall, S.E., Arena, G. and Legge, M., 2004. Health system costs of falls of older
adults in Western Australia. Australian Health Review, 28(3), pp.363-373.
who.int., 2018. A Global Report on Falls Prevention Epidemiology of Falls., retrieved on 17
May, 2018., from: http://www.who.int/ageing/projects/1.Epidemiology%20of%20falls%20in
%20older%20age.pdf
workingwitholderpeople.edu.au., 2018. Public Health Association of Australia: Policy-at-a-
glance – Fall Injury Prevention in Older People Policy., Retrieved on 17 May, 2018, from:
http://www.workingwitholderpeople.edu.au/documents/fall-injury-prevention.pdf
safetyandquality.gov.au., 2018. Preventing Falls and Harm From Falls in Older People,
retrieved on 17 May, 2018., from:
https://www.safetyandquality.gov.au/wp-content/uploads/2012/01/Guidelines-COMM.pdf
phaa.net.au., 2018. Public Health Association of Australia: Policy-at-a-glance – Fall Injury
Prevention in Older People Policy. Retrieved on 17 May, 2018, from:
https://www.phaa.net.au/documents/item/878
health.wa.gov.au., 2018. The Falls prevention policy for older western Australians. Retrieved
on 17 May, 2018 from:
http://www.health.wa.gov.au/publications/documents/Falls_policy_document.pdF
fallsnetwork.neura.edu.au., 2018. Falls Prevention in Older People: Falls Prevention in
Older People: Policy and Practice. Retrieved on 17 May, 2018, from:
http://fallsnetwork.neura.edu.au/wp-content/uploads/2014/02/afrm-lord2.pdf

20Falls Prevention among elderly individuals
who.int., 2018. Falls., retrieved on 17 May, 2018., from:
http://www.who.int/en/news-room/fact-sheets/detail/falls