Policy Analysis: Prevention of Falls and Harm in Older Adults - NSW

This report provides a comprehensive policy analysis of the "Falls - Prevention of Falls and Harm from Falls among Older People: 2011-2015" policy in NSW, Australia. It begins by demonstrating the policy's focus on screening, assessment, and management of fall risk factors among the elderly, partic...Read More

Running head: POLICY ANALYSIS
POLICY ANALYSIS
Name of the Student
Name of the university
Author’s note

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Table of Contents
Introduction......................................................................................................................................3
Demonstration of the policy........................................................................................................3
Reason for selecting the policy....................................................................................................5
Summary of the policy.................................................................................................................5
Policy analysis.................................................................................................................................6
Formulation of the problem.........................................................................................................6
Critical discussion and analysis.......................................................................................................9
Setting out of the objectives and the goals..................................................................................9
Identification of the decision parameters...................................................................................10
Resources...................................................................................................................................10
Alternatives................................................................................................................................11
Conclusion.....................................................................................................................................12
Recommendations..........................................................................................................................13
References......................................................................................................................................15

3POLICY ANALYSIS
Introduction
A fall can be defined as the unintentional and sudden, change in the position causing a
person to land in the lower level, on the ground or on an object, due to the sudden onset of
paralysis, epileptic seizure, or by an external force. Most of the falls has been found to be
occurring due to some predisposing and precipitating factor in the environment where the person
is living. It has been found that one half to two thirds of falls occur in the patient home. This
paper would demonstrate the policy of “Falls - Prevention of Falls and Harm from Falls among
Older People: 2011-2015”.Provide an in-depth knowledge regarding the rationale for choosing
this policy supported by literature and a succinct summary of the policy document. The report
would proceed by the formulation of the identified issue in the policy, the stakeholders involved,
setting out of the objectives and the goals followed by identification of the parameters like the
resources, timeframes and the priorities. The paper would end with a final recommendation for
covering the gaps of this policy.
Demonstration of the policy
The health policy involves the provision, screening, assessment and management of the
fall risk factors among the elderly person. It is presented to the NSW health services after an
incidence of fall, and notifies people at high risk of falls. Minimizing the risks of falls occurring
in the NSW health facilities require implementation of the best practice in the management of the
fall risks. NSW involves in up taking these programs, responding to information and the service
needs of the targeted population, identification of the opportunities for promoting the best
practice in the fall prevention within the external organizations and external providers of the

4POLICY ANALYSIS
aged health care. The action area of the policy is to provide, or arrange for the screening,
management and assessment of the risk factors among the older people coming to the NSW
health services after a fall (NSW government health policy statement, 2011). the initiatives taken
under this section mainly focuses on the dissemination of the best practice guidelines against fall
prevention across the community based services, the outpatient and the in-patient services, the
state government residential aged care services.
Another strategy related to this is the provision of education to the ambulance staffs about
the ACSQHC recommendation guidelines regarding the best practice for fall prevention. Other
strategies involved the issuing of a policy directives, adopting fall prevention initiatives such as
the NSW health and patient safety programs, LHDs for supporting the collection of data
regarding the fall prevention services provided (NSW government health policy statement,
2011). Developing standardized key fall prevention strategies for the aged care emergency teams
and the chronic care provider network. The second action area of the policy refers to the
minimization of the risks of falls within the NSW health care facilities. This can be done by the
adoption of proper risk assessment tools for the adult patients admitted to the acute care
facilities. Another initiatives includes seeking of advice from the fall prevention experts at the
time of the development of the guidelines. Other reason in this policy involves services for the
special group in the population. Identification of the opportunities for promoting best practice in
terms of fall prevention. An important point of this policy is that apart from the adoption of risk
assessment, this policy also supported the healthy, active ageing by continuing the support for
the healthy life styles and the effective management of chronic diseases.

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Reason for selecting the policy
Injuries due to fall are very common among the older people. It is the major cause of pain
and discomfort, loss of independence, disability, premature death. In Australia it has been found
that 1 in every 3 adults fall every year.
Older people are subjected to slips and falls. This is a serious problem with a potential
impact on the health and the health care costs (Moyer, 2012). In spite of the several measures
taken, the size and the procedure for the prevention of falls and subsequent mortality and
morbidity in the old age due to falls are still to be addressed. Incidence of the fall hip fractures
are “38.0, 135.8 and 501.9” per 100 person years among the males. Incidence of the fall hip
fractures are “67.3, 214.7 and 564.6” per 100 person years among the female age group 60-69,
70-79 and 80 + respectively. In each year approximately 27,000 people were admitted to the
hospital causing almost 400 deaths each year (NSW government health policy statement, 2011).
Furthermore the age standardized hospitalizations among the older people had been found to be
increasing for more than 10 years. The substantial health care cost for slips and the falls have
also been found to be increasing drastically. Prolonged hospital stays and rehabilitation has been
long and expensive and recent fall has been considered as one of the leading cause of premature
admission in the hospital.
Summary of the policy
Nine areas are defined in this policy (NSW government health policy statement, 2011):-
1. Provision of “screening, assessment and management” of the fall risk factors among the older
people.

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2. Minimizing the risk of falls and injuries in the NSW health care facilities, by the
implementation of the recommendations.
3. Implementing best practice in the management of falls.
4. Conduction of exercise regimen for the aged people.
5. Support healthy and active life style by adoption of proper nutrition regimen.
6. Provision of proper education to the patient and the carers for fall prevention.
7. Provision of services to special groups in need, such as the culturally and linguistically diverse
group, people having low income status or with disability.
8. Identification of opportunities for promoting best practices in fall prevention in the external
organization.
9. Dissemination of the research regarding the fall prevention strategies.
Policy analysis
Formulation of the problem
In spite of the policy take for mitigating the risks of fall among the older adults, gaps are
still left in the strategy taken. It has been proven by the studies that even after he implementation
of the policy, older people who have been discharged from the hospital settings are at risk of
functional decline, adverse events, infections, medication complications, unplanned readmission
to the hospitals, falls during the post discharged period (Chase et al., 2013). However the older
people in the community do not view the fall prevention strategy to be equally relevant that can
be explained by the low adherence by the older community older adults to the fall prevention

7POLICY ANALYSIS
strategies (NSW government health policy statement, 2011). Hence this can provide rationale to
the fact that the strategies taken for educating the patients about the fall prevention strategies
have not been successful.
The policy did not provide any information about the cost estimation regarding the
implementation of the initiatives (Moyer, 2012). Other program gaps in the fall prevention
strategies for the older adults involves the recommendations for the use of restraints in case of
the older adults. Fall prevention committees should be careful about the any long term and the
short term goals to transition any kind of restraint out of the structure of the community wall and
culture (Chase et al., 2013). Fall prevention strategies often overlook the importance of the
environmental factors throughout the living spaces of the residences. Uneven floors, rugs in the
bathrooms and crowded living rooms with big furniture and can lead to falls in the older adults
(Inouye et al., 2013). The policy did not emphasize on the environmental fall risk assessment
performed in the resident rooms or the living areas. Another limitation of this policy is that it did
not emphasize on the work force of the clinical settings. It has been found that the low workforce
in a clinical setting is directly proportional to the occurrence of the adverse events (Hempel et al.,
2014). The policy also did not provide a detailed explanation of any health monitoring
technologies such as provision of the sensors and monitors. It has been found that that discreetly
place data can be useful in providing information to the staff members regarding the unusual gait
changes, increased heart rate and increased early symptoms of illness that can lead to fall
(Cameron et al., 2012). One of the gap that has been identified is that the policy did not identify
any community based health groups that would assist in providing care to the fall prone elderly
in need (Hempel et al., 2014).. Social workers have to collaborate with the health care team in
identifying the people who are unable to approach any clinical settings and remoteness. It is

8POLICY ANALYSIS
evident from the policy that social marketing would be done for the dissemination of the
research. But how many of the older adults are under the umbrella of social networking is
questionable (Hempel et al., 2014).
The policy analysis is vital for the social workers at every levels of practice. Several
authors organize the policy analysis into frame works that are used to judge the policy. One of
the framework for the policy analysts consists of a policy cycle including- formulation of the
problem, developing objectives and the goals, identifying decision parameters, looking for the
alternatives, proposing a remedy and the options.
Policy analysis iteration
Source: (Althaus, Bridgman & Davis, 2007).

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Critical discussion and analysis
Setting out of the objectives and the goals
There are two aims for the policy - One is to decrease the occurrence and the severity of
the falls and another is to minimize the social, psychosocial and economic impact of falls in
older population and their families (Boehm et al., 2014).. The goals for the policy has been
appropriate in its sense. Falls can cause significant harm to the older people and hence shall be
prevented at its earliest level. It has been found that falls in the older adults brings about
psychosocial burden to the older people and hence any policy that should be made should
include the mental stats of both the formal and the informal caregivers (Moyer, 2012). Hence one
of the objective for the policy is relevant to its context. Other goals such as multifactorial
interventions that includes assessments of the fall risk, the exercise programs are appropriate for
the policy. It has been found in a number of trials and systematic reviews that exercise has been
found to decrease the chance of falling in the older adults (El-Khoury et al. 2013). An
individualized exercise regimen is important for improving the balance deficiencies in the older
adults (Boehm et al., 2014). The policy has emphasized on the staff education but has not
emphasized on the means of education. The policy has also discussed about addressing the needs
of culturally diverse population groups but did not emphasize on the way they has to be educated
or how the guidelines can be disseminated (Moyer, 2012). The policy have emphasized on the
reduction of the face to face delivery by providing telephone based support, but the validity of
providing a telephone based support to the linguistically diverse cultural group is questionable as
it is difficult to conduct an exercise regimen or fall risk screening. Furthermore communication
with individuals from different culture can be challenging hence the telephone based support
might not be much useful. Furthermore the development of the materials can be

10POLICY ANALYSIS
Identification of the decision parameters
There are several parameters that guides the credibility of the policies and makes them
acceptable. It is this parameters that decides whether this policy has to be implemented or not.
The parameters helps the analysts to decide how much time and attention should be given to a
problem. The clear cut identification of the parameters help them to identify the issue and the
time that a problem deserves.
Resources
The resources that have been used for this policy included written fall prevention control
materials, printed resources, training and the resources for assisting the health professionals in
communicating key messages to the elderly people. The policy did not provide much information
regarding the budget that would be required for implementing this practice. It has only been
mentioned that the Clinical excellence program would get the funding from the NSW department
of health for the supporting the local health districts through program (Robertson & Gillespie,
2013).
If policies are the outcome of the choices that the entities make to achieve their goals.
The legislation and the budgetary process is the important factor of a policy implementation. It is
important to understand how the system operates at various levels, as not all the policies comes
in to effect through the law making process. The budget is one of the important policy document
in any government and it shows how the government allocates the resources among the various
needs. The policy did not provide an insight to how the budget would be distributed in this
program. Furthermore politics is another parameter that decides what has to be done, what, when
and how. It is government officials that has to decide on the funding and for that they should be
provided with a clear estimation of the spending which is absent in this report (Miake-Lye et al.,

11POLICY ANALYSIS
2013). Another factor is the time frame. Furthermore the policy did not clearly mention the time
frame required for carrying out the interventions. Timeliness is an important parameter for the
success of a policy as the advice should be timely and forward looking. A policy without a
stipulated time frame can lose proper directives and may take several time for the
implementation which can lead to the failure of this project. A proper time line helps in the
accomplishment of the goals quickly. The priorities highlighted in the policy are relevant as the
policy not only focuses on preventing falls in the clinical setting but also in residential care
settings.
One of the priorities that has been identified in the policy is the adoption of certain
exercise programs such as the balance restraining and the muscle straining exercises such as Tai
Chi group exercises (Li et al., 2014). Some of the interventions that has been focused on are
commendable and are important facts to be considered while the making up of the fall prevention
strategies such as the withdrawal of the psychotropic medications that can lead to seizures.
Another priority of this policy involves the social engagement for the older people in the
interventions by providing personal invitation s for the participating in the community based
program (Li et al., 2014)..
Alternatives
The policy contains several factors that can be implemented successfully for preventing
falls, but most of the interventions have been mentioned for a clinical settings. The policy could
inform very less about the prevention strategies that could be used at home and about the
nutritional assessment that could have been made for the adults. According to El-Khoury et al.
(2013), falls have been found to be related with functional disability and decline, and it has been
found that in many cases the nutritional status of the person who has suffered from fall is limited.

12POLICY ANALYSIS
Hence apart from the risk assessment, nutritional assessment should also be done. Interventions
involves supplementation of calcium and vitamin D in food regimen (Bischoff-Ferrari et al.,
2016).
The involvement of the stakeholders is an important aspect of this policy. The
stakeholders has been rightly identified in the policy, that is the Australian, hospitals, the
residential aged health care facility, health districts, the elderly people, the families and the
health care professionals.
A structure of the lobby group for the fall prevention policies for the elderly is given below.
(Source: Buse, Mays & Walt, 2012)
Conclusion
In conclusion it can be said that the policy analysis reveals the gaps and the problems in
the broader sense, including the legislation. The rationale behind the fall prevention policy has
TheSocialinteresegroups-Thegovernment,nonprofitorganisations,theinsurancecompanies,patients.Thepolicymakinggroup-Thepoliticians,ministryofhealth,politiciansandlegixlature.

13POLICY ANALYSIS
been found to be quite relevant but the success of this policy is questionable as there are certain
gaps in the policies that has to be addressed (Sherrington et al., 2012). The main focus of the
project is to arrange for a screening, fall assessment and its management in the older adults. It
involved the application of the risk assessment techniques, supporting program for the older
people and their family caregivers and provision of exercises regimen for the vulnerable group.
The policy also provided information about the continuing support for the vulnerable group
belonging culturally diverse background (Lukaszyk, et al., 2016). The NSW fall prevention
policy for the older adults was expected to reduce the leading cause of mortality among the older
adults. The cost burden of falls in NSW is as high as $558.5 million. This policy would probably
help in reducing the cost burden by reducing the number of hospital admissions due to all. Proper
exercise regimen proposed in the policy would effect in strengthening of the bones and restoring
balance in the older adults. The risk assessment would definitely help in identifying the
individuals that are at a greater risks of falls. And there was an urgent need of such a policy to be
implemented.
Recommendations
An important recommendation for this policy would be to emphasize more on staff
education. It will help create awareness of the issue, its importance, and preventive measures.
Provision of latest technologies is suggested for providing training and education to the staff. It
will also help educate the families regarding the prevention of falls and home remedies to avoid
the fall. The rationale is most of the falls are avoidable by using simple strategies. Falls are also
common due to the carelessness of the formal or the informal caregivers. Education and policy
will ensure adherence to fall prevention protocol (Robertson & Gillespie, 2013). Furthermore,
anthemion should be focused more towards the diverse cultural groups to minimize the language

14POLICY ANALYSIS
barriers in addressing fall related concerns. It is suggested to obtain the exact data regarding the
number of sentinel events occurring due to fall. This would help to assign the focus groups
required for providing the fall prevention activities. To evaluate the outcome of the policy it is
suggested to conduct surveys involving the patients and other stakeholders (Spoelstra et al.,
2012). Questionnaire may be used to investigate the use of healthy and the ageing services
mainly targeting the aboriginal people for giving the feedback and the staff. It will help make
modification to existing policies. It is recommended to develop multiple fall prevention
programs to address this issue among the diverse groups. Online health care service databases
must be regularly updated and used to spread the awareness on recent evidence of fall prevention
for nurses (Lukaszyk et al., 2016). Another key recommendation is to include strategies that are
culturally acceptable and appealing for the older aboriginal people. It can be achieved by
recruitment of indigenous health care professionals, and culturally competent nurses as they can
better understand the needs of the Indigenous population (Chase et al., 2012).

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References
Althaus, C., Bridgman, P., & Davis, G. (2007). The Australian policy handbook (pp. xii-268).
Sydney: Allen & Unwin.
Bischoff-Ferrari, H. A., Dawson-Hughes, B., Willett, W. C., Staehelin, H. B., Bazemore, M. G.,
Zee, R. Y., & Wong, J. B. (2014). Effect of vitamin D on falls: a meta-analysis. Jama,
291(16), 1999-2006.
Boehm, J., Franklin, R. C., & King, J. C. (2014). Falls in rural and remote community dwelling
older adults: a review of the literature. Australian journal of rural health, 22(4), 146-155.
Buse, K., Mays, N., & Walt, G. (2012). Making health policy. McGraw-Hill Education (UK).
Cameron, I. D., Gillespie, L. D., Robertson, M. C., Murray, G. R., Hill, K. D., Cumming, R. G.,
& Kerse, N. (2012). Interventions for preventing falls in older people in care facilities
and hospitals. The Cochrane Library.
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Chase, C. A., Mann, K., Wasek, S., & Arbesman, M. (2012). Systematic review of the effect of
home modification and fall prevention programs on falls and the performance of
community-dwelling older adults. American Journal of Occupational Therapy, 66(3),
284-291.

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Chien, M.-H., & Guo, H.-R. (2014). Nutritional Status and Falls in Community-Dwelling Older
People: A Longitudinal Study of a Population-Based Random Sample. PLoS ONE, 9(3),
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