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Falls

Falls

Definition of Falls

A fall is defined as an event which results in a person coming to rest inadvertently on the ground or floor or other lower level.1

Impact of Falls on Western Australia

Who does it impact?

In Western Australia between 2007 and 2011, there were 756 deaths due to falls.1

In Western Australia between 2008 and 2012 there were:

  • 73,509 hospitalisations due to falls.3
  • 45.7% of hospitalisations for falls were males.1
  • people aged 65+ years had the highest incidence of falls.3

In Western Australia Aboriginal People make up 3.8% of the population, however between 2008 and 2012 5.5% of falls hospitalisations were Aboriginal People.3

When does it occur?

In Western Australia, between 2008 and 2012, hospitalisations for falls were greater during May (9%), December (8.7%) and October (8.6%).2

Where does it occur?

In Western Australia, between 2008 and 2012, the three regions with the highest age-standardised rate for hospitalisations for falls, were the Kimberley (1150.1), Pilbara (799.4) and Wheatbelt (798.1).3

The age-standardised hospitalisation rates are standardised with the Australian 2001 population and expressed per 100,000 person years.

Impact on the health system

In Western Australia in 2012, there were 16,762 hospitalisations for falls, consuming an estimated 61,124 bed days at an approximate cost of $117,957,168.3

Determinants of Falls (Risk / Protective Factors)

Social Determinants

Income and socioeconomic status
Research has associated lower socioeconomic status with an increased risk of falls due to factors such as education, income and employment status influencing an individual’s falls prevention knowledge.1 A lack of opportunities to participate in social activities and low levels of social support can also increase the individual’s risk of falling.

Environmental, Community and Organisational Determinants

Environmental hazards
There are a range of environmental hazards that have the potential to increase an individual’s risk of falling including stairs, loose rugs and cords, poor lighting, furniture height, uneven surfaces and slippery floor surfaces.1

Falls among children under the age of 10 years mostly occur in the home due to hazards such as nursery furniture, baby walkers, tables, beds and playground equipment.1

Behavioural and Individual Determinants

Footwear
An individual’s risk of falls is increased when wearing footwear that has no support, has worn soles, heels or a slippery surface.5

Eyesight
Vision related factors including reduced contrast sensitivity, reduced depth perception and reduced visual field can increase an individual’s risk of a fall.1

Mobility
Muscle weakness and pain when walking can have a negative impact on an individual’s mobility. This places them at a higher risk of falls due to their negative effect on postural sway, gait velocity, stride length, step height, reaction time, visual acuity and depth perception.5

Medical Conditions
Medical conditions that decrease an individual’s physical and mental functioning, including Parkinson’s disease, cardiovascular disease, depression, stoke, visual and auditory impairments, osteoporosis and dementia have been associated with an increased risk of falling.5

Medications
Specific drugs including antipsychotics, antidepressants and benzodiazepines have been connected to an increased risk of falling. Also, the use of multiple medications (polypharmacy), inappropriate prescribing, misuse and inappropriate dosage can influence an individual’s risk of falling.5

History of falling
If an individual has experienced a fall they are at a higher risk of having another fall in the future. This increased risk has been associated with a fear of falling, a lack of confidence in the individual’s ability to carry out everyday activities and the negative impact that the fear of falling can have on the individual’s activity levels, which can further increase the individual’s risk of falling.5

Age and gender
A child’s age and development stage influences the activities and environments where falls injuries occur as well as the characteristics of injuries.1 Young Western Australian males aged 0-14 years have a 50% higher rate of falls injuries compared to females of the same age group, which can be associated to the gender difference in their physical and psychosocial development, patterns of child-rearing, socialisation and the amount of risk taking behaviours.8 In Western Australia the rate of hospitalisations and deaths due to falls is at the highest level among people over 65 years of age.3

Effective Interventions

Legislation, Policies, Standards and Codes of Practice

Legislation
In Australia, legislation for older people can be divided into two areas; community welfare and nursing home, and retirement village regulation. Despite falls prevention programs falling across both areas, there is currently no legislation in Western Australia that directly addresses falls prevention in older people.5

Policies
The Federal Government established the National Falls Prevention for Older People Initiative, which focuses on reducing the incidence, morbidity and mortality relating to falls in people aged 65 and over.5

In 1996 the Australian Health Ministers, in recognition of the negative impact that injury was having on the nation, endorsed Injury Prevention and Control as a National Priority Area.1

Australian standards for falls amongst children
There are a number of Australian Standards that aim to support the minimisation of injury risk to children, including the following standards;5

  • Playground Equipment for Parks, Schools and Domestic Use
  • Playground Surfacing Specifications, Requirements and Test Methods
  • Playgrounds and Playground Equipment: Development, Installation, Inspection, Maintenance and Operation
  • Fixed Platforms, Walkways, Stairways and Ladders – Design, Construction and Installation
  • Bunk Beds and Cots of Household Use – Safety Requirements
  • High Chairs, Prams and Strollers – Safety Requirements
  • Pedal Cycle Helmets.

Environmental, Community and Organisational Initiatives

Falls prevention campaigns
A falls prevention campaign that includes a number of elements targeting falls risk factors and involves professionals from a range of health services is recommended.5 Evidence also supports falls prevention campaigns that are developed to match their target audience, with the differentiation of community dwelling, residential aged care and acute care based individuals.5

Falls prevention programs in the community
Falls prevention programs that outline the importance of identifying any falls risks as soon as possible, how falls risk factors can be minimised and highlights the importance of referring to other specialist services if required, all contribute to successful organisational and health service initiatives.5

Western Australian example

Stay On Your Feet WA® is a falls prevention program that aims to promote healthy, active ageing in Western Australia to reduce falls among older people. The program does this by raising awareness of the risk factors for falls in older people with community members, health professionals and other service providers.

Western Australian example

‘Have a Go Day’ is a community initiative that supports lifelong physical activity.5 As part of The Department of Sport and Recreation’s Seniors Recreation Councils support of seniors’ involvement in sport and recreation they sponsor ‘Have a Go Day’.

Falls Prevention programs in primary health care and other health services
Due to the impact that the number of medications prescribed to an individual has on an individual’s risk of falling, initiatives within health services that centre on; improving prescribing practices, reducing the incidence of polypharmacy, reducing vitamin D deficiencies and advocating for falls prevention, would assist towards reducing the impact that medication intake is having on falls.5

Western Australian example

Within the residential aged care settings a range of falls prevention programs have been implemented by the overarching organisation. Falls risk assessments, physical activity, medication review and environmental modifications are common aspects of the programs.5

Falls Prevention programs in hospitals
A specific hospital initiative that works towards reducing the rate of falls is the instillation and active use of patient bed alarms that notifies hospital staff when patients who require assistance to leave their beds are attempting to leave their bed without assistance.5 Staff education and training programs that encourage individual falls prevention actions are a key component towards an effective falls prevention initiative.

Western Australian example

Specialty medical clinics in falls, falls prevention education classes and home-based Falls Risk Assessments and Falls Prevention Programmes are provided by Sir Charles Gairdner Hospital.5 The initiatives run by Sir Charles Gairdner Hospital target their staff, patients and community members.

Group and Individual Initiatives

Individual actions
On an individual level there are a number of actions that can be taken to decrease falls risk including; wearing safe footwear, getting eyesight checked regularly, making homes safer by removing hazards, building their balance, strengthening legs, regularly getting medications checked, keeping a health mind and ensuring that their body is receiving the nutritional intake that it requires.1

Western Australian example

As falls in children are the cause of many child injuries, Kidsafe focus on this as part of their safety awareness. Kidsafe run a Safety Demonstration House and Resource Centre in Perth, which displays situations around the house that could be hazardous for young children and a range of prevention methods that individuals can implement to reduce the risk of injury.5

Key stakeholders in Western Australia

Other Resources

References

1 World Health Organization. (2012). Falls. Retrieved from http://www.who.int/mediacentre/factsheets/fs344/en/
2 Department of Health, Western Australia. (2015). Health condition overview. External causes of mortality deaths – Western Australia State.
3 Department of Health, Western Australia. (2015). Specific health condition analysis. Accidental falls hospitalisations by external cause (injury and poisoning) – Western Australia State.
4 Department of Health and Human Services. (2014). Prevention Injury. Retrieved from http://www.dhhs.tas.gov.au/healthpromotion/wihpw/priority_areas/preventing_injury
5 Arena, G., Cordova, S., Gavine, A., Palamara, P. & Rimajova, M. (2002). Injury in Western Australia: a review of best practice, stakeholder activity, legislation and recommendations. Perth: Injury Research Centre, The University of Western Australia.
6 Pointer, S. (2014). Hospitalised injury in children and young people 2011 – 12. Injury research and statistics series. 91(1). Canberra: Australian Institute of Health and Welfare.
7 Fall Prevention Centre of Excellence. (2012). Falls and vision loss. Retrieved from www.stopfalls.org/grantees_info/files/FallsVision1.pdf
8 Peden, M. et al. (2008). World report on child injury prevention. World Health Organization. UNICEF. Retrieved from www.who.int/violence_injury_prevention/child/injury/world_report/en/
9 Australian Government, Department of Health. (2013). Injury Prevention in Australia. Retrieved from http://www.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-strateg-injury-index.htm
10 Stay On Your Feet® WA. (2015). About us. Retrieved from https://www.stayonyourfeet.com.au/about-us/

Printable Fact sheet

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