Approximately 15% of falls in Australia occur in Residential Aged Care (RAC) facilities and these falls account for 20% of the death related falls for people aged 85 years and over (Australian Council for Safety and Quality in Health Care 2005: xiii). Review of falls data in a rural RAC facility identified the need for review and improvement of falls prevention strategies. Implementation of a falls prevention program which focuses on making falls prevention a part of everyday activity within the facility demonstrated that the fitness level of residents can be increased with a resulting decrease in the number of residents sustaining injuries related to falling.

Development of an ongoing program to reduce the incidence of falls in a RAC facility through identifying balance, mobility and strength problems in residents and tailoring individual programs to address these.

Fall related injury is one of the leading causes of morbidity and mortality in older Australians (Australian Council for Safety and Quality in Health Care 2005: xiii). Approximately 15% of falls in Australia occur in RAC facilities and these falls account for 20% of the death related falls for  people aged 85 years and over (Australian Council for Safety and Quality in Health Care 2005: xiii).

In the 12 month period from March 2006 to March 2007, 46% of residents fell and 19% of those residents reported more than three falls in that period. There were a total of 69 falls in this period with 42% of these resulting in injury to the resident. This data was collected through the Incident Information Management System (IIMS). It was recognized that the management of falls prevention within the unit needed to be reviewed and improved.

The falls prevention program relates directly to the NCAHS Falls Injury Prevention and Management Plan 2005-2008, in particular Objective 1: Lead and manage preventative and treatment responses to fall injury based on identified local need and Objective 3: Maintain and Improve the Mobility, Strength and Fitness of Older People.

The program also relates to the NCAHS Health Promotion Strategy 2006-2010. One of the four priority areas in this plan is preventing injurious falls in older people.

A Falls Prevention Committee was formed with multidisciplinary membership including management, nursing, activities officer, physiotherapy, and support services.

The data from IIMS was analysed to determine patterns and trends in the falls to ascertain possible causes and solutions. A literature review provided potential evidence-based solutions that were discussed by the committee. According to the Safety and Quality Council's Guidelines 'Preventing Falls and Harm from Falls in Older People' (2005), individual programs identifying and addressing balance, mobility and strength problems may reduce the risk of falls. Implementation of such a program is a Grade B recommendation.

The Falls Committee was successful in gaining a $5,000 grant from the Area Health Service (AHS) which provided the funding for an individual assessment of each resident by a Physiotherapist and other resources to assist with a falls prevention program. The Falls Committee oversaw the management of this program and was very involved in the on-ground implementation of it and worked with the residents, staff and volunteers to create a positive culture of improvement and success within the unit.

All ambulant residents were invited to participate in the program. The Physiotherapist used the Timed Up and Go (TUG) test (LTCCC-RIAFSA 2004) to assess each resident's baseline fitness level. This was reassessed after six weeks following implementation of the program. Individualized exercise programs were developed for each resident. In-service education was provided to appropriate staff regarding falls prevention and supervision of the activity program. The funding also provided items including educational material, portable chair and bed alarms, hip protectors, traction socks and extra staff hours to implement the program.

Intervention practices included individual and group programs.  The resident's individual programs were (and still are) facilitated by the Physiotherapist Aide and nursing staff. The exercise programs were built into the resident's every day routine. Group programs were conducted by the Activity Officer and Volunteers and included both the residents who have individualized programs and those who were unable to participate in such programs due to immobility.

Residents were assessed for appropriate foot and eye wear and walking aids. Residents assessed as being a high falls risk or with a repeated history of falls were allocated hip protectors. Bed and/or chair alarms were used with identified residents in an effort to maintain independence and increase staff awareness when the resident was ambulant or getting out of bed. Traction socks were provided to residents as required.

Nineteen (19) of the twenty four (24) residents were included in the study group. Analysis of the IIMS data shows an 8% decrease in the number of fall related injuries (refer to Figure 1.) with only 2% (1/61) of falls resulting in a fracture and 4% (2/61) resulting in a laceration requiring suturing required suturing.

Figure 1

Fourteen (14) of the group were tested with the Timed Up and Go Test. Of this group:

• 64% of the study group improved their timed up & go testing
• 21% of the study group decreased their timed up & go testing, while
• 14% of the study group were unable to do the second timed up & go testing 

The falls program demonstrated that although the exercise program did not reduce the number of falls, it did increase the mobility of the residents (as measured by their TUG score). There was also a decrease in the number and extent of injuries occurring as a result of the falls. Although the falls incidence may not have improved, the quality of life for the residents most certainly has (increased mobility and decreased injuries). Anecdotally, the staff and residents embracing the program report they are having fun and there appears to be an elevation of mood and well being in the whole unit.

The success of the Falls Prevention Program is sustainable by:

• Adapting the Physiotherapist Aide's role to include the facilitation and implementation of the individual resident’s program.
• The coordination of group walks and exercises being incorporated in the Daily Activity Program by the Activity Officer with Volunteers and Nurses assisting in the facilitation.
• The Nurses encouraging the residents in a range of movements while attending their personal care.
• The utilization of staff across different units within the facility has meant the lessons learnt in Aged Care have transferred to the General Ward and Community Health resulting in a culture of falls prevention throughout the facility.

The falls prevention program is easily transferable to other nursing RAC facilities within the AHS. The assessment tools and resources used are readily available and relatively inexpensive. The focus is on making falls prevention part of the every day routine and thus it becomes part of the everyday care delivered and part of the culture.

The enthusiasm of the Falls Prevention Committee has generated a Community Falls Prevention Program run by the Community Nurse and Physiotherapist. Patients presenting to the Emergency Department are assessed , and those identified as medium to high risk are referred to the Community Falls Prevention Program.

• Australian Council for Safety and Quality in Health Care. (2005) Residential Aged Care Facilities Preventing Falls and Harm from Falls in Older People. Resource Package: Falls prevention strategies, 22 - 38.
• LTCCC-RIAFSA (2004) Timed Up and Go Test "Falls Prevention Train - the - Trainer" Conference.