Falls cause 43% of injury hospitalisations. Here’s how to better predict and prevent them
Falls are the leading cause of injury hospitalisation in Australia, costing the public health system billions of dollars each year.
The Australian Institute for Health and Welfare (AIHW) reports that there were 548,654 injury-related hospitalisations throughout the country in 2022-23, and falls made up over 43 per cent of them, with the next highest cause, 'contact with objects', responsible for just 14 per cent.
“Falls have remained the leading cause of injury-related hospitalisation and fatality in Australia over the past decade and across most regions,” AIHW spokesperson Dr Sarah Ahmed said.
As a person's balance begins to decline at 45 years old, it is no surprise that the risk of a fall resulting in serious injury or death increases with age, but the data shows that there is a significant jump in the occurrence of fall injuries after 65.
Australians aged 65 and over are almost 12 times more likely to get injured due to a fall in comparison to those aged between 25 and 44, with people above 85 the most likely to spend time in hospital.
Neuroscience Research Australia's (NeuRA) Professor Kim Delbaere, a senior principal research scientist and director of innovation and translation at the Falls, Balance and Injury Research Centre, told Aged Care Insite that around one in three people aged 65 and over will experience a fall at least once a year, and half of those people will fall more than once. A quarter will suffer an injury, 10 per cent of them serious and from the age of 85, the risk doubles.
“Falls can be really life changing. We're talking here about serious injuries, like hip fractures that can lead to ongoing disabilities,” Professor Delbaere said.
"Falls can also affect someone's confidence, with fear of falling often resulting in a negative spiral of inactivity, social isolation and further health decline.
“With Australia’s ageing population, this challenge is only growing – the 2021 Census marks the first time in history that we have more people aged 65 and over than we have children aged 14 and younger,” she said.
“But we are not ageing in perfect health – we are ageing with disabilities.”
Key risk factors for falls in old age include poor balance, reduced muscle strength and certain medical conditions that are often associated with ageing, like Parkinson's disease, dementia and osteoarthritis, and even a reduced ability to multitask while we are walking.
While researchers have gained extensive knowledge on understanding and preventing falls, Professor Delbaere said it is crucial for the public to be aware that falls are not inevitable.
“We can absolutely do something about [falls],” she said.
“The single most effective strategy for people aged 65 and above is to add two hours of balance exercises a week into their exercise routine, for at least six months.”
Preventative action should start earlier, she added. “From the age of 45, our balance starts to deteriorate. Taking preventative healthcare actions, like balance training, should really start then.”
“As a child you don't care, but as adults we don't like falling anymore, so we don't practise it.
“But you can absolutely train yourself to be able to stand on one leg.”
A study published in 2022 observed the link between balance and mortality by following 1702 participant’s health over a 12 year period. It found that people aged 50 and over who are unable to balance on one leg unassisted for at least 10 seconds were 84 per cent more likely to die in the subsequent decade than those who could.
“Raising awareness that falls can be prevented with simple actions like balance exercise is key,” Professor Delbaere said.
“We need national leadership that recognises falls as a critical public health issue. This means better access to and coordination of services to prevent falls and manage fall risk as people age.”
Other factors like mental health can also be the catalyst for an increase in someone's fall risk.
“I often like to refer to [fall prevention] as moving, thinking, feeling,” Professor Delbaere said.
“If you don't feel well in yourself, you won't go out and do exercises ... not having that social interaction with people can lead to depression and will lead to lower activity levels and deconditioning.”
“It just becomes this negative spiral that it's actually very hard to get out of.”
Technology offers enormous potential to support fall prevention at scale, especially in the context of limited allied health services. Programs like NeuRA's StandingTall application – an unsupervised, home-based digital exercise program – can help ease the pressure on care staff while empowering older adults.
“We can deliver [exercise] programs through an app, which we have shown can reduce injuries from falls by 20 per cent, for as long as two years,” Professor Delbaere said.
An international implementation trial published in 2024 successfully demonstrated the feasibility of implementing StandingTall into clinical practice.
“If we can encourage and support older people to use these exercise programs, we can achieve a broad reach, regardless of whether people live in the city, regionally or remote - and irrespective of access to an exercise professional," she said.
“Evidence-based digital programs like StandingTall have the potential for a significant population-level impact.”
Professor Delbaere encourages the aged care sector to embrace technology as part of their care delivery, but cautioned against adopting just any solution.
“There are a lot of apps out there, and it is essential to look out for programs that are backed by research evidence.”
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