Falls are the leading cause of injury-related hospitalisation in people aged 65years and over. You can help older people to access falls prevention programmes that ACC is involved in delivering.
Falls statistics
Falls are the cause of half of all ACC claims and costs in people aged 65 years and over. They account for 75% of injury-related hospital admissions [1].
Depending on the population under study, between:
- 22-60% of older people suffer injuries from falls
- 10-15% suffer serious injuries
- 2-6% suffer fractures
- 0.2-1.5% suffer hip fractures.
How you can help
Although falls are very common among people aged 65 years and over, we know that they are not a natural part of ageing. There is also strong evidence to indicate that many falls can be prevented.
Health professionals, in particular general practitioners, play an important role in:
- assessing older people who are at risk of falling, or have had a fall, to determine the reason for their falls
- referring older adults to the appropriate intervention. In many cases this will be to improve their strength and balance, such as modified Tai Chi classes
- prescribing patients in residential care with Vitamin D supplements when appropriate.
What causes falls?
Human balance is thought to depend on the interaction of multiple sensory, motor and integrative systems. A growing body of evidence indicates that functioning in sensory, motor and integration systems declines significantly with age. Impairment in these systems is associated with falling in older people.
Injuries sustained from falls
Self-reported injuries most commonly include superficial cuts and abrasions, bruises and sprains. The most common injuries that require hospitalisation are:
- femoral neck fractures
- other fractures of the leg
- fractures of radius, ulna and other bones in the arm
- fractures of the neck and trunk.
The most serious of the fall-related injuries is fracture of the hip. Older people require a long recovery period from hip fractures and are vulnerable to post-operative complications. Hip fractures frequently result in death. For those who do survive, many never regain complete mobility.
Sometimes an older person may remain on the ground or floor for more than an hour after a fall (‘long lie’). The long lie is a marker of weakness, illness and social isolation and is associated with high mortality rates among older people. Time spent on the floor is associated with fear of falling, muscle damage, pneumonia, pressure sores, dehydration and hypothermia.
Falls also result in restriction of activity, and reduced quality of life and independence. Even falls that do not cause physical injuries can result in a loss of confidence, or hesitancy, which may in turn lead to a loss of mobility and independence. It has been found that after falling, 48% of older people report a fear of falling and 25% report curtailing activities.
Falls are frequently cited as a contributing reason for an older person requiring admission to a nursing home.
Assessing older people
When you assess an older person to identify why they are falling, or if they are at risk of falls, consider:
- psychological and demographic factors, eg advanced age, history of falls
- balance and mobility factors, eg impaired gait and mobility (consider if appropriate to refer to modified Tai Chi classes)
- impaired joint proprioception, eg following a hip or knee replacement, cervical spine degenerative disorders
- sensory and neuromuscular factors, eg vision, muscle weakness and reaction times
- medication factors, especially multiple medications such as sedatives, antidepressants, antihypertensives, antiarrythmics, anticonvulsants, diuretics and alcohol
- medical factors, eg stroke, Parkinson’s disease, MS
- environmental factors, eg footwear, home environment.
There is strong published evidence to link the first five factors with falls. There is little published evidence that environmental factors are primary risk factors.
A 2007 review of 50 randomised, controlled trials involving exercise for preventing falls and fractures was carried out by Professor Stephen Lord. The interventions that were consistently shown to be effective were challenging and progressive weight-bearing balance exercises, such as OEP and Tai Chi.
A review of international falls prevention programmes in residential care and acute hospital settings by Dr Clare Robertson and Professor John Campbell indicated that Vitamin D supplementation in specific groups of older people can lead to a significant reduction in falls. See Optimisation of ACC's fall prevention programmes for older people (PDF655K).
Falls prevention programmes
ACC is involved in the delivery of falls prevention activities to older people living in the community or residential care facilities. The main focus in the community is delivering exercise programmes that have been shown to improve strength and balance.
Modified Tai Chi classes
Modified Tai Chi is a style of Tai Chi developed for older people that focuses on preventing falls by improving lower limb strength and balance.
The eligibility criteria for ACC-funded modified TaiChi classes is that participants:
- are aged 65 years or older (55 years or older if Maori or Pacific)
- are living independently in the community
- have had a fall in the last 12months (or are identified to be at high risk of a fall by a registered health professional)
- have been assessed to ensure that they are not in the small percentage of people who are too fit or too frail for the class.
Referring people to modified Tai Chi classes is easy. Just call the local co-ordinator in your region to secure a place. See Modified TaiChi classes around New Zealand for contact details. Please note that some areas do have waiting lists.
Otago Exercise Programme
The Otago Exercise Programme (OEP) consists of a series of leg-strengthening and balance-retraining exercises that get progressively more difficult as the person gets stronger. It also involves a walking plan.
ACC is no longer funding new participants of OEP, however some providers may continue to offer OEP under different funding options.
Vitamin D supplements
ACC, district health boards and primary health organisations support the provision of Vitamin D supplements for older people who live in residential care facilities.
A resident must be prescribed a Vitamin D supplement by their GP. A prescribing guideline has been developed by ACC and a Specialist Advisory Group to determine appropriate treatment, as well as recommendations on dose and frequency.
For more information, see:
Ongoing falls prevention evidence
The field of falls prevention research has expanded enormously with a complex and rapidly growing body of literature on risk factors for falls and falls prevention strategies.
ACC faces the challenge of keeping up to date with this growing body of evidence and practices.
For more information about existing interventions evidence, see Key references for falls prevention.
Last updated:30October2009