Fall Prevention in Australia: Policies and Activities

https://doi.org/10.1016/j.cger.2010.07.002Get rights and content

Section snippets

Problem recognition and policy development

Policy is implemented when recommendations are converted into action by government, agendas are defined, and there are mechanisms in place to bring policy into action.6 Elements of these mechanisms can be legislative, financial, or administrative. Fall prevention has gained momentum as an important element of the health policy agenda. The major driver of fall prevention policy has been the recognized financial burden to health care costs associated with fall injuries.7 This driver received

Health reform: the current national agenda

Governments have talked about reorienting health services by placing the role of preventive health more centrally; however, achieving a systematic balance between prevention and treatment has seen little progress in the past decade in Australia or elsewhere.15 A change of government in 2007 saw a commitment to primary health care reform and preventive health reform. So far this has translated into national policy to develop strategies to tackle smoking, obesity, and alcohol, all important

Policy implementation

The national guidelines for best practice in fall prevention, released in December 2009, are divided into 3 practice settings: community care, residential care, and hospitals (http://www.health.gov.au/internet/safety/publishing.nsf/content/FallsGuidelines). The guidelines have been developed from expert review, supporting evidence of interventions, and, where available, cost-effectiveness information. To facilitate uptake, they have provided some information on assessment and intervention

Delivering fall prevention: a historical perspective

Fall prevention activities have traditionally been considered a part of population health and health promotion because of the strong recognition that it is the health sector that bears the costs of falls and fall injuries. In the early 1990s, developing prevention activities were largely aimed at key messages and raising awareness among the community. However, geriatricians, therapists, and nurses who provide health care to older people have long recognized the consequences of frailty and

Knowledge and skills base

Fall researchers in Australia and New Zealand have had a remarkable international presence, enabling local knowledge to be relevant and accessible. The Australian and New Zealand Falls Prevention Society, formalized in 2008 (http://anzfallsprevention.org/index.html), has embraced biennial national fall conferences to bring together stakeholders, health professionals, researchers, and policymakers. Some states have had long-standing injury and fall prevention interest groups that have formalized

Physical Activity and Exercise

As in other countries, physical activity messages have been accepted by older people, with walking and gardening the most favored activities,35 and preferred exercise tending toward light to moderate activities.36 Although Active Australia campaigns demonstrate some change in activity levels, there are no evident changes in the numbers of older people who are inactive (18% of 65–75 year olds) or those whose physical activity is considerably less than the national standards (39%).37 The most

A snapshot of fall prevention activities across Australia

Across Australia, there are diverse approaches to funding and activities across state government and other organizations, as well as across the public health, welfare, and community sectors. For example, NSW displays a strong government leadership and direction toward services, relationships, and processes, Victoria is rich in community-government alliances, and Western Australia (WA) has adopted a collegial partnership approach to leadership with innovation in the use of diverse funding

The Victorian Picture

In the state of Victoria, prevention of falls was first identified as a priority in 1994,54 and has received dedicated state government funding since 1997. The Department of Human Services Aged Care Branch has led responsibility for planning and policy development for fall prevention among older people, and funds most activities at a state level, although other sections of the state service (eg, acute and subacute health) fund fall and mobility clinics and center- and home-based rehabilitation.

Fall Prevention in WA

Fall prevention activities in WA in the early years were primarily focused on health promotion activities. The SOYF program was first implemented in WA in 1996 following the NSW program and, in 1998, was adopted by the WA Department of Health Injury Prevention Branch (Stay On Your Feet WA [SOYFWA]). The program targeted healthy seniors and focused on fall risk identification and management, operated in partnership with community agencies, and actively involved older people as volunteers.

Fall and fall injury data: determining population effects

The development of policy initiatives, including the setting of funding priorities and directions, as well as assessing the effect of any implemented programs, requires accurate information at a population level. There is no overarching national mandate covering the systematic collection of fall and fall injury data nationally. The only routinely collected sources of data relate to the national mortality data collections, the National Coronial Information System (NCIS) and hospital admissions,

Challenges and future directions

Several major challenges persist. Implementation of prevention across the health sector has not been equitable, and fiscal constraints have been felt at the local level with staff shortages. Increasing activity and expertise in one area often means a reduction of services in another. In some states more than others, there has been a retreat by health services in engaging with the community in preventive health initiatives; for example, with community teams having a focus restricted to

Summary

The committed ground-up fall prevention activities have provided a strong and collegial environment for robust fall prevention activities in Australia. There are active fall prevention networks, increasing commitment at state and local levels, champions emerging, and activities crossing sectoral boundaries. Education, workforce training, and population reach are key issues. There is a commitment to continue to improve data systems and monitoring, with a strong view to evaluating policy outcomes.

First page preview

First page preview
Click to open first page preview

References (74)

  • H. Kendig et al.

    Health, economic and policy implications of an ageing Australia

  • National Health and Hospitals Reform Commission

    A healthier future for all Australians: final report 2009

    (2009)
  • G.R. Palmer et al.

    Health care & public policy. An Australian analysis

    (2000)
  • J. Moller

    Changing resource demands related to fall injury in an ageing population

    (2000)
  • J. Moller

    Projected costs of fall related injury to older persons due to demographic change in Australia

    (2003)
  • Commonwealth Department of Human Services and Health

    Better health outcomes for Australians. National goals, targets and strategies for better health outcomes into the next century

    (1994)
  • Day L, Finch C, Harrison J, et al. Modelling the population level impact of a proven falls intervention for community...
  • L. Day et al.

    Modelling the impact, costs and benefits of falls prevention measures to support policy-makers and program planners

    (2008)
  • C. Finch et al.

    Development of a workforce education program for exercise practitioners in falls prevention and exercise prescription for older people

    (2008)
  • L. Clemson et al.

    Translating research into practice: sustainability of a community-based falls prevention program in minority communities

    (2008)
  • M. Wise et al.

    Enabling health systems transformation: what progress has been made in re-orienting health services?

    Promot Educ

    (2007)
  • United Nations. Report of the Second World Assembly on Ageing, Madrid, 8–12 April 2002 (United Nations publication,...
  • Commonwealth Government of Australia. 2020 Summit Final Report: a long-term national health strategy. May 2008. p. 165....
  • R.G. Poulos et al.

    Towards enhancing national capacity for evidence informed policy and practice in falls management: a role for a “Translation Task Group”?

    Aust New Zealand Health Policy

    (2007)
  • D. Preen et al.

    Willingness of general practitioners to participate in enhanced primary care discharge care planning

    Med J Aust

    (2006)
  • S. Wilson et al.

    General practitioner multidisciplinary skills for enhanced primary care

    Aust Fam Physician

    (2004)
  • S. Mackintosh et al.

    Falls and injury prevention should be part of every stroke rehabilitation plan

    Clin Rehabil

    (2005)
  • K. Hill

    Invited commentary: don’t lose sight of the importance of the individual in falls prevention interventions

    BMC Geriatr

    (2009)
  • Russell M, Hill K, Blackberry I, et al. A randomized controlled trial of a multifactorial falls prevention intervention...
  • L. Clemson

    Prevention of falls in the community: is successful in trial settings, but translation into practice remains a challenge

    Br Med J

    (2010)
  • C. Bradley et al.

    Fall-related hospitalisations among older people: sociocultural and regional aspects. Injury Research and Statistics Series, Number 33

    (2007)
  • B. Cardona et al.

    Diverse strategies for diverse carers: the cultural context of family carers in NSW. Research report

    (2006)
  • X.J. Yang et al.

    Older Chinese Australians’ understanding of falls and falls prevention: exploring their needs for information

    Aust J Prim Health

    (2008)
  • A. Kempton et al.

    Older people can stay on their feet: final results of a community-based falls prevention programme

    Health Promot Int

    (2000)
  • L.M. Barnett et al.

    Program sustainability of a community-based intervention to prevent falls among older Australians

    Health Promot Int

    (2004)
  • W. Hughes

    Preventing falls in older adults project: stay active, stay independent, stay on your feet: research report

    (2007)
  • R. McClure et al.

    The population approach to falls injury prevention in older people: findings of a two community trial

    BMC Public Health

    (2010)
  • Cited by (17)

    • Pain, not structural impairments may explain activity limitations in people with gluteal tendinopathy or hip osteoarthritis: A cross sectional study

      2017, Gait and Posture
      Citation Excerpt :

      The ability to negotiate ones’ environment safely is imperative to remaining independent. Falls among older people are a common cause of injury [21] and cost the community significant amounts of money per annum [22]. The ability to balance on one leg is required in order to safely undertake activities of daily living such as dressing and ascending stairs.

    • Integrating proven falls prevention interventions into government programs

      2014, Australian and New Zealand Journal of Public Health
    • Sustainability of community-based fall prevention programs: A systematic review

      2013, Journal of Safety Research
      Citation Excerpt :

      Studies conducted to date on the translation of fall prevention research into practice have focused on the factors influencing program participation by older people (Bunn, Dickinson, Barnett-Page, McInnes, & Horton, 2008; Child et al., 2012; Dickinson et al., 2011; Høst, Hendriksen, & Borup, 2011), barriers and facilitators to program implementation by health professionals (Child et al., 2012; Jones, Ghosh, Horn, Smith, & Vogt, 2011), and the evaluation of methods to improve the implementation of fall prevention programs in practice (Goodwin, Jones-Hughes, Thompson-Coon, Boddy, & Stein, 2011; Tinetti et al., 2008). Despite a growing understanding of the issues surrounding the uptake and implementation of community-based fall prevention programs, factors impacting on the sustained use of such programs in practice are less understood (Clemson, Finch, Hill, & Lewin, 2010). Program sustainability can be defined as the continued use of programs by organizations over time to achieve desired health outcomes (Scheirer & Dearing, 2011).

    View all citing articles on Scopus

    Caroline Finch was supported by an NHMRC Principal Research Fellowship.

    View full text