Background Australia has an ageing population due to a decreasing fertility rate and increasing life expectancy. The Australian Water Safety Strategy 2030 identified older people aged 65 years and over as a priority population. Unexpected falls into water are common among this demographic.

Methods The Royal Life Saving National Fatal Drowning Database was used to examine unintentional drowning deaths among people aged 65 years and over from 1 July 2009 to 30 June 2019 (2009/10 – 2018/19). Only deaths which resulted from a fall into water were included.

Results Between 2009/10 and 2018/19, 116 older people drowned after falling into water, frequently into a swimming pool (32%) or river/creek (32%). A pre-existing medical condition was present in 89% of cases, most commonly cardiovascular disease (72%), dementia (22%), mental health conditions (18%) and musculoskeletal conditions (17%). Blood alcohol concentration (BAC) ≥ 0.05% in 19% of deaths, while medication was present in 60% of deaths. Other risk factors included a history of falls (14%), poor mobility, frailty or balance issues (24%), use of a mobility aid (13%), visual impairment (6%) and environmental hazards (19%).

Conclusion Risk factors for fall-related drowning deaths among older people include pre-existing medical conditions which impact both physical and cognitive abilities, decreased mobility, increased frailty and localised environmental hazards.

Learning outcomes Drowning prevention strategies focusing on older people need to recognise the risk factors for falls into water. Partnerships with other sectors, such as healthy ageing and falls prevention more broadly, will be critical to success.