The new national guidelines in falls prevention include seven, fourteen and four recommendations for residential aged care, community and hospital settings respectively, along with good practice points to help all those involved in the care of older people to help prevent falls among seniors.
The Falls Guidelines 2025 released on Thursday have been five years in the making and come more than 15 years after the previous edition. Authored by experts Dr Jasmine Menant, Professor Cathie Sherrington, Dr Suzanne Dyer and Professor Stephen Lord, they combine research, community consultation and more to offer the best advice available for each setting.
The release includes details on the strength of the recommendation (1-3) and quality of evidence (A-C) supporting it, where the best-practice rating of 1A indicates a strong recommendation with benefits for fall prevention that clearly outweigh undesirable effects, and such high quality that “further research is unlikely to change confidence in the estimate of effect”.
This new version consolidates previous work but importantly shows irrefutable evidence and best-practice interventions for preventing falls, said Professor Lord – a scientia professor at the University of New South Wales and a senior principal research fellow at Neuroscience Research Australia.
“We’ve definitely found consistent evidence that exercise is a key element in terms of trying to prevent falls; not just any exercise, but exercise that has a balance challenge, and is ongoing. So that’s definitely confirmed,” Professor Lord told Australian Ageing Agenda.
“There’s also been some very nice evidence that you can actually prevent falls in nursing homes, which has been one of the big changes in terms of exercise programs, but also nutritional interventions,” said Professor Lord referring to research on the benefits of dairy.
“That’s just been very encouraging too because in 2009 there was no real evidence apart from maybe vitamin D being protective.”
The updated advice for vitamin D recommends daily or weekly supplements, but not monthly or annual doses, which can actually increase the risk of falls.
The guidelines recommend daily or weekly vitamin D supplements be provided to all aged care residents unless contraindicated, and to all older people in the community who are deficient in vitamin D or have little sunlight exposure – which is less than 5‐15 minutes of exposure, four-to-six times per week.
Older people in both settings with diagnosed osteoporosis or history of low‐trauma fractures should be prescribed bone treatments, according to the recommendations.
“Apart from that there’s been further work evaluating the role of dizziness and how you can reduce dizziness handicap, and in terms of vision, clearly now early cataract extraction and surgery is effective in preventing falls,” Professor Lord said.
“And there’s been a lot of consolidation with systematic reviews so that we can come up with what we call grade 1A evidence that these sorts of processes and interventions are effective.”
These guidelines are for anyone involved in the care of older people who might fall across the three settings, including care workers, general practitioners, and nurses. There are also guidelines for those incidentally involved such as cleaning and reception staff, emphasised Professor Lord.
Welcoming the release of the guidelines, fellow author Associate Professor Menant, a senior research scientist at NeuRA’s Falls, Balance and Injury Research Centre, noted the cost of falls to individuals and the economy.
“Falls have a big impact on individuals, as the consequences can be life-changing, from injury, to early admission into residential aged care or even mortality,” Dr Menant said.
“They also have a big impact on our economy, with falls of Australians aged over 65 years old costing the health system more than $2.8 billion annually.
Dr Menant said the guidelines stressed the importance of interventions across the three settings.
“For all settings there is an emphasis on implementation of interventions rather than assessment of risk,” Dr Menant said.
“For example, in residential aged care, there is stronger evidence to support the ongoing delivery of exercise for fall prevention, and in the community, highlighting different approaches to intervention for people with different levels of risk.”
In addition to the list of recommendations across the settings below, see this article from Dr Dyer – senior research fellow at Flinders University – who has written for AAA about how to prevent falls in residential aged care.
For more on the best-practice guidelines in community settings, see our detailed report in Community Care Review.
Recommendations for residential aged care
The Falls Guidelines for Residential Aged Care Services in Australia has seven recommendation to support the prevention of falls among aged care residents. They are:
1. Multifactorial interventions
Provide multifactorial fall prevention interventions as part of routine care for all older people including:
- regularly assessing both individual and facility-level fall risk factors, including for environmental interventions and medication review
- developing a tailored fall prevention plan based on the findings of the older person’s fall risk assessment
- providing education and engaging the workforce about preventing falls and harm from falls in older people. (Level 1A)
2. Tailored exercise
Provide tailored supervised exercise to all older people who choose to participate. Ensure health professionals, such as physiotherapists or exercise physiologists, or appropriately trained instructors, design and deliver the exercise programs. (Level 1B)
3. Continued exercise
Provide continued exercise for fall prevention as the effect of structured exercise programs diminishes over time after the program has ended. (Level 1A)
4. Hip protectors
Consider the use of hip protectors for older people to reduce the risk of fall-related hip fractures. (Level 2A)
5. Dairy food provision
Ensure menus have at least 3.5 servings of dairy foods, such as milk, yoghurt, cheese, daily to meet protein and calcium requirements of older people. Engage dietitians to assist with menu design that reflects dietary requirements and older people’s needs and preferences. (Level 1B)
6. Vitamin D and supplements
Administer recommended doses of daily or weekly vitamin D supplements to all older people unless contraindicated. (Level 1A)
Avoid monthly or once yearly mega doses of vitamin D, as they can increase the risk of falls. (Level 2A)
7. Osteoporosis medicines
Administer prescribed osteoporosis medicine for older people with diagnosed osteoporosis or a history of minimal trauma fractures, unless contraindicated. (Level 1A)
The resources include:
Recommendations for community settings
The Falls Guidelines for Community Care have 14 recommendations for community care including five about exercise, one on home safety, two with multiple components and factors, and seven single interventions for specific risk factors.
Exercise to prevent falls
1. Ongoing exercise for all
Support all older people to undertake 2-3 hours of exercise per week on an ongoing basis to prevent falls. Primarily target balance and mobility and include strength training. Ensure health professionals, such as physiotherapists or exercise physiologists, or appropriately trained instructors design and deliver exercise programs. (Level 1A)
2. Cognitive impairment
Support older people with mild cognitive impairment or mild-to-moderate dementia to undertake exercise to prevent falls if they choose to. (Level 1B)
3. Low risk of falls
Support older people at low risk of falls (less than one fall a year) to attend community exercise or safely undertake home exercise. (Level 1A)
4. Increased risk of falls
Provide older people at increased risk of falls (one or more falls per year) with tailored exercise programs. Supervision or assistance from a health professional, such as physiotherapists or exercise physiologists, or an appropriately trained instructor may be required to ensure the older person exercises safely and effectively. (Level 1A)
Home safety interventions
5. Home safety
Following a home safety assessment, provide tailored home safety interventions delivered by an occupational therapist for older people at increased risk of falls, including those with severe visual impairment, who have fallen in the past year, who need help with everyday activities, who have mobility impairment or use a mobility aid, or who have recently been discharged from hospital. (Level 1A)
Multiple component and multifactorial interventions
6. Education and exercise
Provide older people at increased risk of falls (one or more falls per year) home and community safety education in addition to exercise. (Level 1A)
7. Tailored multifactorial interventions
Provide older people at high risk of falls (two or more falls per year) with a fall risk assessment from a health professional to inform tailored fall prevention interventions. Interventions may include exercise, home safety, assistive devices, medication reviews, interventions to maximise vision, podiatry and strategies to address concerns about falling, anxiety, depression and cognitive impairment. (Level 1B)
Single interventions for specific risk factors
Provide single interventions for older people at increased risk of falls with specific risk factors:
8. Podiatry
Provide older people with foot problems or disabling foot pain with access to multifaceted podiatry interventions. (Level 1A)
9. Cataract surgery
For older people with clinically significant visual impairment primarily due to cataract, facilitate timely referral to a medical practitioner for cataract surgery in both eyes (unless contraindicated). (Level 1A)
10. Medicines review
Facilitate access to collaborative medication reviews by a general practitioner and pharmacist, in partnership with the older person to minimise use of psychotropic medicines and other medicines that increase the risk of falls. (Level 2B)
11. Pacemakers
Facilitate access to a medical practitioner to treat older people diagnosed with the cardio inhibitory form of carotid sinus hypersensitivity with fitting of a dual-chamber cardiac pacemaker. (Level 2B)
12. Eyewear prescription
Advise active older people to use single-lens distance glasses (rather than bifocal, multifocal or progressive lenses) when active outdoors. (Level 2B).
When updating the older person’s glasses prescription, limit the change in prescription where possible. (Level 2B)
13. Vitamin D supplementation
Support access to recommended doses of daily or weekly vitamin D supplements for older people deficient in vitamin D or with little sunlight exposure (i.e., less than 5-15 min exposure, four to six times per week) unless contraindicated. (Level 1B)
Avoid high monthly or yearly mega doses of vitamin D as these can increase the risk of falls. (Level 1A)
14. Osteoporosis medicines
Facilitate access to prescribed osteoporosis medicines for older people with diagnosed osteoporosis or a history of minimal trauma fractures, unless contraindicated. (Level 1A)
The resources include:
Recommendations for hospitals
The Falls Guidelines for Hospitals have four evidence-based recommendations.
1. Education
Provide tailored education about fall prevention to older people who wish to participate, and to all staff and families. (Level 1B)
2. Tailored interventions
Provide tailored multifactorial fall prevention interventions for all older people based on an assessment of individual risk factors. (Level 2B)
Calculating a fall risk score is not necessary. (Level 2B)
3. Hip fracture care
Following a hip fracture in an older person, provide post-operative care in a geriatric orthopaedic service with multidisciplinary comprehensive geriatric assessment, management and rehabilitation. (Level 1B)
4. Home safety after discharge
As part of discharge planning, arrange home safety interventions delivered by an occupational therapist for older people at an increased risk of falls after they have returned home. (Level 1A)
The resources include:
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