Resources for planning No. 3 - Falls prevention

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Major aims

The major aims of this review are:

• To develop a critical appraisal system for application to falls prevention programs.
• To critically appraise the community-based falls prevention programs identified.
• To identify a means to enable access to the information derived from these processes.
• To develop a database of recent community-based falls prevention programs in Australia.

Executive summary

Falls are common among older Australians living in their own home and can have significant cost to the individual and the community in terms of morbidity and mortality, reduced confidence and activity, as well as financial burden. Many falls prevention programs have been developed in recent years which aim to reduce the frequency and severity of falls, as well as addressing a range of falls risk factors. However, much of this work has occurred in isolation, with minimal communication beyond the local area of development. As a consequence, there can be a duplication of effort; lack of communication about the strengths and weaknesses of programs; and minimal evaluation and reporting of outcomes.

The major aims of this review are:

• To develop a critical appraisal system for application to falls prevention programs
• To critically appraise the community-based falls prevention programs identified
• To identify a means to enable access to the information derived from these processes
• To develop a database of recent community-based falls prevention programs in Australia

This evidence-based planning resource forms part of a review of community-based falls prevention programs commissioned by the Public Health Division, Victorian Department of Human Services, and undertaken by the National Ageing Research Institute. The full report of this work and a database of 131 community-based falls prevention programs complement this evidence-based resource and are available on the Internet as separate resources.

The focus of this review was to ascertain the efficacy of community-based falls prevention programs. A set of evidence-based evaluation guidelines was developed, drawing on available research and expert opinion. The guidelines encompassed the full spectrum of activities pertinent to falls prevention and health promotion programs. This included issues concerning:

• The design and development of programs
• The content of programs (in particular the approach adopted to address the issue of falls)
• The sustainability and effectiveness of programs as reported by organisations directly involved in their implementation

The number of dedicated falls prevention programs increased substantially within the last two years in Australia. A multi-factorial and multi-strategic approach to falls prevention was frequently adopted by organisations. There was also a diverse range of target groups and locations and a variety of individuals involved in implementing programs. A significant number of falls prevention programs were sustainable and measures of sustainability have been incorporated into several new programs.

While programs predominantly aimed to reduce the rates of falls among older people, the primary target group, only a small number have been able to report this as an outcome. Nevertheless, some programs have demonstrated intermediate outcomes, such as improved balance. Other target groups for programs included sub-groups of older people (for example, frail older people receiving Home and Community Care services), as well as medical and other health professionals and families or carers of older people at risk of falling.

The critical appraisal process identified the strengths and weaknesses of the programs included in the review. Most programs performed well in the program design and development and content sections of the evaluation guidelines. Similarly, the majority of organisations could identify processes for sustaining their program and rated highly in this section. In contrast, the limited evaluation of falls prevention programs resulted in very few programs rating well in the evaluation and effectiveness section of the guidelines. Formal evaluation of existing programs will provide a sound basis for informing new program development or in restructuring existing programs in line with the best available evidence in falls prevention.

There remains scope for further refinement of existing programs and development of other innovative approaches to falls prevention for older Australians. The resources from this project will facilitate this development, including increasing networking and sharing of information, while minimising duplication of effort. Together with a range of other current initiatives, the outcomes from this project contribute to the goal of reducing falls and associated injuries among older Australians.

Contents

1. Introduction

• 1.1 Effectiveness in falls prevention

2. Rationale for conducting the review

• 2.1 The epidemiology of falls among older people
• 2.2 Health care costs associated with falls
• 2.3 Falls prevention programs
• 2.4 Scope of the current review

3. Methods

• 3.1 Program review procedure
• 3.2 A review of the epidemiology of falls
• 3.3 A review of falls prevention programs

4. Results and discussion

• 4.1 Factors leading to program development
• 4.2 Awareness of falls prevention programs
• 4.3 Target groups
• 4.4 Consideration of language and cultural background of the target audience
• 4.5 Program objectives
• 4.6 Program accessibility
• 4.7 Involvement of stakeholders
• 4.8 Promotional strategies
• 4.9 Follow-up
• 4.10 Funding sources
• 4.11 Location of programs
• 4.12 Intervention types
• 4.13 Program sustainability and institutionalisation
• 4.14 Program evaluation and effectiveness
• 4.15 Improving the effectiveness of programs
• 4.16 Critical appraisal of program outcomes
• 4.17 Summary and discussion

5. Recommendations for falls prevention strategies

• 5.1 Framework
• 5.2 Project overview: Individualised assessment
• 5.3 Project overview: Structured exercise intervention
• 5.4 Summary

Reference

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Resources for planning: No. 3 falls prevention (512kb, pdf)

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