Part 3 Falls in Older Community‐Dwelling People

For the purpose of the Community Guidelines, the definition of a fall is that adopted by the World Health Organisation [33]. A fall is an event which results in a person coming to rest inadvertently on the ground or floor or other lower level. This definition excludes falls resulting from an intentional change in position, but does include those where the person inadvertently comes to rest on furniture, against a wall or other objects [32]. Valid data on the rate of falls in the community is difficult to obtain because of reliance on self-reporting which may underestimate the true incidence [33, 34]. Despite these limitations, Australian and overseas prospective studies have reported that between 30 percent and 50 percent of community dwelling older adults fall each year, with up to half experiencing multiple falls [35, 36]. In community-dwelling older people about 50 percent of falls occur within their homes and the remainder in public places [35]. Fall rates are higher in older community-dwelling women (40 percent) than in older men (28 percent) Within the older age group, the risk of falling increases with age and the outcomes take on greater significance [4]. The concern is not simply the high incidence of falls in older people, but rather the combination of high incidence and high susceptibility to injury. The propensity for fall-related injury is caused by the high prevalence of clinical diseases (e.g. osteoporosis) and age-related physiological changes (e.g. slowed 18 Queensland Stay On Your Feet ® community good practice guidelines protective responses) that make falls from a standing height (or even lower) potentially injurious [37]. Although most falls produce no serious injury, between five percent and 15 percent of community-dwelling older persons who fall each year do sustain a serious injury such as a fracture, head injury, or serious laceration [35, 38]. An Australian study reported that, of people aged 65 years and over attending an Emergency Department in Sydney, 18 percent presented as a direct consequence of a fall and over half (58 percent) were subsequently admitted [39]. The rate of fall-related injuries requiring hospital admission increases exponentially from the age of 65 years, with age adjusted incidence rates approximately twice as high in women than in men [40]. National data on hospitalisations due to falls among older people in 2003-04 [41] showed that 4.3 percent of all hospitalisations in people aged 65 and over were fall-related. The total …