TOPIC

1
Falls in older people: the impacts

Why have this programme about reducing harm from falls? 2

What the 10 Topics cover 2
How you can use Topic 1 2
Key messages in Topic 1 3
What Topic 1 covers 3
Why we should make older people a priority 4
What the number of falls in older people tells us 5
Reducing harm from falls in New Zealand 5
How to identify risk factors and hazards 6
Why two specific risk factors are important 6
What are the impacts when an older person falls? 7
What a duty of care means in practice 9
60 minutes of professional development 9
+30 minutes of recommended viewing 10
Professional development: questions to test your knowledge 11
References 12

May 2022, v2
 TOPIC 1 – FALLS IN OLDER PEOPLE: THE IMPACTS 2

Why have this programme about reducing harm from falls?

On the International Day of Older Persons in 2012, Ban Ki-moon, then United Nations Secretary-General,
reminded us:
Longevity is a public health achievement, not a social or economic liability... let us pledge to ensure
the well-being of older persons, and to enlist their meaningful participation in society so we can all
benefit from their knowledge and ability. (World Health Organization 2012)
Ideally, no older person would come to harm as the result of a fall. We can help accomplish this if everyone
including the older person and every service involved in the care of older people take every possible step to
prevent falls and reduce harm from falls. The result would be a health service achievement, and a social and
economic contribution.
Unfortunately, most people who injure themselves in falls do so in the community – at home or when out
and about (De Raad 2012). To achieve a real difference requires a whole-of-health-system approach across
primary care, aged residential care (ARC) and hospital care.
By adopting a population-health perspective as part of our ‘duty of care’ approach, we are committed to
supporting older people in positive actions (such as active lifestyles and appropriate exercise programmes
to ‘stay on their feet’). Preventing falls and falls-related injuries in the community gives a good return on
investment by reducing hospital admissions for falls-related injuries and admissions to ARC, while helping older
people maintain their independence and quality of life (Robertson and Campbell 2012).
If we acknowledge falls are everyone’s business, do you consider older people on the liability side of the ledger
or falls prevention for older people as a worthwhile investment?

What the 10 Topics cover

The 10 Topics in this series are:

• Topic 1: Falls in older people: the impacts
• Topic 2: Which older person is at risk of falling? Ask, assess and act
• Topic 3: Falls risk assessment: a multifactorial approach
• Topic 4: Addressing risk factors in an individualised care plan
• Topic 5: Safe environment and safe care are essential to prevent falls
• Topic 6: After a fall: what should happen?
• Topic 7: Why hip fracture prevention and care matter
• Topic 8: Medicines: balancing intended benefits and increased falls risk
• Topic 9: Improving strength and balance to prevent falls
• Topic 10: An integrated approach to falls in older people: what part can you play?
You can also find an evidence resource page with many of the key guidelines, systematic reviews, meta-
analyses, and toolkits and guides here.

How you can use Topic 1

Use Topic 1 as:

• an information resource that explains the evidence of, and rationale for, preventing older people from falling
• a 60-minute professional development exercise (see 60 minutes of professional development in
this resource).

May 2022, v2
 TOPIC 1 – FALLS IN OLDER PEOPLE: THE IMPACTS 3

Key messages in Topic 1

• Many more people are living longer in generally good health, yet the risk of falling increases with age.
• The burden that falls and falls-related injuries impose on an older person, their family/whānau, carer,
health services and the national economy can be severe.
• By helping to prevent a significant proportion of these falls, we can reduce falls-related costs, the
number of falls-related injuries (such as fractures and head injuries), and psychological impacts.
• The nationwide reducing harm from falls programme helped reduce the number of hip fractures in
hospitals in 2013–16.
• Yet most hip fractures occur in the community – estimated at 30 hip fractures for every one hip fracture
in a hospital setting. We need to try harder to help reduce harm from falls in older people, whether they
are in ARC facilities, at home, or out and about.
• The 10 Topics in reducing harm from falls set out a systematic and evidence-based approach to both
assessing risk and implementing care plans tailored to each older person. This approach aims to prevent
harm from falls in all settings.

Key evidence sources for all 10 Topics can be found at the evidence resource page.

What Topic 1 covers

Topic 1 outlines how a fall can be a life-changing event for an older person, impacting on their
independence and wellbeing, with implications for their family/whānau and significant others. The burden
that falls and falls-related fractures impose on an older person, their family/whānau, carer, health services and
the national economy can be severe. It is possible to prevent a significant proportion of these falls. Topic 1
also introduces the remaining nine topics, which explain what interventions to put in place to prevent harm
from falls.
In this first topic we’ll set the scene for the 10 Topics, and explain why the national programme aimed to
prevent falls and reduce harm from falls at individual, health system and population levels by encouraging
the implementation of effective interventions. Overall, the Health Quality & Safety Commission (the
Commission) works toward the New Zealand Triple Aim for health quality improvement, aiming for improved
quality, safety and experience of care; improved health and equity for all population; and best value for
public health system resources.
First we should explain reasons for the focus on ‘older people’ in this context.

May 2022, v2
 TOPIC 1 – FALLS IN OLDER PEOPLE: THE IMPACTS 4

!
Why we should make older people a priority Why choose to focus on
There are evidence-based and pragmatic reasons for making older people older people when people
(generally those over 65) (Statistics New Zealand 2000; Woodhouse 2013) the of all ages fall and sustain
priority in the national falls programme. falls-related injuries?
• Falls happen at all ages, but for older people, a high incidence of falls
combines with: (1) high susceptibility to injury because of age-related
physiological changes (such as slower protective reactions and loss of muscle mass); and (2) high
prevalence of clinical conditions implicated in increasing risk of falling (such as postural hypotension) or
risk of injury (such as osteoporosis) (Rubenstein 2006).
• Overall, studies of patient safety show that older people are much more at risk of adverse health events
than the young and middle-aged (Leape et al 1991; Oliver 2012; Woodhouse 2013).
• Good evidence shows we can prevent older people from falling (Sherrington et al 2019; Hopewell et al 2018).

Trends in improved health and more effective health care have seen an
… increasingly the increase in the number of older people living longer. That group ranges
story of patient safety in from people who are generally healthy and active to people who are very
hospitals is in essence the frail or debilitated (Clegg et al 2013; Robertson and Campbell 2012). Given
story of older patients. the increased number, more people will be at risk of falling and the burden
(Oliver 2012)
of falls in our community is set to rise.
Although the incidence of falling increases with age, studies have found
older people living in the community are ‘unrealistically optimistic’ about
falling. A majority (88 percent) believe falls are a potential problem for their
age group, yet only a minority (37 percent) believe this risk applies to them (Dollard et al 2013). This view is
despite many falls happening at home from standing height.
Older people living in ARC have even higher rates of falling and more serious falls-related injuries than older
people living in the community, with 10–25 percent of falls resulting in fracture or laceration (Rubenstein
2006) and as many as 5 percent resulting in intracranial bleeding (de Wit et al 2020).
For older people admitted to hospital, the vulnerability of being unwell is increased by the unfamiliar
environment and risks associated with treatment. Despite their right to safe care (Health and Disability
Commissioner 2009), too many patients fall and suffer injuries when they are in our care. Falls are consistently
one of the leading causes of serious injuries reported by hospitals to the Commission as adverse events.

May 2022, v2
 TOPIC 1 – FALLS IN OLDER PEOPLE: THE IMPACTS 5

3
2 4
1 0 5
9 6
87

What the number of falls in older people tells us

Here is what the numbers tell us.
• Overall, around 30 percent of people aged 65 and over who live in the community will fall at least once a
year. Most will not be seriously injured, but about 5 percent will have a fracture or require hospitalisation
related to a fall.
• Each year about 4000 New Zealanders fall and break a hip.
• Thirteen percent of residents in New Zealand aged care facilities had a fall in the previous 30 days, and 55
percent had a fall-related physical injury (Carryer et al 2017).
• Falls account for 74 percent of trauma admissions in older people. Of these, 4 percent result in the person
dying (Fairfax et al 2015).
• Falls and injury rates rise with age and the figures double for people aged over 75 who live in the
community (Bergen 2016; Rubenstein 2006).
• In one New Zealand study of Māori over 80 and non-Māori over 85, 37 percent of people reported a fall in
the preceding year, and 7 percent of those had four or more falls. Of the people who fell, 35 percent were
injured and 10 percent sustained a fracture (LiLACS NZ 2014).
• Falls also occur in hospital. For example, one study noted a fall rate after surgery of 0.8–16/1000 person
days, and 5–20 percent of these falls resulted in the person being severely injured (Kronzer et al 2016).
• Overall, the vast majority of falls occur in the community – estimated at 30 falls for every one fall in hospital
(Accreditation Canada et al 2014; Jones et al 2016).

Reducing harm from falls in New Zealand

A national programme, reducing harm from falls (2013–15), saw the Commission (as the lead agency) partnering
with the ACC and other stakeholders across the health sector. The programme implemented quality and safety
markers as a way to help drive change by giving providers feedback about the uptake of two care processes
known to be effective in preventing falls: risk assessment and care planning.
Over three years this programme to target inpatient falls saw a nationwide reduction in hip fractures resulting
from falls occurring in hospital – from 12 per 100,000 admissions to 8 per 100,000 admissions (Jones et al 2016).
Following this success, the Ministry of Health’s Healthy Ageing Strategy (2016) also called on hospitals
to continue to improve their strategies to reduce the number of falls and harm from falls. Those strategies
include using data to identify older people at risk and improving the quality of care for those admitted due to
falls and fractures.
The success of the reducing harm from falls programme in reducing inpatient hip fractures shows it’s possible
to coordinate national-level interventions. But this early success notwithstanding, the overall evidence more
strongly supports community interventions than those in hospitals and care facilities. In the community is also
where more than 95 percent of falls occur. The 10 Topics elaborate on this evidence base and a range of clinical
guidelines and standards, toolkits and guides are detailed in the reducing harm from falls evidence base.
Additionally, the Live Stronger for Longer initiative, supported by ACC and the Commission, is now in place and
resources can be ordered, downloaded or shared online by visiting the website www.livestronger.org.nz.

May 2022, v2
 TOPIC 1 – FALLS IN OLDER PEOPLE: THE IMPACTS 6

How to identify risk factors and hazards

Falls in older people are often categorised as being an ‘accident’ caused by an identified hazard in the
environment, according to a review of studies looking at causes (Rubenstein 2006).
Yet the interaction between the hazard and the person’s accumulated age-related changes in functioning and
disease processes causes the fall, not the hazard by itself. For instance, age-related vision, hearing or memory
impairments increase the potential for tripping, slipping or stumbling. And an older person’s balance-correcting
strategies are less effective or not effective in regaining balance (Rubenstein 2006).
We can improve both sides of this interaction: we can remove or minimise environmental hazards, and actively
manage or support many age-related impairments and conditions to reduce an older person’s risk of falling
(Miake-Lye et al 2013; Rubenstein 2006).
A review of controlled studies identified the following important risk factors
for falls: A fall is often the result
of interactions between
• muscle weakness
[person]-specific risk
• deficits in balance, gait and vision factors and the physical
• limited mobility environment. (Miake-Lye
• impairments in cognition and functional status et al 2013)
• postural hypotension (Robertson and Campbell 2012).

Other risk factors consistently found to increase the risk of falling include:
• the use of psychoactive medications • arthritis
• the use of multiple medications (polypharmacy) • diabetes mellitus
• depression • urinary incontinence (Delbaere et al 2010)
• dizziness • chronic pain.
• limitations to activities of daily living
An older person may have just one risk factor. Yet, as the above risk factors show, it’s quite likely that a person’s
risk profile may have several interrelated factors (such as muscle weakness and impaired mobility) that
compound their risk of falling. At the same time, an older person’s health or treatment profile may also reveal
factors such as osteoporosis or anticoagulant therapy that increase the possibility of harm should they fall.

Why two specific risk factors are important Why not reduce the
Two important risk factors for falls and falls outcomes deserve special mention: number of falls-related
frailty and cognitive impairment. hospital admissions by
helping older people ‘stay
Risk factor 1: Frailty on their feet’?
Frailty is a key risk factor for falls (Hubbard et al 2015). In the first systematic
review of studies examining frailty as a predictor of falls in the community,
results pooled from 11 studies (incorporating 68,723 individuals) showed that
frailty (assessed using a variety of methods) predicts an increased risk of falls (Kojima 2015). Frail people or those

May 2022, v2
 TOPIC 1 – FALLS IN OLDER PEOPLE: THE IMPACTS 7

nearing frailty were 1.84 times more likely to fall. This underscores the need to assess for frailty and provide falls
prevention interventions tailored to each frail older person. A key goal of the 2016 Healthy Ageing Strategy is
to slow or stop older people progressing toward frailty (Associate Minister of Health 2016). A position statement
from the Australian and New Zealand Society for Geriatric Medicine offers guidance on identifying and
managing frailty (Hubbard et al 2015), and the Commission has published a range of frailty care guides to assist
with care of the frail elderly.

Risk factor 2: Cognitive impairment

Injury is the most common reason why people with dementia are admitted to hospital. Of hospitalised patients
who suffer from dementia, 90 percent are hospitalised because they have fallen (Harvey et al 2016). An Australian
study found that, compared with people without dementia, people with dementia are 4.3 times less likely to
receive rehabilitation while in hospital. However, when the person does receive rehabilitation they achieve
significant motor functional gain after being discharged from hospital (Harvey et al 2016).
We should not view cognitive impairment as a barrier to falls prevention interventions for older people. A report
on interventions for reducing harm from falls in those with cognitive impairment explains how. Individuals
with cognitive impairment respond to many of the falls prevention strategies that those without cognitive
impairment undertake. Often intervention actions just require close supervision and care. For example, a
systematic review concluded that long-term exercise programmes reduce the number of falls in older people
with cognitive impairment (Lewis et al 2017). Many of the same guideline-based fall and fracture prevention
interventions apply to this group of people who have an even higher risk of falling.
We know that health professionals and carers vary in their ability to meet the needs of people with cognitive
impairment and dementia, there are knowledge gaps, and additional training may be required (Bamford et al
2018; Francis-Coad et al 2019). Close care with dignity is important. Both frailty and cognitive impairment are
discussed in more detail in the other nine topics.

What are the impacts when an older person falls?

Impact 1: Fractures and head injuries
The most serious injuries resulting from falls are fractures and head injuries (Miu et al 2016).
Falls account for 85 percent of traumatic brain injury in elderly trauma patients. Mortality from these injuries
increases with age (Hawley et al 2017); if a person is taking oral anticoagulants, the mortality doubles (due to the
increased risk of bleeding) (Inui et al 2014). The incidence of intracranial bleeding after a ground-level fall in the
older population may be as high as 5 percent (de Wit et al 2020).
Hip fracture is the most common fracture after age 75 and has serious implications (Rubenstein 2006). Outcomes
following hip fracture have a high impact on independence – and implications for families/whānau. Half of
all patients with a hip fracture will need ongoing support with daily living or getting and keeping mobile
(Osteoporosis New Zealand 2012). The Australian and New Zealand Hip Fracture Registry indicates that 10
percent of those who fractured their hip in New Zealand had died within 120 days, of survivors only 79 percent
had returned to their private residence, and only 21 percent had returned to their pre-fracture level of mobility
(ANZHFR 2019).
Impact 2: Psychological harm and fear
Even without physical injury, a fall can create a loss of confidence and anxiety in the person and their family/
whānau or caregiver. Fear of falling can create a downward spiral in which physical and social activities are
restricted unnecessarily. This can lead the person to avoid activity, become physically deconditioned, suffer
increased frailty and become psychologically distressed, depressed and isolated – all leading to a poorer quality
of life (Delbaere et al 2010; Faes et al 2010).

May 2022, v2
 TOPIC 1 – FALLS IN OLDER PEOPLE: THE IMPACTS 8

The psychological impact of falling includes fear and anxiety – and even post-traumatic stress disorder – in
the older frail who fall at home (Bloch 2017). Fear of falling affects more than 50 percent of older people
in long-term care, and is associated with falls, functional impairments, depression and poor quality of life
(Lach and Parsons 2013). Fear of falling is seen in 3–85 percent of older people living in the community who
fall and up to 50 percent of older people who have never fallen (Parry et al 2016; Shoene et al 2019). Social
support does not compensate for the negative impact when the older person’s fall causes them to reduce
or stop participating socially. An older person’s fall affects not just their mobility, but body image, mental
health and capacity to participate (Ehlers et al 2018). The importance of preventing falls is clear.
Impact 3: Costs
Falls have direct costs for the initial treatment of falls-related injuries and longer-term costs such as
residential care. Further cost is incurred as older people typically take longer to recover, with inactivity and
loss of condition contributing to an increased risk of further falls (Delbaere et al 2010; Rubenstein 2006).
More than 25,000 people across Australia and New Zealand break their hip each year, with the cost to the
economy approximately $1 billion annually (ANZHFR 2019).
An evaluation of the reducing harm from falls programme conducted in 2016 reported that it helped to
prevent an estimated 67 fractured hips in hospitals over three years, saving $2.8 million in total avoidable
costs (Appleton-Dyer et al 2016). Given that about 30 times more falls occur in the community than in
hospital (Accreditation Canada et al 2014; Jones et al 2016), there is great scope for scalability of these
savings as we extend falls prevention successes outside hospitals. Economic evaluations indicate that a
range of falls prevention strategies are cost-effective in New Zealand (and sometimes cost-saving), these
include strength and balance exercise programmes (Deverall et al 2017), home safety assessment and
modification (Pega et al 2016), and expedited cataract surgery (Boyd et al 2019).

   Psychological impact on patients: a patient’s story

Betty is a 93-year-old woman with a history of falling. Her daughter Barbara talks about what happened when
avoidable environmental factors (a cluttered toilet space) interacted with her mother’s risk factor of impaired
mobility (for which she was using a walker) to cause a fall. Barbara talks about the impacts for her mother and
the family. You can read a summary or watch the video (2 minutes 1 second) of Barbara talking about her
mother’s fall. TRANSCRIPT VIDEO

   Psychological impact on staff: a health professional’s story

Patient falls also affect staff and health services. Health professionals often feel a sense of dismay and failure
when a patient is harmed in a fall, not least because they are aware of the possible outcomes for the patient
and the patient’s family.
You can read a transcript or watch the video (1 minute 22 seconds) of health professionals talking about
patient falls. TRANSCRIPT VIDEO

May 2022, v2
 TOPIC 1 – FALLS IN OLDER PEOPLE: THE IMPACTS 9

What a duty of care means in practice

Although all health care carries some risk, the proportion of admissions associated with an adverse event while
in hospital in New Zealand is unacceptably high – estimated at 12.9 percent (Davis et al 2002). And while a
‘duty of care’ means that managers, professionals, caregivers and other support workers want to make safe
environments and safe care a priority, we can involve patients, and families/whānau, in learning how to reduce
the older person’s risk of falling while in hospital or when they are discharged from hospital.
Resources that outline some simple safety practices for older people are available here:
• Falls hurt: patient information
• (ACC) Staying safe in your home.

We recommend these leaflets to you as a reminder about the basics of living and working in a safe environment.
More importantly, you can use the two educational resources with your patients to help keep them safe in the
hospital environment and at home after discharge. The checklists in the leaflets enable you to work through
relevant risk factors and actions with your patient and their family/whānau.
Additionally, strength and balance exercise is proven to reduce falls and may be the only measure some older
people living in the community need. You can encourage older people to find a strength and balance exercise
programme near them. Finally, consumer feedback has taught us that it is important to ensure that the older
person, their carers and/or family and whānau understand the reasons why falls need to be avoided, why the
interventions are important and what the evidence base means.

60 MINUTES OF PROFESSIONAL DEVELOPMENT

60
MINUTES
This learning activity equals 60 minutes of your professional development.
You can add it to the personal professional record you keep to check off your
competence framework requirements.
To complete this learning activity, first read the whole topic and the five required
readings, then assess your learning with the 10 self-test questions.

Learning objectives
Reading and reflecting on Topic 1 and the materials in this teaching and learning package will enable you to:
• outline why we should make the topic of older people falling a priority
• describe possible impacts and outcomes when older people fall
• review a fall incident in relation to hazards in the physical environment or risk factors specific to a particular
person
• explore what ‘a duty of care’ means in relation to older people who fall.

Teaching and learning package

Gather up the resources you’ll need. Use the hyperlinks in this topic, or download or print the reference material.
Required reading
These five readings will help you form evidence-informed perspectives about the impact of falls on older people.
1. Reducing harm from falls in hospital: the facts
2. Reducing Harm from Falls (New Zealand Medical Journal article)
3. Patient story, staff perspective
4. (ACC) Staying safe in your home
5. Falling costs: the case for investment (summary)

May 2022, v2
 TOPIC 1 – FALLS IN OLDER PEOPLE: THE IMPACTS 10

+30 MINUTES OF RECOMMENDED VIEWING

These two audiovisuals are relevant to many of the 10 Topics, but are
recommended as a good overview with Topic 1 being an introduction. Viewing
them will help you relate evidence and best practice to real-life initiatives.

30
MINUTES
If you watch the video ‘Preventing falls in hospital’, you don’t need to click
through for the patient’s story or the health professional’s story, as both
items are extracted from that video.
1. Preventing falls in hospitals (2 versions):
Short summary version (7 minutes 50 seconds)
Full-length version (13 minutes 30 seconds)
2. Staying safe on your feet at home (12 minutes 26 seconds)

May 2022, v2
 TOPIC 1 – FALLS IN OLDER PEOPLE: THE IMPACTS 11

1O QUESTIONS
TOPIC Professional development:
1 questions to test your knowledge PROFESSIONAL
DEVELOPMENT
ANSWER these questions to check you have retained the knowledge reviewed in this topic and readings ACTIVITY

1 Reasons why the national falls programme included a focus on falls in older people are:

ANSWER
the incidence of falling increases with age
an older person is highly susceptible to injury
an older person typically takes longer to recover from a falls-related injury
fear of falling can create a downward spiral for an older person
all of the above
2 The infographic ‘Harm from Falls’ notes the cost of a hip fracture that results in a three-week stay in hospital as:
$13,500.00  $26,000.00  $47,000.00
3 The percentage of admissions associated with an adverse event while in hospital in New Zealand is estimated at:
9.2 percent  12.9 percent  19.2 percent
ASSESS the processes used for assessing the impact of all on older people in your setting

4 Read the Code of Health and Disability Services Consumers’ Rights. Which of the 10 Rights of Consumers and Duties of Providers do you think best

ASSESS
expresses a patient’s right to safe care?

5 If asked to explain the term ‘duty of care’ in your own words, what would you say?

Give an example of your usual practice of putting your understanding of a ‘duty of care’ into action. Use an example from your last week at work.

6 Think about an older person or patient you know. Think about a fall that person has experienced.
Assess how this idea explains their fall:
   A fall is often the result of interactions between [person/patient]-specific risk factors and the physical environment.
   Outline how you think their fall is best explained. Their fall is best explained by:
    factors related to the patient factors related to the environment an interaction between patient and environment factors
Why did you choose one or more of those factors?

7 Examining that specific fall with the benefit of hindsight, what environmental hazards or specific risk factors could have been considered earlier?
1.

2.

3.

4.

5.
Outline three learnings or insights and how you will APPLY them in your practice
8 My first learning/insight is:
APPLY

I will apply it in practice by:

9 My second learning/insight is:
I will apply it in practice by:
10 My third learning/insight is:
I will apply it in practice by:

LEARNER NAME: PROFESSION: DESIGNATION:

DATE: REGISTRATION ID: WORKPLACE:

Validation that learner has completed this professional development activity Signature:
NAME: PROFESSION: CONTACT:
DATE: REGISTRATION ID: WORKPLACE:

For answers to the above self-assessment questions click here. May 2022, v2
 TOPIC 1 – FALLS IN OLDER PEOPLE: THE IMPACTS 12

REFERENCES
Accreditation Canada, Canadian Institute for Health Information, and Canadian Patient Hubbard R, Ng K, Australian, et al. 2015. Australian and New Zealand Society for Geriatric
Safety Institute. 2014. Preventing Falls: From Evidence to Improvement in Canadian Health Medicine: position statement – frailty in older people. Australasian Journal on Ageing
Care. Ottawa: CIHI. 34(1): 68–73.
ANZHFR. 2019. 2019 Annual Report. Australian and New Zealand Hip Fracture Registry. Inui TS, Parina R, Chang DC, et al. 2014. Mortality after ground-level fall in the elderly
patient taking oral anticoagulation for atrial fibrillation/flutter: a long-term analysis of
Appleton-Dyer S, Edirisuriya N, Boswell A. 2016. Reducing Harm from Falls Programme risk versus benefit. The Journal of Trauma and Acute Care Surgery 76(3): 642–9; discussion
Evaluation: A Report for the Health Quality & Safety Commission. Auckland: Synergia. 9–50.
Associate Minister of Health. 2016. Healthy Ageing Strategy. Wellington: Ministry of Jones S, Blake S, Hamblin R, et al. 2016. Reducing harm from falls. NZMJ 129(1446):
Health. 89–103.
Bamford C, Wheatley A, Shaw C, et al. 2018. Equipping staff with the skills to maximise Kojima G. 2015. Frailty as a predictor of future falls among community-dwelling older
recovery of people with dementia after an injurious fall. Aging & Mental Health 15: 1–9. people: A systematic review and meta-analysis. Journal of the American Medical Directors
DOI: 10.1080/13607863.2018.1501664. [Epub ahead of print] Association 16(12): 1027–33.
Bergen G. 2016. Falls and fall injuries among adults aged≥ 65 years—United States, 2014. Kronzer VL, Wildes TM, Stark SL, et al. 2016. Review of perioperative falls. British Journal of
MMWR. Morbidity and Mortality Weekly Report 65. Anaesthesia 117(6): 720–32.
Bloch F. 2017. Literature review and meta-analysis of risk factors for delayed post- Lach HW, Parsons JL. 2013. Impact of fear of falling in long term care: an integrative
traumatic stress disorder in older adults after a fall. International Journal of Geriatric review. Journal of the American Medical Directors Association 14(8): 573–7.
Psychiatry 32(2): 136–40.]
Leape LL, Brennan TA, Laird N, et al. 1991. The nature of adverse events in hospitalized
Boyd M, Kvizhinadze G, Kho A, et al. 2019. Cataract surgery for falls prevention and patients: results of the Harvard Medical Practice Study II. New England Journal of Medicine
improving vision: modelling the health gain, health system costs and cost-effectiveness 324(6): 377–84.
in a high-income country. Injury Prevention. DOI: 10.1136/injuryprev-2019-043184. [Epub
ahead of print]. Lewis M, Peiris CL, Shields N. 2017. Long-term home and community-based exercise
programs improve function in community-dwelling older people with cognitive
Cameron I, Gillespie L, Robertson M, et al. 2012. Interventions for preventing falls in impairment: a systematic review. Journal of Physiotherapy 63(1): 23–9.
older people in care facilities and hospitals. Cochrane Database of Systematic Reviews
12(CD005465). LiLACS NZ. 2014. Falls in advanced age: Findings from LiLACS NZ.
Carryer J, Weststrate J, Yeung P, et al. 2017. Prevalence of key care indicators of pressure Miake-Lye I, Hempel S, Ganz D, et al. 2013. Inpatient fall prevention programs as a patient
injuries, incontinence, malnutrition, and falls among older adults living in nursing homes safety strategy: a systematic review. Annals of Internal Medicine 158(5 (Pt 2)): 390–6.
in New Zealand. Res Nurs Health 40(6): 555–63.
Miu J, Curtis K, Balogh ZJ. 2016. Profile of fall injury in the New South Wales older adult
Clegg A, Young J, Iliffe S, et al. 2013. Frailty in elderly people. The Lancet 381(9868): population. Australasian emergency nursing journal 19(4): 179–85.
752–62.
Oliver D. 2012. Managing risk in older hospital inpatients. SAGE Publications.
Davis P, Lay-Yee R, Briant R, et al. 2002. Adverse events in New Zealand public hospitals I:
occurrence and impact. NZMJ 115(1167): U271. Osteoporosis New Zealand. 2012. Bone Care 2020: A systematic approach to hip fracture
care and prevention for New Zealand. Wellington: Osteoporosis New Zealand.
De Raad J. 2012. Towards a value proposition… scoping the cost of falls. Wellington: NZ
Institute of Economic Research. Osteoporosis New Zealand. 2014. Fracture Liaison Services Resource Pack. Wellington:
Osteoporosis New Zealand.
de Wit K, Merali Z, Kagoma Y, Mercier E. 2020. Incidence of intracranial bleeding in seniors
presenting to the emergency department after a fall: A systematic review. Injury 51(2): Parry SW, Bamford C, Deary V, et al. 2016. Cognitive-behavioural therapy-based
157–63. intervention to reduce fear of falling in older people: therapy development and
randomised controlled trial – the Strategies for Increasing Independence, Confidence
Delbaere K, Close JC, Heim J, et al. 2010. A multifactorial approach to understanding fall and Energy (STRIDE) study. Health Technology Assessment (Winchester, England) 20(56):
risk in older people. Journal of the American Geriatrics Society 58(9): 1679–85. 1–206.
Deverall E, Kvizhinadze G, Pega F, et al. 2018. Exercise programmes to prevent falls Pega F, Kvizhinadze G, Blakely T, et al. 2016. Home safety assessment and modification to
among older adults: modelling health gain, cost-utility and equity impacts. Inj Prev. DOI: reduce injurious falls in community-dwelling older adults: cost-utility and equity analysis.
10.1136/injuryprev-2016-042309. [Epub ahead of print] PubMed PMID: 29363590. Injury Prevention 22(6): 420–6.
Dollard J, Barton C, Newbury J, et al. 2013. Older community-dwelling people’s Robertson M, Campbell A. 2012. Falling costs: the case for investment. Dunedin: University
comparative optimism about falling: A population-based telephone survey. Australasian of Otago.
Journal on Ageing 32(1): 34–40.
Royal College of Physicians. 2016. National Hip Fracture Database annual report 2016.
Dyer SM, Crotty M, Fairhall N, et al. 2016. A critical review of the long-term disability London: RCP.
outcomes following hip fracture. BMC Geriatrics 16: 158.
Rubenstein L. 2006. Falls in Older People: epidemiology, risk factors and strategies for
Ehlers MM, Nielsen CV, Bjerrum MB. 2018. Experiences of older adults after hip fracture: prevention. Age and Ageing 35(Suppl 2): ii37–ii41.
an integrative review. Rehabilitation 43(5): 255–66. DOI: 10.1097/rnj.0000000000000096.
Schoene D, Heller C, Aung YN, et al. 2019. A systematic review on the influence of fear
Faes MC, Reelick MF, Joosten-Weyn Banningh LW, et al. 2010. Qualitative study on of falling on quality of life in older people: is there a role for falls? Clin Interv Aging 14:
the impact of falling in frail older persons and family caregivers: foundations for an 701–19.
intervention to prevent falls. Aging & Mental Health 14(7): 834–42.
Sherrington C, Fairhall NJ, Wallbank GK, et al. Exercise for preventing falls in older people
Fairfax LM, Hsee L, Civil I. 2015. An ageing trauma population: the Auckland experience. living in the community. Cochrane Database Syst Rev 2019, Issue 1, Art. No. CD012424.
NZMJ 128(1414): 36–43.
Statistics New Zealand. 2000. Population ageing in New Zealand. Wellington: Statistics
Francis-Coad J, Hang JA, Etherton-Beer C, et al. 2019. Evaluation of care staff knowledge, New Zealand.
confidence, motivation and opportunity for preventing falls in residential aged care
settings: A cross-sectional survey. Int J Older People Nurs 14(2): e12224. Technical Advisory Group for Community Group Strength and Balance Programmes.
2016. Community Group Strength and Balance Programmes: ACC Commissoned
Gillespie L, Robertson M, Gillespie W, et al. 2012. Interventions for preventing falls in older Independent Strength and Balance Technical Advisory Group.
people living in the community. Cochrane Database of Systematic Reviews 9(CD007146).
Technical Advisory Group for In-home Strength and Balance Programmes. 2016. In-
Harvey L, Mitchell R, Brodaty H, et al. 2016. The influence of dementia on injury-related home Strength and Balance Programmes: ACC Commissoned Independent Strength
hospitalisations and outcomes in older adults. Injury 47(1): 226–34. and Balance Technical Advisory Group.
Hawley C, Sakr M, Scapinello S, et al. 2017. Traumatic brain injuries in older adults – Woodhouse K. 2013. Treating older people. European Journal of Clinical Pharmacology
6 years of data for one UK trauma centre: retrospective analysis of prospectively collected 69(1): 53–7.
data. Emergency Medicine Journal 04: doi:10.1136/emermed-2016–206506.
World Health Organization. 2012. Press release for International Day of Older Persons.
Health and Disability Commissioner. 2009. Code of Health and Disability Services
Consumers’ Rights. Wellington: Health and Disability Commissioner.
Hopewell S, Adedire O, Copsey BJ, et al. Multifactorial and multiple component
interventions for preventing falls in older people living in the community. Cochrane
Database Syst Rev 2018, Issue 7, Art. No. CD012221.

May 2022, v2