All seniors benefit from fall prevention exercise regardless of diagnosis

All older people in the community should be supported to undertake exercises tailored to their ability that target balance, mobility and strength to prevent falls, according to new guidelines that also recommend interventions related to feet, vision, medication and the environment inside and outside of the home.

The 32-page Falls Guidelines for Community Care has 14 recommendations for older Australians living in the community and those who care for them.

The complete Falls Guidelines 2025 release was published by the Australian Commission on Safety and Quality in Health Care on Thursday. As outlined in this report on Australian Ageing Agenda, it includes 25 recommendations plus complementary good practice points targeting falls prevention among older people across residential aged care, community care and hospital settings.

Coming more than 15 years after the previous 2009 edition, the guidelines have been authored by experts Dr Jasmine Menant, Professor Cathie Sherrington, Dr Suzanne Dyer and Professor Stephen Lord following a five-year project combining the latest research and community feedback.

All recommendations are based on interventions proven to make a difference, said Professor Lord – a scientia professor at the University of New South Wales and a senior principal research fellow at Neuroscience Research Australia.

“Where ours differs a little bit from other ones is it’s got the overall approach in the evidence base, but it looks at particular factors too,” Professor Lord told Community Care Review.

“If you’re looking after someone and the person has a problem with their continence, or they’ve got painful feet, dizziness or vertigo, there’s a chapter there that says, ‘well, this is what you should do for this individual in terms of this risk factor’.”

Screening and how that can be put in place are among the key interventions, including simply initially inquiring about whether a person has fallen in the past, said Professor Lord.

“That’s a big flag because people who have fallen before are likely to fall again. And then if that’s the case, have some simple screening tests and balance tests to identify the level of risk and to inform a better assessment.”

However, it should not be screening for screening’s sake, he stressed, but rather to inform a suitable intervention to prevent falls. The guidelines also feature a range of different interventions focused on challenging exercises targeting balance and mobility.

“We recommend ongoing exercise for everybody, and there’s evidence now that people who’ve got a cognitive impairment or Parkinson’s disease … will also benefit from exercise programs,” Professor Lord said.

Conditions including cognitive impairment, dementia or Parkinson’s disease should not be a barrier to any intervention, he said. There’s always something a person can do and programs should be tailored to the individual and their abilities and issues, he added.

“You target, you make it appropriate, and you get benefits in terms of mobility and fall reduction. That’s been shown to be the case,” Professor Lord said.

“There’s a whole section on modifying environments for people who’ve got cognitive impairment. So again, [not] disregarding those people at all, but adapting it so that it is appropriate, because the fall rate in such people is about twice that of people who don’t have cognitive impairment,” he said.

“About one in three people in the general community are likely to have a fall in a year, but it’s two in three people with a cognitive impairment, and that’s the same in Parkinson’s disease and stroke too. All of these groups need to be included rather than excluded.”

There are also interventions that look at feet and footwear and a targeted podiatry assessment.

“Painful feet is much more common in older people than you might imagine – about a quarter to a third of people – and a targeted podiatry intervention can reduce falls,” said Professor Lord.

“And there are also sections around vision [such as] cataract extraction and also the wearing of – or the non-wearing of – multifocal glasses when people are outside in unfamiliar settings because they’re more likely to trip on an obstacle.”

People are more likely to trip when wearing a multifocal because the bottom section is designed for near vision.

“And yet, we look out at the bottom part of our glasses for trip hazards of course. So there’s good evidence that wearing multifocals – bifocals, trifocals, doesn’t matter which one – increases the risk of falls. And if people restrict the use of these when they’re outside, they significantly have reduced rate of falls,” Professor Lord said.

The guide also covers medication management including the minimisation and safe use of multiple drugs, plus psychoactive drugs like sleeping tablets and anti-anxiety agents, which are implicated in falls.

“They’re known as falls risk increasing drugs. So the careful management of those is important,” said Professor Lord.

Anyone at increased falls risk – such as those who have recently been in hospital or people with visual impairment – benefit from an occupational therapy intervention looking at the environment to minimise hazards in the home, he said.

“But importantly, also working with the older person to make sure they’ve got safe mobility in the home,” Professor Lord said. “It seems to be a combination of not just removing the hazards but working with a person to negotiate, in simple terms, their home and outside environments. It’s crucial.”

Other sections of the guidelines relate to fall injury protection, including work on hip protectors, vitamin D, calcium and the management of osteoporosis.

“They’re all targeted to if a person does fall, how can you reduce the risk of breaking the bone in particular.”

Recommendations for community settings

Of the 14 recommendations in the Falls Guidelines for Community Care, there are five related to 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:

• the best-practice guidelines for community care in Australia
• a fact sheet for health professionals on preventing falls in community care.

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