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Kia āta kōwhiri Choosing Wisely

The Choosing Wisely campaign seeks to reduce harm from unnecessary and low-value tests and treatment.

The national falls programme, Reducing Harm from Falls, has aligned its approach with the Commission’s Triple Aim outcomes framework for improving quality and safety:

  • improved quality, safety and experience of care – at the level of the individual
  • best value for public health resources – at a system level
  • improved health and equity for all populations – at a population level.

The expert advisory group (EAG) and programme team are aware of the impact of a fall for an older person (and their family/whanau) and the need to ensure integrated care and system sustainability for the ageing population. The programme is committed to preventing falls and injuries by promoting effective, evidence-based approaches.

We’ve detailed our aims in the first and last of 10 Topics in reducing harm from falls. While Topic 1 looks at the impact of falls in older people, Topic 10 outlines ten priorities and argues that an integrated whole-of-system approach is necessary. Each of the topics is a short summary of current research and up-to-date information in an accessible format, suitable for everyone who has a stake in the wellbeing, coping and independence of older people.

Overall objectives

The 'big picture' aim of the programme is two-fold:

  • to reduce harm associated with older people's falls in care settings
  • supporting older people in the community in taking the positive actions which will help them avoid falls and maintain independence.

A 'duty of care' informs both parts of this aim, as does an analysis of costs associated with falls in older people and a review of the return on investment in various strategies in preventing falls.

The ten priorities set by the national programme relate to:

  • components for effective falls prevention programmes
  • service delivery
  • leadership actions.
Components for effective falls prevention programmes
1 Exercise programmes reduce falls and fall-related injuries in community-living older people. Effective programmes typically include balance retraining and lower limb strengthening exercises.[1] A range of programmes caters to different levels of physical function and personal preferences. More in Topic 9 Improving balance and strength to prevent falls.
2 Multifactorial risk assessment and interventions are recommended for patients at risk of falling and reduce the rate of falls for inpatients[2] and older community-dwellers.[1] More in Topic 3 Falls risk assessment and care planning – what really matters?
3 Home safety assessment and modifications reduce the rate of falls and risk of falls, being more effective for those at higher risk of falling and when delivered by an occupational therapist.[1]
4 Medicine use review to target and modify the use of falls-risk-increasing medicines (especially psychotropics) reduces the rate of falls.[1,3] Prescribed vitamin D supplementation for older people likely to be at risk of vitamin D deficiency/insufficiency may reduce falls. More in Topic 8 Medicines: balancing benefits and falls risks and Topic 7 Vitamin D and falls: what you need to know.
Service delivery
5 Locally developed integrated falls pathway and referral processes, in which ‘any door is the right door’ for assessment of falls risk and referral for appropriate interventions.[4]
6 Systematic approaches to assessment of bone health and fracture risk and appropriate interventions for primary and secondary prevention of fragility fractures; and improvement of fracture care and recovery. More in Topic 6 Why hip fracture prevention and care matters.
7 For older people identified as frail, comprehensive geriatric assessment as a key to safe, compassionate integrated care in primary, long-term care and acute settings, especially for those with problems which contribute to falls risk, such as impaired mobility and dementia.[5,6]
Leadership actions
8 Keep falls on the agenda as everyone’s business. The causes of falls in older people are complex – we should not be surprised that service improvement is more complex than straightforward and will take sustained effort and attention.[7] Using patient stories at all levels is a powerful reminder and motivator.
9 Ensure systems and processes are in place to collect, monitor and analyse data related to fall prevention measures and falls incidents; provide meaningful feedback to those involved to promote learning.

Ensure system capacity and capability for quality improvement and innovative practice for falls prevention. Both evidence and experience-based fall prevention practices require behaviour change and new competencies for staff, and change management to support organisational and system change.[8] Networks can be energising, build resilience and spread knowledge and learning.[9]

  1. Gillespie LD, Robertson MC, Gillespie WJ et al. Interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews (9): CD007146.
  2. Cameron ID, Gillespie LD, Robertson MC et al. 2012. Interventions for preventing falls in older people in care facilities and hospitals. Cochrane Database of Systematic Reviews (12): CD005465.
  3. Blalock SJ, Casteel C, Roth MT et al. 2010. Impact of enhanced pharmacologic care on the prevention of falls: A randomized controlled trial. American Journal of Geriatric Pharmacotherapy 8(5): 428–40.
  4. Ganz DA, Alkema GE, Wu S. 2008. It takes a village to prevent falls: reconceptualizing fall prevention and management for older adults. Injury Prevention 14(4): 266–71.
  5. Clegg A, Young J, Iliffe S et al. 2013. Frailty in elderly people. The Lancet 381(9868): 752–62.
  6. Taylor ME, Delbaere K, Close JC et al. 2012. Managing falls in older patients with cognitive impairment. Aging Health 8(6): 573–88.
  7. Oliver D, Healey F, Haines TP. 2010. Preventing falls and fall-related injuries in hospitals. Clinics in Geriatric Medicine 26(4): 645–92.
  8. Fixsen D, Scott V, Blase K et al. 2011. When evidence is not enough: the challenge of implementing fall prevention strategies. Journal of Safety Research 42(6): 419–22.
  9. Mountford J, Marshall M. 2014. More dialogue, more learning, more action. BMJ Quality & Safety (23): 89–91.
Published: 27 Oct 2021 Modified: 28 Feb 2022