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Another video shows a woman
losing her balance when stepping
backwards then landing heavily
on her right side. Robinovitch's
research points to the following
as falls prevention strategies:
ensure furniture and equipment
is stable and clutter is minimised;
and look at ways to improve
balance and recovery strategies.
Currently the evidence
for successful approaches to
preventing falls in residential
aged care is limited. The highest level
of evidence, Cameron's 2012 Cochrane
review, indicates that vitamin D
supplementation is effective, and possibly
a medication review by a pharmacist.
The use of multifactorial interventions,
which include a suite of falls prevention
strategies, is supported by the research
literature, as is staff education.
However, it is less clear that exercise,
as a single strategy, is effective and may
possibly contribute to an increase in falls
in some residents. That's not to say that
exercise programs should be discarded!
Exercise has a range of other very
important benefits and may be effective
in falls prevention if targeted correctly.
Again, additional research is required to
evaluate innovative approaches to exercise
and to understand the most effective
exercise type, dosage and frequency and
crucially, how to maximise adherence.
What can be done? At an individual
level we know that addressing identified
falls risk factors as well as reducing
the risk of injury is required for every
resident. This includes implementing the
proven strategies as well as strategies
that are largely untested in care settings
but may be effective. Examples include
correction of cataracts, use of single vision
distance glasses and environmental hazard
reduction. Secondly, we need to consider
falls as a red flag. A resident who is falling
more frequently than usual should trigger
investigation of what could be causing the
We urgently need to educate the
sector including government, funding
bodies, managers, carers, residents
and their families about the need for
research in residential aged care and
the risks that exist if this research is
not undertaken. Too often research in
residential aged care is placed in the "too
hard" basket: difficult to attract funding,
difficult to recruit participants and
difficult to undertake.
But without well-funded, targeted
research conducted in partnership with
residents and residential care facilities we
will continue to offer band-aid solutions
to the complex issues facing older people
living in residential aged care, one of
which is falls. n
Dr Frances Batchelor is the deputy director
of health promotions and stream leader for
falls and balance at the National Ageing
included in the 2012 Cochrane
Review by Lesley Gillespie
There is simply not enough
research done in residential aged
care to truly understand falls,
their causes and to evaluate a
range of interventions. This leads
to the situation in which many
facilities and aged care providers
are proactive in working with
staff, residents and families in
attempts to prevent falls and
injury, but many of the strategies do not
have a strong evidence base.
So what does work? Complex
problems require complex solutions
and this also applies to residential aged
care where there is no silver bullet for
preventing falls. In order to implement
effective interventions we first need to
understand how and why people fall. This
is particularly challenging in residential
aged care as most falls are unwitnessed
and residents may not always be able to
accurately describe a fall.
Ground=breaking research is providing
valuable insights. Canadian researcher
Stephen Robinovitch has used digital video
recording in communal areas of facilities
(not bathrooms or bedrooms) to capture
falls. The videos are not easy to watch
but clearly show how and why falls occur.
One video shows a resident attempting
to sit down but falling backwards as the
wheelchair rolls away from him.
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