Falls are common adverse events in residential aged care facilities (RACFs). Reported figures indicate that at least 50% of residents fall in a 12 month period, and that this figure is substantially higher in some at risk populations such as people with dementia where the incidence is 70-80% [1
]. Injuries from falls are also more common for RACF residents than for older people living in their own home, with a study by Kallin et al (2002) reporting injuries associated with 54% of falls, and a third of injuries being fractures [2
]. Another study identified that over half of the fractures sustained from falls by residents were hip fractures, which have an enormous associated personal and societal cost [3
]. Although accurate cost data is not available for costs associated with falls in RACFs in Australia, some data from Europe estimates the costs associated with falls in residential care to be 994EURO/fall (approximately $AUD1,560) [4
There are clear benefits of a multiple strategy approach to falls reduction for older people in residential care settings, both as an intervention and prevention strategy [5
]. Randomised trials have shown that multifactorial interventions, either based on falls risk assessments, or a range of general interventions introduced for all residents can reduce falls in residential care settings [6
]. Single interventions including medication review [9
], vitamin D supplementation [10
], continence management combined with functional training [12
], and staff education [13
] have also been shown to reduce falls. Other interventions such as exercise have had mixed outcomes in residential care settings [14
]. Approaches such as providing information for residents and carers, and strategies to improve observation or surveillance of at risk residents (e.g. bed and chair alarms) are recommended as part of best practice in residential care settings, although there are no randomised trials evaluating the effectiveness of these approaches [5
Previous reviews have shown that the involvement of staff, the method of training provision, staff awareness of falls and staff implementation of evidence based strategies to prevent falls and falls related injuries are areas requiring further exploration [5
Despite the availability of evidence-based guidelines for implementing falls prevention and other interventions in residential aged care, there is moderate evidence that these interventions are not routinely or easily incorporated into routine practice. For example, in a study aiming to implement pain management guidelines and falls prevention guidelines in residential care settings, less than 45% of facilities participating in a training program regarding the guidelines actually implemented the one or the other of the guidelines [18
]. While there was some evidence of practice change in line with the guidelines in some of the facilities, a range of barriers to implementation were identified.
Action research is an approach that could be useful in engaging staff in falls prevention interventions and for achieving sustainable practice change. Action research is a process where staff are supported to undertake an investigation into their current practice, recognise problems, envisage possible solutions and take action with the intentions of working towards addressing the problem. Utilising this approach, groups of staff collaborate to take action to identify context specific issues, identify and implement an evidence based approach and in the process support and challenge each other to make progress on the problem [19
]. Action research is a method of choice when a group of people have a desire to work collaboratively to develop new understandings of their situation to address practical problems through locally specific and contextually appropriate forms of action [20
In addition to limitations implementing evidence based practice, few studies have investigated the financial implications of falls prevention strategies in the residential care setting [5
The primary aim of the project is to implement evidence based falls prevention guidelines in nine RACFs in Australia with the intent to reduce falls and falls-related injuries. The approach to be adopted involves multiple strategies to improve falls management. These include: improving RACF staff knowledge and attitudes with respect to falls risk; actively engaging a core group of staff in a process of designing, implementing and evaluating local specific interventions to reduce falls in the context of their participation in action research falls groups in each RACF, and; identifying a range of falls risk factors for individual residents (e.g. undertaking falls risk assessments) and for facilities (e.g. environmental falls risk factors). This project also encompasses an economic evaluation for which additional data to support economic variables will be collected.
The project is funded by the Australian Government Department of Health and Ageing, as part of the "Encouraging Best Practice in Residential Aged Care" (EBPRAC) program. The EBPRAC program aims to improve evidence-based clinical care for residents in aged care homes and to enable nationally consistent application of this care.