From cradle to grave: falls represent a lifetime of risk to us all

Public Health Association of Australia

According to the World Health Organization falls are the second leading cause of accidental or unintentional injury deaths worldwide after road traffic injuries. Each year an estimated 646,000 individuals die from falls globally, and more than 80 per cent are from low and middle-income countries.

This week’s Global Injury Prevention Showcase is shining a light on the serious impact of falls, with experts from around the world sharing their knowledge and experience.  Adults over the age of 65 suffer the greatest number of falls and were at the centre of this week’s Showcase. However, the conference also heard about the cause and impact of falls on infants, based on new Australian research.

Understanding the cause of fall injuries for infants

Nipuna Cooray from The George Institute for Global Health told the Showcase that in Australia falls are the most common way that children are injured.

He said while most effective interventions focused on older children, his team studied the impact and cause of falls on infants aged 12 months and younger.

Through the study, 481 fall incidents were identified with the most common fall mechanism involving a fall from furniture (270 incidents, 58.6%).

These falls most commonly involved infants on beds (146), change tables (64) and a chair or sofa (53).

‘I left her in the middle of my queen bed while I did some vacuuming…screaming like she had never screamed before. I ran into the room and she was on the floor.’

The second most common reason for an infant falling was while being carried or supported by someone (92 incidents, 20%). These involved the care taker tripping or slipping, stumbling on stairs of falling asleep while holding the infant.

‘I fell down the last two stairs carrying my one-year-old son. We both fell to the tiled floor.’

The next most common reason for an infant falling involved baby products (e.g. baby capsules, bouncers, prams and high chairs) (55 incidents, 11.9%).

‘Mother of the Year here took a few months to really internalise the ‘strap them in’ message and the baby bounced herself face first out of the bouncer at about three months old.’

The study findings aligned with other hospital record analysis and in the majority of cases parental behaviour was central for prevention.

Falls among older people living independently

While the majority of older people live independently in the community, falls pose a major threat to their health and independence.

Aleksandra Natora from Monash University’s Accident Research Centre told the Showcase that one in three older people fall each year, and governments around the world are struggling to reduce the burden of falls among aging populations and contain costs to health and aged care systems.

Her team’s study explored the policy impact on community falls prevention through a literature review of 107 articles published around the world between 2005 and 2020 (26 of them from Australia).

The preliminary implications and learnings included:

  • Governments assume shared responsibility with others;
  • Considerable international government policy effort in falls prevention in the community setting; and
  • More policy evaluation is needed to ensure public health policy can reduce falls incidence and prevent falls burden on older people in our communities.

Association between mortality, falls and head injuries in nursing homes

Presenter Yijian Yang, from the Chinese University of Hong Kong, told the Showcase the rate of falls for older adults in long-term care was worryingly high, with 50% falling at least once a year.

He said falls were the leading cause of injury related death among older adults and up to 50% of fall-related deaths were due to traumatic brain injury (TBI). In nursing homes nearly one third of falls resulted in head impact but most aren’t diagnosed with TBI.

His study reviewed the lives of 194 residents from two nursing homes in British Columbia, Canada between 2007 and 2016 (117 participants died during the study period).

To better assess the nature and impact of the falls, 280 digital cameras were installed in common areas in the nursing homes (dining rooms, sitting areas and hallways). An expert team reviewed each video to examine the circumstances of each fall, which included that one third of the falls that resulted in a head impact.

The findings of the study included:

  • Those who suffer more than two falls a year will have a shorter life expectancy;
  • Among older adults in long-term care who fall, the average rate of falls was more than five per year, and the average rate of head impacts was one per year; and
  • Mortality is associated more strongly with the occurrence of head impact during falls than with the frequency of falls

The study findings highlighted the need to develop strategies for preventing and reducing the consequences of falls that lead to head impact, and the need for environmental modification in aged care facilities such as compliant flooring.

A review of hospital falls in people with stroke

The Showcase was told falls make up 38% of patient safety incidents in Australian hospitals and are now one of the most common, harmful and costly adverse events.

Rebecca Sullivan from UTS shared the findings of her team’s study of 6,935 patients, which aimed to identify any association between communication disability following stroke and falls in hospital, and to understand more about the circumstances surrounding the falls to inform future research and identify clinical implications.

The presenter said people with stroke were particularly at risk of falling in hospital and an estimated 88% of people with stroke have a communication disability (e.g. slurred speech or difficulty explaining themselves or understanding health care staff).

In fact, people with communication disability are three times more likely to experience an avoidable adverse event in hospital than those without.

While the literature review suggests a higher rate of falls in people who have difficulties understanding or following commands, overall, it found no association demonstrated between an unspecified communication disability and a risk of falls.

It suggests further research is required to provide greater certainty about any association for patients with varying degrees of severity of communications disability.


The Global Injury Prevention Showcase is hosted by the Public Health Association of Australia and supported by the Australasian Injury Prevention Network and the World Health Organization. The event is being held in the lead-up to the 14th World Conference on Injury Prevention and Safety Promotion in 2022.


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