1. Introduction

The title of the study is “Re-conceptualizing Fall Prevention Approaches for the Elderly Population in Aged Care”. The study involves the observation on falls that happen to the elderly population in aged care, to further evaluate the relation between the threat of falls, related depressive symptoms and life satisfaction among urban home-dwelling adults aged 40-70, and to propose a theoretical framework that focuses on reframing the perspective of falls from the current view of a biomedical based problem, to a self-fulfilling prophecy. This will in turn lead to the enhancement of fall prevention approaches, at both the individual and public health level, to provide a more holistic approach in reducing falls among the elderly. This involves the implementation of life enriching programs for the elderly, to increase motivation and life satisfaction, ultimately increasing autonomy and decreasing the loss of functional abilities which will consequently lead to a reduction in falls. The importance of this study is to bring to light the current overly simplistic and negative imagery that surrounds falls and the lack of clear discussions on what constitutes as success in the area of fall prevention, which has led to limited effectiveness in the effectiveness of current prevention programs. This has been described by Yardley et al. (2006) as the need to shift from thinking of fall prevention as only seeking to prevent a fall, to also ensuring that it maximizes the person’s confidence and capability in continuing to carry out their day to day activities without the need to unnecessarily restrict their lifestyle. The loss of functional abilities and fear of falling into which much current fall prevention is focused on preventing, is not the same thing as the acute event of a fall, yet many conflate the two as being inevitable consequences of falls.

1.1. Background

Identification of key risk factors and knowledge of effective prevention strategies does not guarantee that best practices will be used in care settings. To date, the promotion of best practices in fall prevention at a population-wide level has received little attention by researchers or funding bodies. Most research studies have been well removed from the realities of the settings where the risk and the consequences of falls are most acute. Therefore, a long-term and holistic fall prevention research agenda needs to be developed that is focused on all populations of older adults and all settings in which they receive care. This includes at-risk individuals residing in the community and older adults with varying degrees of physical and cognitive impairment. A comprehensive prevention agenda needs to involve all relevant stakeholders and address issues of coordination and gaps in services. With an aging population and increases in fall-related hospitalization, this area of research is now more important than ever. This knowledge translation research builds on past and ongoing work to implement best practices in fall prevention in acute, rehab, and community settings that have shown to be both effective and cost-effective. What makes the proposed approach distinct is the emphasis on shifting the culture and norms around fall risk and prevention, and the methodical coordination of the continuum of services for at-risk individuals.

The wholesome efficiency, success, and quality of the preventative approaches are reliant on how strategies are developed, sustained, and successfully translated into practice. Translation of knowledge is an important and growing area in fall prevention research. Improved translation of knowledge into practice and policy requires observational and experimental research that tests strategies to overcome barriers and identify specific factors that determine successful adoption of preventive practices. This research often returns insights into the dynamics of fall risk and prevention that can further inform and improve prevention strategies. Additionally, involving change agents at multiple levels of the healthcare system in fall prevention communities of practice can foster shared learning and ongoing improvement in fall prevention practices. By situating learning communities within research studies, researchers and practitioners with an interest in fall prevention can collaborate to evaluate and improve the strategies being studied. This type of participatory research can enhance capacity for evidence-based practice and maintain a two-way flow of knowledge between researchers and knowledge users. Finally, the new knowledge gained from knowledge translation research can be extended to the elderly community.

1.2. Purpose of the Study

The conception, design, and implementation of the program will be informed by the results of Aim 1 and 2 and input from aged care staff and will be informed by a contemporary injury prevention framework. Outcome measures of the program will also be formulated. A randomized controlled trial will then be conducted to evaluate the program.

– Develop a comprehensive understanding of the fall risk factors, the circumstances of falls, and the reasons for such falls among the elderly people in aged care facilities. – Identify the prevention strategies which have been successful in reducing falls and/or fall-related injuries and the factors which have facilitated or inhibited their implementation. – Develop an evidence-based fall prevention program which is both effective and feasible for the aged care context.

This research aims to re-conceptualize the fall prevention approaches for the elderly population in aged care facilities in Australia. In particular, this study is designed to meet the following aims:

1.3. Scope and Limitations

This study has two key aims which will manifest themselves as two separate research projects. The first aim is to investigate the nature of falls and fall-related injuries in residential aged care, and the perception of falls and their prevention among residents and family members. The second aim is to establish a culture of best practice and continuous quality improvement in fall prevention. This will be achieved by implementing and evaluating a Change of Practice intervention focused on organizational culture, involving staff and residents in decision-making processes regarding falls and their prevention. Both research projects will employ a participatory action research design. This design is suited to research at aged care facilities where there are complex issues that require long-term solutions, and where the research uptake is likely to have a direct impact on the quality of care provided (McCormack et al, 2003).

This study is a collaboration between Deakin University Falls and Injury Prevention Group, Bendigo Health Aged Services, and La Trobe University Austin Regional Clinical School. This study will take place across different facilities in the aged care sector managed by Bendigo Health. These include independent living units, hostel, and nursing home providing a wide range of complex clinical care services. The project has been funded by the Victorian Department of Health. The study will be conducted over a period of 18 months.

2. Understanding Fall Prevention

2.1. Definition of Falls

2.2. Risk Factors for Falls

2.3. Consequences of Falls

2.4. Current Fall Prevention Approaches

3. Re-conceptualizing Fall Prevention

3.1. Rethinking the Approach

3.2. Person-Centered Care

3.3. Multidisciplinary Collaboration

3.4. Technology and Innovation

4. Implementing New Strategies

4.1. Assessing Individual Needs

4.2. Creating a Safe Environment

4.3. Education and Training

4.4. Monitoring and Evaluation

5. Overcoming Challenges

5.1. Resistance to Change

5.2. Resource Allocation

5.3. Staffing and Training

5.4. Ethical Considerations

6. Case Studies

6.1. Successful Fall Prevention Programs

6.2. Lessons Learned

7. Conclusion

7.1. Summary of Findings

7.2. Recommendations for Future Research

7.3. Implications for Practice