Australians have one of the highest life expectancies in the world, and today are living longer than ever.

In fact, one in seven Australians (15 per cent) or roughly 3.8 million are over 65 years of age, and this demographic is expected to continue growing as a proportion of our population in decades to come.

Ensuring continued good health as we age is therefore becoming increasingly important.

A key concern for geriatric health is the prevention of falls, the leading cause of deaths from injury for those over 65 years of age, one in three of whom sustain a fall each year and are at a major risk for subsequent long-term care and institutionalisation.

The physiotherapy profession has long understood its role in reducing the risk of falling through strength and balance training.

The good news is that there is a growing recognition within the community, aged care sector and among decision-makers of the critical role of physiotherapy in supporting people to age well.

However, converting that recognition to real policy change requires a multi-pronged approach underpinned by a solid body of evidence and strong advocacy.

The profession is now well placed to advance its policy position using new economic modelling that unpacks the cost benefit of physiotherapy in falls prevention.

This was developed using rigorous research demonstrating the efficacy of physiotherapy-led interventions in this area.

The APA last year engaged economic consultancy Nous to examine the costs and benefits of a representative selection of physiotherapy treatments relevant to various life stages.

The result was the Value of Physiotherapy in Australia report, which synthesises the clinical research into the treatments, and compares the benefits they deliver with estimates of the cost of delivering the treatments.

Nous reviewed several key studies that examined the use of physiotherapy for the prevention of falls, which included randomised controlled trials and epidemiological modelling.

The literature indicated that there are a variety of treatments that can effectively reduce the risk of falls among older people, but that the relationship between falls reduction and healthcare costs can sometimes be complicated.

Physiotherapy for falls prevention can improve patient quality of life by improving strength and balance to reduce the risk of injury through falls.

The modelling primarily drew on data from two Australian studies that demonstrated the cost-effectiveness of physiotherapy-led falls prevention programs using simulation modelling.

One Australian study from 2014 measured the impact and cost-effectiveness of a public health falls prevention program, while a second also informed the evidence base, including through interviews with the study’s lead author.

Interventions in the studies included individual exercise, group community exercise programs and multifactorial interventions.

The costs and benefits of the program were measured as an average across each participant, and were calculated in comparison to the alternative where a no falls prevention program was introduced.

The Nous report steps through an economic analysis of the cost of a physiotherapy-led falls prevention program compared to the cost of not undertaking the program, resulting in a fall.

The average quality of life benefits of physiotherapy-led programs was calculated at $3000 per episode.

The total cost of physiotherapy treatment averaged $1680 per episode. Nous concluded that the benefit of physiotherapy-led falls prevention programs (ie, quality of life benefit minus the cost) equalled $1320 per falls episode. 

In a major breakthrough in community awareness of physiotherapy’s value, the Royal Commission into Aged Care Quality and Safety—first through its investigation into the impacts of COVID-19 on aged care and then in its final report—this year identified mobility as a critical issue for older people.

The Royal Commission recognised that reduced mobility as a result of lockdowns in COVID-affected residential aged care facilities had serious impacts on the physical and mental health of the elderly.

It recommended the government immediately fund a six-month group therapy program, based on APA member Dr Jennifer Hewitt’s Sunbeam program.

The Sunbeam program is one of the key pieces of research used in the falls prevention analysis work that underpins the Value of Physiotherapy in Australia report.

Dr Hewitt designed the temporary program, which is expected to be rolled out in COVID-affected facilities from this month, and will assist in its evaluation.

The Royal Commission’s final report, handed down after more than two years of investigation, noted that promoting and maintaining mobility and reducing the risk of life-threatening falls in older people is critical.

The investigation found that access to physiotherapists who are highly trained and skilled in strength, balance and mobility training is essential.

The APA made a total of six submissions to the Royal Commission and APA National Vice President Rik Dawson, a gerontologist, presented expert evidence on falls prevention programs for both physical and mental wellbeing.

The report recognised that ‘mobility was closely linked with people’s health and their quality of life [and that] poor mobility increased the risk of falls and fall-related injuries due to deconditioning and reduced muscle strength’.

APA National President Scott Willis said, ‘Falls are the number one cause of preventable death in residential aged care.

'The lack of investment in falls prevention programs over a long period of time, particularly when there is such strong evidence for their value, is an oversight that has had tragic consequences for too many families.

‘The Royal Commission has rightly identified the critical role that physiotherapists play in aged care.

'These are highly skilled mobility experts who are literally helping to save and improve lives by ensuring residents are active, mobile and ultimately confident in their movement.

'We know that mobility programs led by physiotherapists can reduce the number of falls in residential aged care by 55 per cent.’

While many may have hoped that the Royal Commission’s final report would be the end of years of advocacy, and herald a clear path forward for the aged care sector and physiotherapy, that is not the case.

Aged care reform will take years to embed. Fortunately for physiotherapy, we now have the data and research to support our future advocacy.

Click here to access the Value of Physiotherapy in Australia report and more. And click here to check out the Physiotherapy Research Foundation-funded animation ‘Falls prevention in Australian residential aged care—Sunbeam trial’.