In a busy private practice focused on older people and disability, falls prevention is not a subspecialty of Community Therapy – it is a core business. 

For Scott Lynch APAM and his team, the release of the Falls Guidelines for Community Care has reinforced and refined work they were already doing, while also prompting renewed reflection on systems, screening and progression.

‘We see falls risk as everyone’s responsibility. If you’re treating an older person, you’re thinking about balance, strength, vision, medication load – all of it. It’s not a separate box you tick.’

The 2025 Falls Guidelines emphasise systemic screening for falls risk, multifactorial assessment for those at increased risk and targeted, evidence-based interventions – particularly progressive balance and strength training delivered at sufficient intensity and duration. 

In Scott’s practice, these principles are embedded from the first point of contact.

While experienced clinicians often develop a strong instinct for identifying risk, the updated guidelines advocate for consistent, documented screening processes in community settings. Scott says this is in line with their practices.

‘We are always focused on objective measures driving our risk assessments and our treatment pathways. The guidelines have reinforced that our processes are appropriate.’

At Scott’s mobile physiotherapy practice, which covers community and aged care providers in the Central Coast and Hunter regions of New South Wales, new clients who are over a certain age are routinely asked about falls in the past 12 months. 

This includes questions about any near misses, their fear of falling and any changes in their mobility.

Standardised outcome measures, such as mobility and balance assessments, are incorporated early, not only to establish baseline function but also to stratify risk. 

‘It’s about asking the question every time. 

'You’d be surprised how often someone won’t volunteer that they’ve had a fall unless you create the space for it.’

The guidelines’ emphasis on identifying both actual falls and fear of falling has resonated strongly with Scott.

He notes that fear can precede measurable physical decline. 

‘We see people who’ve stopped walking to the shops, stopped gardening, because they’re worried. That reduction in activity becomes the risk factor. The guidelines validate that fear itself is a clinical finding.’

For those identified as at increased risk, the 2025 guidelines recommend a multifactorial assessment addressing strength, balance, gait, vision, footwear, medications and environmental hazards. 

In hospital or community health settings, this often involves multidisciplinary teams. In private practice, coordination can be more complex.

Scott sees the physiotherapist as a central node in that network. 

‘We can’t do everything ourselves but we can connect the dots. If we pick up that someone’s on multiple medications that might affect balance, we’ll write to the GP. 

'If we’re concerned about vision, we’ll recommend an optometrist review. It’s about being proactive.’

Community Therapy – a multidisciplinary service including physiotherapy, occupational therapy, dietetics, speech pathology, exercise physiology, massage and manual handling training – offers detailed and functional assessment. 

Scott Lynch.

Beyond standardised tests, physiotherapists observe transitional movements, dual-task challenges and real-world gait demands.

‘The guidelines talk about task specificity and functional relevance, so we’ll look at how someone turns, how they step backwards, how they manage uneven surfaces. That’s where falls actually happen.’

Importantly, assessment findings are shared transparently with clients. 

Rather than framing results as deficits, clinicians position them as modifiable factors. 

‘We are careful with language. It’s not “You’re a falls risk”. It’s “Here are the areas we can strengthen to keep you independent”.’

Perhaps the most unequivocal message in the 2025 falls guidelines is the central role of exercise – particularly high-challenge balance training and progressive resistance training delivered at adequate intensity, at least two to three times a week, over months rather than weeks.

Scott is emphatic about this point. 

‘Low-level exercises won’t cut it. The evidence is clear and the guidelines are clear. If you want to reduce falls, you have to challenge balance in a meaningful way.’

In practical terms, this means moving beyond seated exercises or gentle range-of-motion work. 

Physiotherapists design programs that deliberately reduce upper limb support, narrow the base of support, incorporate perturbations and introduce dual-task components as appropriate for the individual client, Scott says. 

‘There’s a sweet spot. You want people working at the edge of their ability, safely but enough that the system adapts.’

Strength training is similarly progressive. Using resistance equipment, free weights and functional tasks, loads are increased systematically. 

‘We track it like you would in a sports setting. If someone can do let’s say 15 reps comfortably, it’s time to go up. Older adults deserve proper strength training, not token exercises.’

The guidelines’ recommendation for long-term engagement has also influenced program design. 

Rather than time-limited blocks of therapy, the clinic encourages ongoing participation in supervised classes or independent programs with periodic review. 

‘Falls prevention isn’t a six-week fix. The guidelines talk about sustained intervention and that aligns with what we see. Gains disappear if you stop.’

While many of the clinic’s practices predate the 2025 falls guidelines, Scott notes that the guidelines provide an external reference point, particularly when discussing care with patients, families or other health professionals.

‘If a family member questions why their 85-year-old mother is lifting weights, we can point to national guidelines that recommend exactly that. 

'It gives confidence, to them and to us.’

The guidelines also support difficult conversations about risk-taking. 

For some clients, reducing falls risk may mean confronting longstanding habits or modifying the home environment – and sometimes their expectations about what they can and cannot achieve. 

‘Having that evidence base behind you helps. You can say, “This isn’t just my opinion – this is best practice.”’

The guidelines have also prompted Scott and his team to review documentation templates and outcome tracking. 

Consistent recording of falls history, reassessment intervals and program progression ensures alignment with recommended standards.

‘It’s made us tighten up. Not because we weren’t doing good work but because the guidelines raise the bar on consistency.’

A significant thread of the 2025 guidelines is the recognition of psychological factors, including fear of falling and reduced confidence. 

Scott and his team see this daily. 

‘Sometimes the physical capacity is there but the confidence isn’t. And that can be just as limiting.’

Physiotherapists address this through graded exposure – gradually reintroducing feared activities under supervision. 

Education plays a central role. 

‘We explain what’s happening physiologically, how strength and balance improve with practice. When people understand that change is possible, they engage differently.’

Success is measured not only in reduced falls but in restored participation: returning to bowls, resuming community volunteering, walking with the grandchildren. 

‘The real outcome is someone saying, “I’m doing the things I’d stopped doing.”’

Private practice brings particular challenges in implementing guideline recommendations. 

Cost, transport and motivation can limit attendance and frequency. 

The guidelines recommend exercise at a frequency and intensity that may exceed what some clients initially expect. 

‘We’re honest about what’s required. If someone can only come once a week, we’ll build a strong home program and follow up closely.’

The guidelines also place strong emphasis on primary prevention – intervening before the first fall occurs. 

Scott believes private practice is well positioned to lead in this space. 

‘Many of our clients come in for something else: knee pain, back pain. That’s an opportunity for us.’

Rather than waiting for a fall, physiotherapists can screen and, where appropriate, introduce balance and strength components early. 

‘If someone is 70 and starting to lose muscle mass, why would we wait? Prevention is far more powerful than reaction.’ 

This proactive stance aligns with the broader public health intent of the guidelines, which is reducing falls at a population level by embedding prevention in routine care.

Ultimately, Scott resists viewing the guidelines as a checklist. 

‘If you reduce it to ticking boxes, you miss the point. 

'It’s about creating a culture where maintaining mobility and independence is central.’

As the broader health sector considers implementation of recommendations from the Falls Guidelines for Community Care, private practice physiotherapists will play a pivotal role. 

They are often the most consistent allied health contact for older adults living independently.

‘We have the skills. The guidelines give us a framework and a mandate. 

'Now it’s about consistency – making sure that every older person who walks into a clinic is assessed, challenged and supported appropriately. 

'If someone can stay in their own home, keep doing what they love and avoid that downward spiral after a fall, that’s success. The guidelines help us aim for that every single day.’