Falls prevention in the older population is something that should be ‘very much part of everything we do’ rather than a discrete speciality add-on to physiotherapy practice, Professor Anne-Marie Hill FACP, a Specialist Research Physiotherapist (as awarded by the Australian College of Physiotherapists in 2024) and member of the APA Gerontology group, believes. 

The science is strong, she argues, but falls prevention implementation across hospitals, the community, home care and residential aged care is where physiotherapists must lead now.

With older people moving fluidly between home, hospital, transition care, community services and residential aged care, Anne-Marie says falls prevention cannot be siloed into single settings or rigid clinical boxes.

‘People don’t fit into one box,’ she says, noting that the same patient may encounter multiple systems in a short period of time.

This reality, she says, requires nimbleness from physiotherapists – the ability to apply evidence flexibly while maintaining fidelity to best practice.

Speaking at the APASC25 conference in Adelaide about her joint research at the University of Western Australia, in collaboration with the Western Australian Centre for Health and Ageing and the Royal Perth Hospital Research Foundation, Anne-Marie highlighted the scale of the problem: based on Australian Institute of Health and Welfare data, falls injuries cost Australia around $5 billion annually and are continuing to rise. 

Professor Anne-Marie Hill at the APASC25 conference in Adelaide discussing falls prevention research. Photo: Michael Blyde

Hospitalisations for falls – around 248,000 people a year – far outstrip those from transport injuries. Yet many older people remain unaware of the high prevalence of falls and their risk.

Anne-Marie says that when presenting to community groups, she often sees astonishment when older people realise how common and costly falls are. 

Many assume that a fall is just an individual misfortune rather than a predictable, preventable public health issue.

A major focus of her talk was the Falls Guidelines, which she described as being strongly grounded in Australian research. 

This local evidence base, she says, gives clinicians greater confidence that recommendations are relevant to Australian healthcare settings. 

At the heart of the guidelines is risk stratification, not through scoring systems but through conversation. 

She stressed the importance of routinely asking older patients about their history of falls and fear of falling, regardless of the setting.

‘No matter what patient you have: “Have you had any falls? Are you feeling fearful of falling?” Those questions should just be part of your general history.’

Central to the guidelines is the principle of tailored intervention. 

Anne-Marie says that strength and balance exercise is fundamental for community-dwelling older people and those in residential aged care but that programs must be personalised, meaningful and motivating. 

She emphasised building on small successes so that older people can see and feel their progress.

However, it is hospital settings that Anne-Marie is particularly passionate about.

She reminded the audience that more than 50 per cent of hospital admissions involve people aged 65 and over, yet falls prevention is still often treated as a niche issue confined to geriatric wards. 

In reality, patients at risk of falls are everywhere in hospitals – medical, surgical, emergency, orthopaedic and beyond.

Falls in hospital, she says, are not only common; they are also dangerous. They are more likely to result in serious injury, functional decline, fear of movement, longer hospital stays and, critically, unplanned admission to residential aged care. 

She says that preventing falls in hospital is not about restricting mobility; it is about supporting safe mobility. 

Anne-Marie challenged the reliance on numerical risk scores such as the Falls Risk Assessment Tool, particularly in residential aged care, where virtually all residents would score as high risk anyway. 

‘Do we really think there is anyone at low risk of falls in a nursing home? You’ve already selected the population most likely to fall.’

Anne-Marie says that rather than obsessing over risk categorisation, clinicians should assume risk and focus on action.

Hospital guidelines now recommend tailored, multifactorial interventions for all older patients without calculating a risk score, she says. 

These include individualised education, medication review, delirium management, appropriate use of walking aids and careful discharge planning.

Anne-Marie highlighted strong evidence that physiotherapist-delivered education can help reduce falls in hospital – a powerful endorsement of the role of physiotherapy. 

She also pointed to emerging work involving allied health care assistants delivering initial education, with physiotherapy following up, signalling new models of workforce implementation.

Importantly, Anne-Marie critiqued restrictive practices in hospitals such as systematically using bed alarms and low-low beds, which have little evidence of effectiveness in preventing falls. 

Despite this, commercial marketing continues to promote such devices aggressively, creating a tension between evidence and industry messaging. 

She called for de-implementation of ineffective practices and a shift towards patient-centred behavioural care plans.

Anne-Marie noted that while falls prevention is often described as ‘everyone’s responsibility’, this can paradoxically lead to inaction. 

Staff and patients can feel disempowered, unsure of their specific role. 

Older people have told researchers that they want clear, personalised conversations about falls prevention, consistent messaging and help with goal setting – areas where physiotherapists are particularly well placed to lead.

Turning to the Falls Guidelines, published in 2025, Anne-Marie emphasised the importance of partnership with older people. 

Falls prevention must be collaborative, not paternalistic, she says. Clinicians need to explore barriers and enablers, understand personal goals and support intrinsic motivation.

Around 50 per cent of falls occur in the home, making home safety conversations and occupational therapy assessments critical for those at higher risk. 

However, Anne-Marie was careful not to frame this as fear-based. Instead, she advocated for practical planning. 

Rather than avoiding discussion of falls, she encourages older people to have a clear plan: carry a mobile phone, know who to call, ensure adequate lighting at night and understand how to get up safely after a fall.

Exercise remains a cornerstone of community falls prevention. Evidence supports two to three hours per week of ongoing activity that includes balance, mobility and strength training. 

Anne-Marie highlighted the work of Professor Cathie Sherrington, a Specialist Research Physiotherapist (as awarded by the Australian College of Physiotherapists in 2019), and others demonstrating that the intensity of balance training matters – too easy is ineffective; too hard is unsafe. 

She urged physiotherapists to prescribe balance at the ‘just right’ level: for some people, standing on one leg by the kettle is challenging; for others, returning to dancing is appropriate. 

The key is progressive intensity. Anne-Marie emphasised again that physiotherapists are ideally equipped to lead in this area.

For people with mild cognitive impairment or mild to moderate dementia, exercise should still be encouraged if they
choose to participate. 

She rejected the assumption that cognitive impairment makes falls prevention futile. Instead, she argues, programs should be adapted, not abandoned. 

She also discussed key single interventions for high-risk individuals including vision correction, cataract surgery, medication review, podiatry, vitamin D supplementation and investigation of unexplained fainting. 

These target actions, she says, could be lifesaving.

Despite strong evidence for falls prevention, implementation remains a major challenge, she says. 

Around 26 per cent of Australians meet the recommended physical activity levels. 

Barriers such as arthritis, pain, fear of injury and low motivation are common – yes, she pointed out, exercise often improves these very conditions. 

She says physiotherapists are uniquely positioned to help older people overcome these barriers by offering choice – home programs, group classes, tai chi, walking groups, water exercise or gym-based strength training – and by aligning activity with enjoyment.

The final part of Anne-Marie’s presentation addressed a less tangible but equally important barrier: ageism. 

Citing data showing that 68 per cent of Australians over 50 believe ageism is a serious problem, Anne-Marie argued that negative attitudes towards aging can undermine rehabilitation, motivation and service access. 

She referenced UK geriatrician David Oliver’s critique of phrases such as ‘no rehab potential’, asking clinicians to reflect on what such labels truly mean.

In closing, Anne-Marie says the evidence for falls prevention is stronger than ever and that Australian researchers are leading the field. 

But without effective implementation, tailored practice, workforce innovation and a commitment to respect older people, preventable falls will continue to cost lives, independence and billions of dollars.