The Australian picture
31.1%
of residents had one or more falls in the January to March 2025 quarter, across 2,593 services and more than 220,000 residents 4.
1.7%
had a fall causing major injury in the same quarter. Major injury means a fracture, a joint dislocation, or a closed head injury with altered consciousness or a subdural haematoma 445.
More than 1 in 3
falls in residential care result in some injury, and one in five result in a hospital admission, according to the national falls guidelines 1.
81.5%
of the 3,289 deaths from external causes among Australian nursing home residents reported to coroners between 2000 and 2013 followed a fall 5.
Why people in aged care fall more
People living in residential aged care fall about three times as often as older people living at home 6. That is not a sign that care is poor. People move into care because of the same things that cause falls: weaker muscles, slower balance reactions, dementia, poor eyesight, continence problems, and illnesses that need several medicines.
A fall rarely has one cause. The usual story is several small problems meeting at the wrong moment: getting up quickly at night to reach the toilet, in dim light, in socks, an hour after a sleeping tablet.
Some causes can be changed and some cannot. Muscle strength, medicines, eyesight, footwear, continence care and the surroundings can often be improved 1. Age, dementia and many long-term illnesses cannot. Good falls care works on the first group and is realistic about the second.
What commonly contributes
These are the areas the national guidelines ask facilities and clinicians to look at for each resident 1.
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Strength and balance. Weak legs and slow balance reactions are the most direct cause, and the one that exercise can change.
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Medicines. Sedatives, some antidepressants, antipsychotics, opioids and some blood pressure medicines are associated with falls. The medicines page in this section covers the evidence.
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Dementia and delirium. Cognitive impairment, including delirium and dementia, is a major risk factor for falls 1. A sudden run of falls can be an early sign of delirium from infection, constipation, pain or a new medicine.
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Blood pressure on standing. A drop in blood pressure on standing causes light-headedness. The guidelines ask for a medication review to look for medicines that may cause it, and for urgent medical assessment of unexplained falls or collapse 1.
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Eyesight. The guidelines recommend an eye examination on entering care and yearly, clean glasses within reach, and distance glasses for walking where a person has separate pairs 1.
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Feet and footwear. Safe, well-fitting shoes with a low square heel, a supporting collar at the ankle, a treaded sole and a firm sole are recommended in preference to non-slip socks 1.
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Continence. Urgency and night-time trips to the toilet are a common setting for falls. The guidelines recommend a continence assessment and proactive help with toileting 1.
Why zero falls is the wrong target
The only reliable way to stop a person falling is to stop them moving. A resident kept in a chair or bed loses strength, becomes more likely to fall when they do get up, and loses the part of the day that was their own.
For that reason the national guidelines are framed around preventing harm from falls, and the Quality Standards require providers to minimise falls and harm from falls by maximising mobility to prevent functional decline 143.
So the useful questions are different ones. Is this person as strong and steady as they can be? Is anything being done that makes a fall more likely? If they do fall, what would reduce the chance of a serious injury? And where safety and freedom pull in different directions, which does this person want more?
Sources cited on this page
- 1 Australian Commission on Safety and Quality in Health Care. Preventing Falls and Harm from Falls in Older People: Best Practice Guidelines for Australian Residential Aged Care Services. Sydney: ACSQHC; 2025. View source
- 4 Australian Institute of Health and Welfare, GEN Aged Care Data. Residential aged care quality indicators — January to March 2025. (2,593 services; 220,707 residents assessed for falls: 31.1% had one or more falls, 1.7% a fall with major injury; 19.8% subject to physical restraint, 15.3% through a secure area only.) Reported quarterly; later quarters are available from the same page. View source
- 5 Ibrahim JE, Bugeja L, Willoughby M, et al. Premature deaths of nursing home residents: an epidemiological analysis. Med J Aust. 2017;206:442–7. (Coronial data, 2000–2013.) View source
- 6 Hewitt J, Goodall S, Clemson L, Henwood T, Refshauge K. Progressive resistance and balance training for falls prevention in long-term residential aged care: a cluster randomized trial of the Sunbeam program. J Am Med Dir Assoc. 2018;19:361–9. View source
- 43 Aged Care Quality and Safety Commission. Strengthened Aged Care Quality Standards (commenced 1 November 2025): Outcome 1.3 Choice, independence and quality of life; Outcome 5.5 Safety of clinical care services, Action 5.5.4. View source
- 45 Australian Government Department of Health, Disability and Ageing. National Aged Care Mandatory Quality Indicator Program: quick reference guide — falls and major injury. 2025. View source
See every source cited across the falls and frailty section →
Written by Dr Josh Hatch, FRACGP. General information only, reflecting his reading of the published evidence as at October 2026. It is not individual medical advice, does not create a doctor–patient relationship, and must not be used to start, stop or change any treatment. Evidence and Australian regulatory and PBS arrangements change — always confirm current advice with the treating GP, pharmacist or specialist.
This is general education, not a clinical protocol. The doctors who practise with Umbrella Aged Care are independent general practitioners, and each makes their own clinical decisions with the resident and family. Your GP’s advice for an individual may differ from what is written here. If it does, please ask them to talk it through with you.