1. Introduction

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• 1.1 How this Report is Organized
• 1.2 Seniors' Falls - Definitions
• 1.3 Action on Seniors' Falls

This report was designed to support the efforts of all those who work on research, programs and policies to reduce seniors' falls and fall-related injuries. It presents a comprehensive analysis of national data - for Canadians age 65 and over - on fall injuries and deaths, as well as evidence on risk factors and best practices for the prevention of injuries to seniors living in both community and institutional settings.

The report provides new national information through analysis of the following data:

• epidemiological evidence on falls highlighting seniors' self-reported data from the Canadian Community Health Survey;
• hospitalization data from the Canadian Institute for Health Information Discharge Abstract Database; and
• mortality data from Statistics Canada's Canadian Vital Statistics.

It also examines:

• information on multifaceted risks for falls among seniors;
• evidence-based best practices for the prevention of falls and injury from falls; and
• issues surrounding the development and sustainability of fall prevention initiatives.

In addition, appendices provide a comprehensive list of risk factors for falls and fall-related injuries, and a list of the Public Health Agency of Canada's fall prevention publications (including the online Inventory of fall prevention initiatives in Canada - 2005).

Four Technical reports are available online describing in detail the data requests, analyses and interpretation of the data used on:

• injury resulting from falls among Canadians age 65 and over;
• hospitalizations due to falls among Canadians age 65 and over;
• hospitalizations due to falls among Canadians age 65 and over living in residential care facilities; and
• deaths due to falls among Canadians age 65 and over.

1.1 How This Report is Organized

Chapter 1, Introduction, presents the document's objectives, definitions, the main data sources used and the work of the Canadian government in the area of seniors' falls prevention.

Chapter 2, The scope of the problem, provides the first comprehensive overview of data on fall-related injuries and deaths among Canadians age 65 and over. Sections present data on self-reported falls, fall-related hospitalization data for all seniors and for seniors living in residential care facilities, and vital statistics data on fall-related mortality.

Chapter 3, Risk factors for falls and fall-related injuries in seniors, presents the latest evidence concerning fall risks from widely adopted guidelines and reviews other more recent studies on the prevention of falls. The information is organized under biological, behavioural, environmental and socio-economic risk factors.

Chapter 4, Evidence-based best practices for the prevention of falls, summarizes the evidence for a broad range of best practices for the prevention of falls and fall-related injuries, plus some recent findings on addressing fear of falling, selecting the best approaches for specific settings, and recovery from a fall.

Chapter 5, Supporting fall prevention strategies, presents new information about factors affecting the sustainability of fall prevention programs.

Chapter 6, The way forward, addresses the potential of provincial and territorial data, including those on hospitalizations and deaths due to falls, to support local and regional fall prevention initiatives that respond to the unique circumstances in each jurisdiction.

1.2 Seniors' Falls - Definitions

All statistics and information reported in this document refer to Canadians age 65 and over unless otherwise stated. Words or expressions such as 'senior', 'older adult', 'older person' — all refer to this age group.

A fall is often defined as a sudden and unintentional change in position resulting in an individual landing at a lower level such as on an object, the floor, or the ground, with or without injury. Different data sets define falls in various ways. These are described under each section.

1.3 Action on Seniors' Falls

Throughout Canada, stakeholders are taking action to reduce falls and fall-related injuries among seniors. Several provinces and territories have identified falls among seniors as a serious public health issue and are developing interventions and strategies for fall prevention. In some cases, strategies are an element of broader approaches that address injury prevention, healthy living or chronic disease across all ages. Professional health associations, universities and research institutes are developing new evidence on seniors' falls and this knowledge development is supported by fall prevention activities of professional and voluntary organizations that have a focus on either injury prevention or seniors' issues.

The Public Health Agency of Canada (PHAC) is leading continued federal action on seniors' falls as an important part of its mandate in preventing disease and injury and promoting good health. PHAC has developed a unique capability as a result of more than a decade of dedicated Health Canada investments in seniors' falls prevention. Within PHAC, research, surveillance and epidemiological activities support the development of evidence to reduce falls.

The Division of Aging and Seniors, originally in Health Canada and now part of PHAC, has been the focal point for seniors' falls prevention activity within the federal government. The launch of The safe living guide: A guide to home safety for seniors in 1996 was the first of several fall prevention publications developed by the Division. (See Appendix B for a complete list of the Division's publications on seniors' falls prevention). The Division has also supported collaborative jurisdictional action between the federal government and the provinces and territories through the Federal/Provincial/Territorial Ministers Responsible for Seniors. In 1999, the F/P/T Ministers Responsible for Seniors commissioned an inventory of prevention programs, An inventory of Canadian programs for the prevention of falls among seniors living in the community, and a systematic review of the effectiveness of fall prevention programs for community-dwelling seniors. The findings of these studies formed the basis of A best practices guide for the prevention of falls among seniors living in the community, published in 2001.

The growing interest in seniors' falls prevention led to the first national meeting of stakeholders from across Canada in July 2000, to determine national priorities and directions on seniors' falls. The subsequent launch of a partnership between Health Canada and Veterans Affairs Canada enhanced the momentum on fall prevention both regionally and nationally.

This partnership, the Health Canada/Veterans Affairs Canada Falls Prevention Initiative, sought to advance understanding and knowledge of effective seniors' falls prevention interventions and to enhance community capacity to deliver fall prevention programs using a population health approach. The Initiative provided time-limited funding to community-based fall prevention projects that addressed environmental hazards, personal health practices, high risk populations and assistive device use. Throughout its four-year mandate, it supported knowledge development on the risk factors for falls, capacity building to address falls, and contributed further evidence on program models best able to reach seniors living in the community.

Across Canada, there are ever growing numbers of fall prevention interventions taking place within community, acute care, and long-term care settings. Key to targeting resources for the prevention of falls and related injuries is enhanced knowledge on the scope and nature of seniors' falls and the evidence for best practices for prevention. It is hoped that the overview of seniors' falls data and the review of the evidence contained in this report will contribute to the ongoing development of seniors' falls prevention strategies of the future.

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