Recently updated falls guidelines in Australia and the UK: what do they say, and what do they mean for you?

Did you know falls are the leading cause of hospitalisations and deaths due to injury in Australia? In 2024–25 there were 253,800 hospitalisations due to falls, accounting for 43% of all injury admissions, and 6,722 Australians died due to a fall [1]. More people die from falls than motor vehicle accidents, yet we hear little about this, potentially because it is older adults that are most likely falling and younger people dying in cars. These numbers are big, but they are not inevitable, and that's what this month's blog is about.

In 2025 we got new falls guidelines here in Australia [2] and the UK's National Institute for Health and Care Excellence (NICE) [3] released their updated guideline in the same year. I thought it would be interesting to put them side by side. Where do they agree, where do they differ, and what does it all mean for you? Last year I wrote about modifiable risk factors for falls, and earlier this year about balance training, so if you missed those, have a look after you've finished reading this one.

Why do we need these guidelines?

In Australia, the new guidelines replace ones that were last revised in 2009 [2; fact sheet]. That's a long time even in research years! A lot of new evidence has come out since then. The guidelines also point out that the number of falls in Australia is increasing and is expected to rise further as the older adult population grows [2].

One thing in the guidelines that I noticed is they estimated that less than 50% of all falls are reported to a health professional like a GP, so that means the other half remain unknown to the people who can help them to try and prevent future falls [2]. Are you one of those people who has had a fall, not been injured and told no one? The guidelines remind us that falls may be the first indication of an underlying condition in an older person that may require assessment, so please let someone know [2].

The UK has a very similar problem. In the UK, it is estimated that one third of people aged 65 and over fall each year and this increases to half of all people aged 80 and over [4]. Even when a fall does not result in injury, fear of having another fall can lead to people doing less which then leads to a decline in physical function and their ability to do everyday tasks within their home. The NICE guideline was first published in 2004, and the 2025 version was prompted by new evidence. It was published on 29 April 2025 [4].

Who are the guidelines for?

Both guidelines are mainly written for health professionals. There is plenty in them for older people and their families too, though. The Australian community guidelines focus on older people aged 65 plus, Aboriginal and Torres Strait Islander peoples are included from 50 years and over [2]. NICE covers people aged 65 and over as well, and those aged 50 to 64 who are at higher risk of falling [3]. Higher risk may mean people with long-term health conditions that are impacting on their daily life. For example, arthritis, dementia, diabetes or Parkinson's disease or having had a stroke [3].

What is the same?

The good news is that the two guidelines agree on a lot.

 Asking about falls. Australia's guidelines suggest members of the multidisciplinary team (GP, pharmacist, nurse, physio, OT, podiatrist, etc) should ask the older person at least once a year as to whether they have had a fall [2]. NICE recommends asking people during routine appointments and annual health checks whether they have fallen in the last year [3]. So, if your GP asks whether you've had a fall, please be honest!

Balance and walking after a fall. Both guidelines say that if you have fallen in the past year, someone should check your balance or gait (how you walk, speed etc). In Australia, for older people who perform poorly, a detailed assessment should be done to identify potential fall risk factors [2]. NICE also says to assess gait and balance for people who have fallen in the previous 12 months and who do not have any of the criteria required to go through a comprehensive falls assessment [3].

More falls means a more thorough assessment. Both guidelines use your falls history to decide how in-depth your assessment should be. In Australia, older people who have had two or more falls are deemed to be at high risk of falls, and they should receive a fall risk assessment from a health professional to identify which tailored fall prevention interventions they should undertake [2]. NICE offers a comprehensive assessment to people who have fallen in the past year and are living with frailty; were injured in a fall that required medical (including surgical) treatment; experienced a loss of consciousness related to a fall; are unable to get up independently after a fall; or have had two or more falls in the past year [3]. Side note, this is similar to the World Falls Prevention Guidelines.

Exercise is front and centre. No surprise here (you knew I'd get to exercise!). Both guidelines say exercise programs should target balance and strength and be delivered by trained people. Australia says programs should primarily target balance and mobility and include strength training, with physiotherapists or exercise physiologists designing and delivering them [2]. NICE says programs should be delivered by appropriately trained professionals and be progressive and tailored to the person's specific needs, preferences, goals and abilities (I really like these)[3]. It also says they should focus on balance, strength, power and coordination [3].

Home hazards and occupational therapists. Both guidelines recommend home safety assessments for people at higher risk, and both name occupational therapists (OTs) as the experts to help with this. Home hazards are often a way to get many wins more easily than exercise. Exercise you need to sustain over the life course and believe that what you are doing is helping you to achieve your goal of independent living, which includes preventing falls. Home hazards could literally mean removing a rug and improving the lighting around you home, boom, easy win.

Medications. Both recommend reviewing medications, with a particular eye on medications that affect the brain. Australia recommends collaborative reviews by a GP and pharmacist to minimise the use of psychotropic medicines and medicines that increase the risk of having a fall [2]. NICE suggests that, as part of a structured medication review, appropriate adjustments to the person's medicines be considered to reduce the risk of falls [3]. The same BUT applies as in my earlier blog: please don't stop taking anything without talking to your GP first.

Cataracts and fainting. Both guidelines recommend referral for cataract surgery when cataracts are affecting vision. Both also say people with a particular heart condition (the cardio-inhibitory form of carotid sinus hypersensitivity, what a mouthful!) should be considered for a pacemaker.

Fear of falling. Both recognise that fear of falling matters. Australia suggests prescribed exercise, cognitive behavioural therapy and occupational therapy [2]. NICE recommends considering cognitive behavioural interventions for people whose concerns about falling are not helped by balance and strength exercises [3].

You are at the centre. Both guidelines put the older person, and their family if they choose, at the centre of decisions. Australia talks about dignity of risk, which means older people have the right to make decisions about their lives, even if there is risk involved [2]. NICE recommends discussing what changes people are willing and able to make to reduce their risk of falls [3]. Both also talk about learning how to get up after a fall, see my earlier blog for information on this.

What is different?

Risk tools. This one is interesting. The Australian guidelines include a good practice point to screen all older adults annually for their fall risk using a validated tool, and then use that screening to guide a more detailed assessment [2]. NICE is very direct: “do not use falls risk prediction tools to predict a person's risk of falling” [3]. The NICE committee found inconclusive evidence for specific falls assessment tools, and they suggested few tools had good paired sensitivity and specificity [4]. In other words, the tools weren't very good at correctly picking who would and wouldn't fall. NICE relies on asking about falls history and checking balance and gait instead.

Exercise for everyone, or for those who have fallen? Australia recommends exercise for all older adults, not just those who have fallen. Their first recommendation is to support all older adults to participate in 2-3 hours of exercise per week on an ongoing basis to prevent falls, and it is graded at the strongest level of evidence (Level 1A)[2]. The UK guideline is about assessing and managing people at risk, so its exercise recommendations focus there. For people who have fallen once and have a gait or balance problem, NICE recommends offering a falls prevention exercise program, because exercise is seen as the most effective intervention and they suggested a comprehensive assessment should not be needed [3]. NICE doesn't put a specific number of hours per week in its recommendations.

Who does the home safety assessment? Australia recommends occupational therapist (OT) deliver home safety interventions for people at increased risk of falls [2]. NICE also found OTs were more effective, but serious concerns about the capacity of occupational therapists to meet this demand in the UK were raised during the guideline consultation [3]. So, it allows other trained staff to do the assessment if an OT isn't available.

Vitamin D. Australian guidelines support recommended doses of daily or weekly vitamin D supplements for older adults deficient in vitamin D or with little sunlight exposure, but warns people to avoid high monthly or yearly mega doses of vitamin D because these can increase the risk of falls [2]. NICE suggests there is insufficient evidence to support taking vitamin D supplements specifically to lower the risk of falls, but people should still follow national advice on vitamin D for bone and muscle health [3].

Breadth. Australia has three separate guidelines, one each for hospitals, residential aged care and the community. The community version has 14 recommendations plus many good practice points. It includes stand-alone recommendations on podiatry for foot problems, single-lens distance glasses (rather than bifocal, multifocal or progressive lenses) when active outdoors, and osteoporosis medicines. It also has sections on continence, hearing and hip protectors [2]. NICE has a single guideline covering community, hospital and residential care. It includes many of these areas, such as footwear, hearing, continence and osteoporosis risk, as part of its comprehensive assessment, but has fewer stand-alone recommendations on them [3].

Rural and remote living. The Australian guidelines recognise our big backyard. They suggest that virtual care strategies like telehealth, should be supported to enable fall prevention interventions where they are deemed appropriate and available. They also advise online balance and strength training for people who can't get to a health professional, for instance those living in rural and remote areas of Australia [2].

• Have you had a fall in the last year, even one where you weren't hurt? Tell your GP. Both guidelines say a fall is a reason for someone to check your balance and walking, and possibly do a more thorough assessment. It’s all about helping you to live independently for longer.

• Are you doing balance and strength exercise each week? I bang away at this so often in my blogs, but it is recommended to do 2–3 hours per week, ongoing, for all older people. If you're not sure where to start, a physiotherapist or exercise physiologist can design a program that suits you. Just make sure you keep progressing with the exercises, otherwise you don’t keep improving.

• If you've fallen more than once, or were injured, couldn't get up, or blacked out, ask your GP for a comprehensive falls assessment. This looks at things like your medications, vision, feet, heart, continence and hazards around your home.

• If you’re taking a few medications, ask your GP and pharmacist for a review, especially any that affect your sleep, mood or the brain. However, please don't stop taking anything on your own, you need a health professional to let you know what is right for you.

• Do you have cataracts? If so speak with your GP, or are you walking around outdoors using multifocal glasses? If you are, speak with your optometrist and watch when stepping up and down from curbs or speed bumps in dark areas like carparks, they can be quite hidden sometimes.

• Are you worried about falling? You're not alone, and help is available. Strength and balance exercise is a great place to start but so is talking with a therapist trained in cognitive behaviour therapy, they can help too.

• Vitamin D: Australia's guidelines support daily or weekly supplements if you're deficient or don't get much sun, but they do say to avoid the big once-a-month or once-a-year mega doses. Have a chat with your GP. I am always Vitamin D deficient, spoke with my GP and I now take a daily supplement.

• Does your home need a once-over? If you've had a fall, have a mobility problem or have just come home from hospital, ask about an OT home safety assessment. Even if you haven’t had a fall, the holidays are coming up soon, this could be a good time to declutter a bit and make sure your lighting and environment is safe.

Live the good life!

References:

[1] Australian Institute of Health and Welfare. (2026). Injury in Australia: Falls. AIHW. [Updated 18 June 2026; https://www.aihw.gov.au/reports/injury/falls]

[2] Australian Commission on Safety and Quality in Health Care. (2025). Preventing falls and harm from falls in older people: Best practice guidelines for community care in Australia. ACSQHC. https://www.safetyandquality.gov.au/clinical-topics/falls (fact sheet available at https://www.safetyandquality.gov.au/sites/default/files/resources/attachments//fact-sheet-preventing-falls-in-community-care.pdf)

[3] National Institute for Health and Care Excellence. (2025). Falls: Assessment and prevention in older people and in people 50 and over at higher risk (NICE guideline NG249). https://www.nice.org.uk/guidance/ng249

[4] Neilson, J., MacIntyre, D., Whitney, J., Aung, T., & Lally, M. (2026). Assessment and prevention of falls in older people and in people 50 and over at higher risk: Summary of updated NICE guidance. BMJ, 392, s223. https://doi.org/10.1136/bmj.s223