Position statement
Falls represent a major public health concern, contributing substantially to injury, hospitalisation and injury-related deaths among older adults. All older Australians deserve access to evidence-based fall prevention care programs and individualised plans tailored to their needs and environments, either in their homes or residential aged care facilities.
In Australia, osteopaths are university-qualified and nationally registered allied health professionals who can play a crucial role in the prevention and management of falls in older Australians.
Osteopaths are trained in a range of manual therapy, exercise prescription, functional movement, and health education approaches to support older Australians in maintaining mobility, function and independence to reduce risks associated with falls.
Osteopaths can provide comprehensive clinical screening and assessments, identify and address modifiable risk factors, and support and develop personalised multidisciplinary care plans that reflect the needs, goals and preferences of older Australians. This may include strategies to enhance mobility, strength, balance, pain management through physical therapy and overall wellbeing.
Where appropriate, osteopaths will refer older Australians to other health practitioners or evidence-based programs that can further support fall prevention and overall wellbeing. This may include other allied health professionals, medical practitioners, and/or community-based falls prevention programs to ensure a comprehensive, multidisciplinary approach.
By providing person-centred care and collaborating through timely referrals, osteopaths help to ensure older Australians have access to quality care, that supports mobility and independence, and that helps prevent functional decline, hospital admissions, and long-term care costs.
Osteopaths can also undertake post-fall assessments to screen, identify and manage injuries, address functional and biopsychosocial concerns and support safe return to activity. This may include evaluating gait, balance, and functional capacity, as well as considering factors such as fear of falling, confidence and participation in daily activities.
While osteopaths can deliver to both rehabilitation and prehabilitation services, current government policy and funding structures do not support affordable access for many Australians.
Background
According to the Australian Institute of Health and Welfare, in 2023-24 that falls among people aged 65 years and over resulted in[1]:
- 248 211 hospitalisations
- 6698 preventable deaths
- Falls hospitalisation was most common among those aged 75 and over (46.7%)
- Falls were the leading cause of death for both sexes.
The risk of falls is multifactorial in nature, and is often a complex interplay between individual, environmental and contextual factors. These may include, but are not limited to2:
- Certain medical conditions (for example stroke, incontinence, Parkinson’s disease, dementia)
- Medications– eg. psychoactives; taking four or more medications
- Impairments in neuromuscular control, balance, strength and gait
- Sensory function and balance- impaired vision, reduced peripheral sensation
- Psychosocial and demographic factors– history of falls, fear of falling, living alone, increasing age, female, depression and cognitive decline. Environmental – poor footwear, home and external hazards.
Fall prevention guidelines
Falls remain a major safety risk and can cause significant harm to older Australians, however there are steps which can be taken to help minimise risk.
Falls risk management should ensure:
- Alignment with the Australian Commission on Safety and Quality in Health Care fall prevention guidelines3
- Timely referral to allied health professionals such as osteopaths for falls prevention management
- Access to individualised multi-modal interventions for managing all falls risks factors
- Exercise prescription aligns with current evidence-based principles and guidelines
- Carers/family members of the older Australian or individual are involved in the management plan and versed in potential risk factors
- Fall management plans should be person-centered, taking into consideration the individual’s beliefs, attitudes, priorities and health literacy levels.
The role of osteopathy in fall prevention
Osteopaths are educated on the neuro-musculoskeletal system and its role in coordination and balance. They assess posture and mobility to identify imbalances and provide individualised treatment to improve movement and balance. In older adults, osteopaths treat a variety of musculoskeletal disorders, degenerative spine disorders and chronic and persistent pain4.
Osteopaths apply evidence-informed interventions by screening older Australians for falls risk stratification or factors, assessing their pain and physical performance and intervening with educational approaches, therapeutic exercises or referrals. As part of an individual management plan, osteopaths can:
- Assess and address factors influencing strength, balance and flexibility
- Use manual therapy to improve mobility and reduce musculoskeletal pain, such as stretching, passive joint mobility exercises, soft tissue massage, while incorporating pain management strategies to support safe movement and reduce avoidance of activity
- Prescribe targeted strength and balance exercises/training to improve coordination
- Provide education and self-management strategies about individual falls risks, pain management, environmental hazards and confidence with movement
- Collaborate and communicate with other health professionals as part of interdisciplinary or multimodal care; including referral and shared management as required
Osteopathy in the aged care sector
Osteopaths are university-qualified and nationally registered allied health professionals, who can help address complex care needs of older Australians. They can work in residential aged care facilities5 and can also provide support in home services to older Australians still living in the community6. Unfortunately, osteopaths are underutilised in both settings.
Osteopathy can help to have positive effects on functional ability of individuals by:
- improving their physical performance
- reducing the risk of falls
- managing chronic pain
- maintaining activities of daily living
- improving their quality of life
- increasing their confidence and autonomy.
The whole-of-person approach to assessment in osteopathy is valuable in identifying problems and establishing appropriate treatments that increase mobility, independence and decrease the need for hospitalisation.
As a part of multidisciplinary teams, osteopaths can provide their services in residential aged care as employees of a registered provider or as an associated provider (sub-contractors of registered providers). Osteopaths will work as part of a wider team to provide fall prevention strategies in residential care are specific to the residential setting and to residents’ individual needs.
Rehabilitation and pre-habilitation are areas where osteopathy can help to improve healthcare consumers’ outcomes and help to reduce the length of hospital stays. However, current government policies and funding structures do not support affordable access to osteopathic services for many Australians.
The new Aged Care Act 2024 classifies osteopathy as ‘Therapeutic services for independent living’ service type under the Support at Home Program. This shows a clear lack of understanding of osteopathy’s capabilities, scope of practice and position within the allied health sector. - Older Australians will have to pay a co-contribution to access osteopathy services since this service type does not attract 100% government funding.
Osteopathy Australia has contacted the Department of Health, Ageing and Disability to rectify this omission and re-categorise osteopathy under the appropriate ‘allied health and therapy’ category, however this has not been successful so far. We will continue to advocate for this change.