New Australian falls guidelines recommend facilitating access to hearing assessment and management for people in residential aged care facilities (RACS) on commencement of care and annually.
They also recommend assessing aged care residents and hospital patients complaining of dizziness and vertigo for vestibular dysfunction (balance problems).
And the guidelines suggest that when discharging hospital patients with undiagnosed hearing problems, part of good discharge planning is to refer them to an audiologist.
The guidelines say hearing impairment contributes to falls in older people as they may fail to detect environmental hazards outside their line of sight.
Poor balance, walking difficulties, impaired cognition and functional decline are also associated with hearing impairment and increase the risk of falling.
The Hearing Health Sector Alliance (HHSA) has previously called for a uniform mandatory protocol to conduct hearing screening for all new residents of aged care facilities within one month of residency in the facility and include this as a quality metric in aged care reporting.
The updated guidelines consider three key settings – residential aged care, community care and hospitals, which are the main settings where falls may occur. They look at the importance of interventions, not just risk assessments.
The Australian Commission on Safety and Quality in Health Care released revised national guidance on how to prevent falls and fall-related injury on 26 June 2025. It is the first revision of the Falls Guidelines since 2009.
The Preventing Falls and Harm from Falls in Older People Best Practice Guidelines are based on the latest scientific evidence. They focus on improved interventions to support fall prevention and offer a nationally consistent approach to preventing falls and harm.
Neuroscience Research Australia (NeuRA) whose researchers helped shape the guidelines welcomed their release.
NeuRa said falls were the leading cause of injury hospitalisations and leading cause of injury deaths in older Australians.
Senior research scientist at NeuRA’s Falls, Balance and Injury Research Centre, Associate Professor Jasmine Menant, was on the team that worked on the five-year project.
“Falls have a big impact on individuals, as the consequences can be life-changing, from injury, to early admission into residential aged care or even mortality,” Assoc Prof Menant said.“They also have a big impact on our economy, with falls of Australians aged over 65 years old costing the health system more than $2.8 billion annually.
“The Falls Guidelines (2025) combined research, community consultation and more to develop recommendations and best practice for a range of settings.”
Prof Menant said the guidelines built on their work at the Falls, Balance and Injury Research Centre, by translating the highest level of scientific evidence into effective fall prevention initiatives and evidence-based guideline care.
“They recommend a tailored approach with different interventions to different people, according to whether they have fallen in the recent past and what additional individual risk factors they have,” she said.
“For example, in residential aged care, there is stronger evidence to support the ongoing delivery of exercise for fall prevention, and in the community, highlighting different approaches to intervention for people with different levels of risk.”
The guidelines provide recommendations and good practice points to address personal and environmental risk factors for falls. They say that in hospitals, residential aged care services and in the community, a tailored, multifaceted approach to preventing falls and harm should consider risk factors including hearing.
Aged care falls guidelines
Good practice points from the aged care guidelines are:
■ Facilitate access to hearing assessment and management for the older person on commencement of care and annually. When undiagnosed hearing problems are identified facilitate access to an audiologist.
■ Ensure older people who use hearing aids have them within easy reach, that the older person wears their hearing aids when mobilising and that the hearing aids are working.
■ Use hearing devices (such as a pocket talker that amplifies sound closest to the listener while reducing background noise) to communicate with an older person with a hearing impairment, as required and in line with the older person’s preferences.
Hospital falls guidelines
Good practice points from the hospital guidelines:
■ Identify any hearing problems that an older person may have as part of the falls risk assessment.
■ Ensure older people who use hearing aids have them within easy reach, that they wear them when mobilising and that they are working.
■ Use a pocket talker to communicate with an older person with a hearing impairment, as required and in line with the older person’s preferences.
■ Provide increased supervision for older people with impaired hearing when they are moving away from their immediate bed surrounds.
■ As part of good discharge planning refer older people with undiagnosed hearing problems to an audiologist.
In the community
Good practice points in the community falls guidelines:
■ Encourage older people to have annual hearing assessments and management with an audiologist to maximise hearing. Support the older person to see an audiologist when required.
■ Encourage older people to wear their hearing aids when mobilising. Ensure that the hearing aids are working.
■ Implement strategies to maximise independence with older people who have hearing impairment. If the older person has fallen, facilitate access to an audiologist for a detailed assessment and fall-specific hearing examination.
■ Use hearing devices (such as a pocket talker that amplifies sound closest to the listener while reducing background noise) or a hearing loop (a sound system that can broadcast to hearing aids) to communicate with an older person with a hearing problem.
Dizziness and vertigo in hospital, aged care and the community
The guidelines say prevalence of dizziness and vertigo increases markedly with age and is associated with an increased risk of falling among older people.
Poor sensorimotor function, impaired balance control, anxiety and neck and back pain are linked to dizziness and falls. Older people with dizziness are also at high risk of experiencing fall-related fractures.
Good practice points:
■ Assess older people complaining of dizziness and vertigo for vestibular dysfunction (balance problems), gait problems, postural hypotension and anxiety.
■ Assess the older person for postural hypotension with tests of lying and standing blood pressure.
■ Review the older person’s medicine regimen to identify medicines contributing to dizziness or postural hypotension, including, but not limited to, antihypertensives, antidepressants, anticholinergics and hypoglycaemics.
■ Facilitate access to an appropriately trained medical practitioner or a physiotherapist who can assess and manage vestibular-related balance problems in the older person. Implement interventions for benign paroxysmal positional vertigo and vestibular rehabilitation when indicated.
The HHSA believes two key initiatives the government could implement would make a huge difference to older Australians in aged care settings. The first is mandating a uniform protocol to conduct hearing screening for all new residents of aged care facilities within one month of residency in the facility and include this as a quality metric in aged care reporting.
The second is creating a new schedule item in the HSP Schedule for aged care facility hearing screenings at the same price as a hearing assessment ($157.40), reflecting the true cost for hearing health care professionals to conduct remote visits and diagnostic services.
