Falls and Fracture Prevention — Canada

A fall is an unintended event in which a person comes to rest on the ground, floor or another lower level. The definition concerns what happened, not whether an injury is immediately visible. Losing balance without coming to rest at a lower level may be a near miss; both events can reveal a need to review the person’s support and environment. Use the setting’s reporting definitions and describe the facts rather than arguing over a label while care is needed.

Practice scenario: a person slides from a chair and is found sitting on the floor. A colleague says it was not a fall because nobody saw a trip. You did not witness the descent. Record where and when you found the person, their position, what they tell you and what help you obtained. Do not state an assumed cause as an observed fact. Ask the responsible clinician to assess the person under the post-fall process.

A second person stumbles but regains balance with their walking aid. Report the new difficulty through the agreed care pathway and consider whether an immediate environmental hazard can be removed safely. A near miss does not establish that future walking is safe without review. Avoid reassurance based solely on the absence of injury.

Practice: Write separate factual descriptions of the chair event and the stumble. Identify which statements would be assumptions, and who should assess the person.

The Public Health Agency of Canada identifies falls as a major source of injury-related hospital care and death among older adults. Such population evidence explains why prevention deserves organised attention. It does not mean that every older person will fall, that every fall causes a fracture, or that one person’s risk can be inferred from age alone. Read each statistic alongside its age group, setting, time period and outcome definition.

Practice scenario: an education slide describes the proportion of injury-related hospitalisations attributed to falls as the proportion of all older Canadians who fall annually. These are different denominators. Rewrite the statement to identify what was counted and remove the unsupported claim. For any local comparison, check whether you are comparing falls, people who fell, fall injuries or hospital admissions. One person can have more than one event.

Use Canadian surveillance to discuss local prevention needs while recognising that long-term-care populations may differ from people living independently. This lesson is a Canadian adaptation and does not claim to fulfil the comparison outcome about UK epidemiology. In a team discussion, connect the evidence to one practical question, such as whether recent near misses are reaching the review process, rather than using numbers to label residents as inevitable fallers.

Practice: Explain the denominator error in the scenario and list the population, period and outcome details needed before comparing two falls statistics.

Evidence-informed prevention combines recognition of risk, assessment, tailored interventions and review. A warning sign alone does not address an individual’s mobility, environment or support needs. RNAO recommends involvement of the person and communication across care transitions. Its public guideline page currently identifies the fourth edition and an anticipated revision; check the issued edition rather than assuming an expected update has already been published.

Practice scenario: a resident is discharged with revised transfer instructions, but the receiving team uses an older mobility plan. Before assisting, obtain the current instructions and resolve the discrepancy with the responsible professional. Explain the plan to the person in an accessible way and check how they prefer assistance to be offered. Do not improvise a transfer because equipment or trained help is unavailable; escalate the obstacle.

A useful prevention plan identifies what staff should do, when they should do it and who will review changes. For a person who needs help reaching the toilet overnight, merely telling them to be careful is insufficient. Discuss practical support with the team, communicate agreed actions at handover and report whether they work. Prevention aims to reduce avoidable harm while supporting participation; it does not justify unnecessary restriction or promise that all falls can be eliminated.

Practice: For the discharge scenario, identify the missing information, the safe action before assisting and the handover detail that would prevent repetition.

Risk can arise from the person, their activities and the environment together. Previous falls, balance or strength difficulties, visual problems, dizziness, medication effects and unsuitable footwear may be relevant. Hazards such as loose rugs, poor lighting or a wet route can add to existing difficulty. Identifying a possible factor is a prompt for assessment, not proof that it caused a particular fall. Follow your role when observing and reporting concerns.

Practice scenario: a client feels dizzy on standing, is trying to reach the bathroom urgently and finds their usual walking route obstructed by a delivery box. If safe, remove the obstruction and obtain help according to the care plan. Report the dizziness and changed assistance need promptly. Do not independently stop medication, alter prescribed mobility aids or encourage the person to walk through symptoms merely to test their balance.

A past fall also warrants attention even if the person cannot recall an injury. Ask respectfully about what they experienced and what they are worried about. Distinguish the likelihood of falling from the likelihood of fracture: bone health may increase injury consequences without explaining why balance was lost. The clinical team considers these issues together. Record observations that can guide a review and avoid blaming the person for needing assistance.

Practice: Identify person-related, activity-related and environmental factors in the bathroom scenario. Separate an action within a support role from an issue requiring clinical review.

After a fall, obtain appropriate help and check the person’s immediate condition within your training. Do not rush to lift them. Unresponsiveness, abnormal breathing, suspected serious injury or deterioration requires the emergency response and first aid within your competence. A person who initially seems comfortable may still need assessment and monitoring. Follow the workplace post-fall procedure and the responsible clinician’s instructions; this lesson does not teach manual lifting or replace first-aid training.

Practice scenario: you find a resident on the floor. They ask to be put back in bed, but report new hip pain. Reassure them, summon the responsible clinician and avoid moving them simply to tidy the room. Use the emergency process when indicated and protect them from an immediate environmental danger. Communicate what you observed, what they report and whether the fall was witnessed. Do not test an injured limb by asking them to walk.

Clinical review considers injury, possible causes and follow-up observation. Report new symptoms even after an initial assessment, including changes in alertness, persistent pain or worsening function. Record who was contacted and the instructions received. If the person declines assistance, seek clinical guidance and follow the setting’s consent and escalation process rather than using force or leaving a concern unreported.

Practice: Prepare a first handover for the hip-pain scenario. State why standing the person up to test their walking is inappropriate.

Falls may cause bruising, wounds, fractures or head injury, and sometimes require hospital care. Their effects can continue after the immediate event: pain, reduced confidence, altered mobility and additional support needs may change everyday life. A person without an obvious injury can still feel frightened or embarrassed. Avoid treating the event as trivial simply because there is no visible wound. Ask about concerns and relay changes through the care team.

Practice scenario: after a fall, a resident stops joining a favourite activity because they fear the walk to the lounge. Saying there is nothing to worry about dismisses their experience. Listen, identify what feels difficult and arrange review of the assistance and mobility plan. Support participation within the agreed plan; do not prescribe independent exercises or pressure the person to demonstrate confidence before they feel ready.

For an organisation, a fall may require urgent staff time, investigation, care-plan changes, equipment review and communication with the person and authorised contacts. Treat these responsibilities as learning opportunities rather than reasons to hide events or blame staff. In the scenario, consider whether the route, timing and availability of help are contributing to avoidance. Record the person’s priorities so recovery is evaluated in terms that matter to them, not just whether another incident occurred.

Practice: Identify one physical, one emotional and one organisational consequence, then propose a person-centred follow-up question for the scenario.

Tailored prevention combines actions suited to the person and the setting. Examples include keeping an agreed walking route clear, making required aids accessible, providing planned assistance, addressing footwear and lighting concerns and communicating changes in mobility. Clinical assessment may lead to medication review, appropriate exercise or bone-health advice. Support workers report concerns and carry out agreed actions; they do not independently change medicines, prescribe supplements or select a new mobility aid.

Practice scenario: a person repeatedly reaches across a cluttered bedside area for their call device. Ask where it is easiest to use, place it within their agreed reach and check that it works. Report recurrent access problems so the plan is reviewed. A call device only helps if the person can use it and help is available. Do not assume that providing equipment completes the intervention.

At handover, explain the specific assistance, equipment and observation arrangements rather than saying only that the person is a falls risk. Check that another worker can describe what to do. Review whether the person finds the plan acceptable and whether circumstances have changed. Avoid blanket bed rest or restrictions as a default response: concerns about safety and independence require discussion with the person and responsible team.

Practice: Convert the call-device scenario into an action, a responsible role and a check of effectiveness. Describe what the next worker needs to know.

Treatment after a fall depends on the injuries, contributing conditions and the person’s goals. Clinicians may arrange investigation, pain management, fracture treatment or specialist review. Rehabilitation may involve physiotherapy, occupational therapy and changes to everyday support. Osteoporosis Canada’s guidance addresses fracture risk, exercise, nutrition and treatment; it does not mean that every person who falls should receive the same medicine or supplement. Clinical decisions require individual assessment.

Practice scenario: a person returns from hospital after a fracture with new mobility restrictions and follow-up arrangements. Before assisting with a transfer, confirm the current written plan, required equipment and level of help. If instructions conflict or equipment is missing, seek clarification rather than applying the previous routine. Record symptoms and difficulties that affect the prescribed plan, and escalate new concerns promptly.

Recovery includes checking that follow-up actually takes place. Help communicate appointment and access problems through the agreed care pathway, including transport or language needs. Encourage the person to explain what activities they hope to resume. Do not independently change weight-bearing instructions or promise that pain-free movement means a fracture has healed. A support worker’s contribution is consistent, respectful implementation and accurate reporting; diagnosis, treatment changes and progression of rehabilitation belong to the appropriate professionals.

Practice: List the information needed before the first transfer after discharge, and distinguish support-worker actions from clinical treatment decisions.

Clinical documentation and incident reporting serve related but different purposes. The care record communicates the person’s condition, care provided, escalation and follow-up. An incident system helps the organisation review what happened and improve processes. Completing one does not automatically complete the other. Use the workplace procedure, your role’s requirements and applicable provincial rules; this overview does not specify every mandatory reporting obligation in Ontario, Alberta or Quebec.

Practice scenario: a fall is unwitnessed. Record the time discovered, where and how the person was found, their own account, observed concerns, immediate assistance and who was notified. Identify uncertainty rather than inventing a mechanism or time of fall. Record instructions and subsequent changes promptly. Correct an error through the authorised correction process; do not silently replace an earlier entry. Protect personal information and use approved systems.

After immediate care, submit the required incident report and take part in the team’s review. Describe contributing conditions without assigning unsupported blame. An improvement action needs an owner and a follow-up check; for example, confirming that an obstructed route remains clear and that the care plan has been communicated. CNO’s documentation standard applies to Ontario nurses and is a reference for that role, not a substitute for every worker’s local documentation policy.

Practice: Draft a factual note for an unwitnessed fall and identify the additional incident-report step, one uncertainty to retain and one improvement action to follow up.