The World Health Organisation (WHO) defines a fall as an event which results in a person coming to rest unintentionally on the ground or floor, or another lower surface. It is not caused by an external force or hazard and may result in no injury. However, service users can suffer consequent non-physical harm such as fear of falling. Fear of falling can cause the service user to restrict their activities, causing reduced strength and balance, further increasing their falls risk. Falls and fall-related injuries are common in older adults, have negative consequences both on their quality of life and functional independence, and are often associated with increased morbidity, mortality and healthcare costs.

What is the impact of falls?

According to the National Major Trauma Audit low falls (falls from less than 2 metres height) continue to be the leading cause of major trauma in Ireland, at 61% of all major trauma cases, often resulting in life-changing or life-threatening injuries. Hip fractures are particularly problematic as the associated morbidity and mortality is significant. Over 4,000 persons experience a hip fracture in Ireland each year, mainly because of a trip or fall. Studies report that nearly 90% of all service users with a hip fracture require assistance with at least one activity of daily living one-year post-fracture,^* and 40% of those who sustain an in-hospital hip fracture die within three months.^†

The theme for the United Nations International Day of Older Persons 2025 was "Older Persons Driving Local and Global Action: Our Aspirations, Our Well-Being, Our Rights". This theme emphasises the transformative role older persons play in driving action and advocating for their well-being, both locally and globally. The HSE’s Patient Safety Strategy 2019-2024 also targets falls as a major safety concern, with a specific focus on falls prevention and management within HSE services.

While a hip fracture is a life-changing event, one can make a good recovery with the right care. Significant efforts are being made to standardise clinical approaches and falls clinical guidelines within and between countries and settings by incorporating current and emerging falls research, including service user and carer perspectives, e-health considerations, as well as addressing differences between settings and countries.

What does our analysis show?

Incident reporting affords health and social care services the opportunity to learn from adverse incidents. In Ireland, publicly funded health and social care services have a statutory obligation to report incidents to the State Claims Agency on NIMS, including those involving slips/trips/falls (STFs). Analysis by the State Claims Agency of incidents reported on NIMS that occurred from 2020 -2024 inclusive shows that:

• STFs accounted for 24% of all service user incidents
• 51.9% of all service user STFs happened at the same level/ground, and another third (34.6%) involved falls from equipment/furniture
• 70.1% of STFs involved persons aged 65 years and older
• The majority of STF incidents reported (82.7%) did not result in injuries
• STFs at the same level/ground resulted in more serious injuries across all settings - hospital, community and residential care
• When injuries were reported they most frequently involved the head - injuries affecting the head accounted for 40.7% of these incidents *
• Fractures were uncommon, recorded in just 1.4% of all STF incidents reported; however, hip fractures accounted for 34.6% of these fractures equivalent to 815 hip fractures over the five-year period *

*Where the injured body part was recorded

How can harmful STFs be prevented?

Most falls are predictable and preventable, with known risk factors, many of which are modifiable. Evidence-informed guidance recommends assessing the risk of falling and interventions to prevent harmful falls in all persons in hospital and residential care aged 65 and over and persons aged 50 and older at higher risk of falls. This practice aims to reduce the risk and incidence of falls, and the associated distress, pain, injury, loss of confidence, loss of independence and mortality.

Health and social care professionals and services play an important role in reducing the risk of harmful falls. Based on the findings above and best practice, the State Claims Agency has prepared the following advice:

• Risk assess: persons aged 65 and older and those 50 and older at higher risk of falls in inpatient hospital settings and residential care need a comprehensive multifactorial risk assessment so as to identify and effectively manage their falls risk. This approach is equally important for persons living in the community who have recently fallen, or have fallen within the past year, or have a fear of falling, and/or who are experiencing issues with gait or balance
• Remediate: conduct a proportionate and responsive post-fall review to identify factors that contributed to the fall and opportunities to prevent another fall. Ensure implementation of service user-centered actions and approaches to prevent harmful falls
• Report and learn: continue to report clinical incidents in a timely manner in accordance with the statutory requirement to report incidents to NIMS, and in line with the HSE’s Incident Management Framework, so that learning and ongoing service improvements can continue
• Reform: collaborate and foster standardisation of fall prevention clinical approaches and guidelines within and between different services, settings, and regions to streamline the approach to falls risk and prevention. Continue to support the implementation of the Irish Hip Fracture Standards (IHFS) in hospitals to optimise outcomes and quality of care for older persons following a hip fracture

References available on request

^{* Kanis JA, Johnell O. (1999), The burden of osteoporosis. J Endocrinol Invest 22:583–588.}

^{† Johal, K.S., et al. (2009), Hip fractures after falls in hospital: a retrospective observational study Injury 40: 201-204.}