Falls Risk Assessment: A Practical Guide for Aged Care and Hospitals

Falls are the leading cause of injury hospitalisation among older Australians, and roughly one in three people over 65 falls each year. In aged care and hospital settings the stakes are higher again: the residents and patients most likely to fall are usually the ones least able to recover well from one. A falls risk assessment is where prevention starts — but only if it's done at the right times, with the right tool, and followed by action rather than filed away.

This guide covers what a falls risk assessment actually involves, the tools commonly used across Australia, when reassessment is required, and — the part that matters most — how to turn a risk score into a plan that prevents falls.

Screening versus assessment: two different jobs

The terms get used interchangeably, but they are different steps. A falls risk screen is a quick check — a few questions or a short scored tool — that sorts people into broad risk categories so that limited clinical time goes where it's needed. A comprehensive falls risk assessment is the deeper multifactorial review that follows for anyone the screen flags: medications, mobility and balance, cognition, continence, vision, footwear, orthostatic blood pressure, fear of falling, and the person's own history of falls.

The evidence is consistent that it's the multifactorial assessment — and the interventions matched to what it finds — that reduces falls, not the screening score by itself. A number on a form never prevented a fall.

The tools used in Australia

FRAT — the Falls Risk Assessment Tool

Developed by the Peninsula Health Falls Prevention Service, the FRAT is the most widely used falls risk tool in Victorian residential aged care and community settings, and it has spread well beyond Victoria. It has three parts:

1. Part 1 — falls risk status: a scored screen covering recent falls, medications, psychological status and cognition. Scores range from 5 to 20: 5–11 is generally categorised as low risk, 12–15 medium, and 16–20 high.
2. Part 2 — risk factor checklist: a structured review of the contributing factors — vision, mobility, transfers, behaviours, continence, footwear, environment.
3. Part 3 — action plan: the interventions selected in response, with space to record what was implemented and referred.

The structure is the lesson: the tool itself walks you from score, to causes, to actions. Facilities that photocopy Part 1 and skip Parts 2 and 3 are doing a screen, not an assessment.

Hospital screening tools

Hospitals typically use short screening tools adapted to acute settings — variants of tools such as STRATIFY — embedded in admission workflows, with comprehensive assessment and care planning following for patients who screen at risk. The National Safety and Quality Health Service Standards expect health services to screen for falls risk, assess those at risk, and deliver targeted prevention strategies as part of comprehensive care.

Aged care obligations

Under the strengthened Aged Care Quality Standards, residential providers are expected to manage falls risk as part of clinical care: assessment on entry, prevention strategies matched to the individual, reassessment when things change, and evidence of all of it. Assessors ask the same question auditors ask about any safety system — not "do you have a form?" but "show me how the assessment changed what you did."

When to assess — and reassess

A falls risk assessment is a snapshot, and falls risk moves. The accepted triggers for assessment and reassessment are:

1. On admission or move-in — within the timeframe your organisation's policy sets, commonly the first day for hospitals and the first week for residential care, with a fuller review once the person has settled.
2. After every fall — including unwitnessed falls and "found on floor" events. A post-fall reassessment is both clinical good practice and the record an investigation will look for.
3. After a change in condition — new confusion or delirium, acute illness, a stroke, worsening mobility.
4. After medication changes — particularly sedatives, antipsychotics, antihypertensives, opioids and diuretics, and any time the total medication load increases.
5. After return from hospital — deconditioning from even a short admission measurably raises falls risk.
6. At regular intervals — commonly every six months in residential care even when nothing has visibly changed, because gradual decline doesn't announce itself.

Turning a score into a plan

The score sorts people; the risk factor review tells you what to do. Interventions worth matching to findings include:

Reversible causes first. A medication review with the GP or pharmacist where psychotropics or polypharmacy are flagged; vision review and correct glasses actually worn; treating the UTI behind the new confusion; managing postural hypotension.

Strength, balance and mobility. Referral to physiotherapy for gait and balance work — the single best-evidenced falls intervention in older people — plus correctly fitted footwear and the right mobility aid, used.

Routine and environment. Toileting routines for residents who fall on the way to the bathroom (a large share of overnight falls), bed at the right height, clear paths, night lighting, personal items within reach, and a call point the person can actually reach and use.

Observation and technology, matched to the highest-risk windows. For residents whose assessment flags overnight bed exits as the danger — the post-surgical patient, the resident with dementia who wanders, the first week after a medication change — targeted monitoring buys staff the seconds that matter: bed, floor and chair sensor mats connected to the nurse call system, and increasingly contactless options like the radar bed exit sensor we are developing, which alerts as the person sits up rather than after they're on their feet.

The order matters. Technology sits at the end of that list deliberately: a sensor doesn't fix the medication load or the loose slippers, and an alert only helps if it reaches staff reliably — which is why monitoring devices should raise alerts through the nurse call system staff already answer, not a separate box nobody watches.

The documentation that stands up afterwards

When a serious fall is investigated — internally, by the regulator, or by a coroner — the questions follow a predictable line: when was this person's falls risk last assessed, what did it find, what was done about it, and was it reviewed after anything changed? A defensible record shows the assessment, the dated action plan, evidence the actions happened, and the reassessments at each trigger point. The gap that hurts facilities is rarely a missing form; it's an assessment that identified a risk nobody can show was acted on.

Frequently asked questions

What is the FRAT falls risk assessment?

The FRAT (Falls Risk Assessment Tool), developed by the Peninsula Health Falls Prevention Service, is a three-part tool widely used in Australian aged care and community settings: a scored risk screen, a risk factor checklist, and an action plan. Part 1 scores from 5 to 20, with 5–11 generally treated as low risk, 12–15 medium and 16–20 high.

How often should falls risk assessments be done in aged care?

On entry, after every fall, after any significant change in condition or medications, after return from hospital, and at regular intervals — commonly six-monthly — even when nothing has visibly changed. Your organisation's clinical policy sets the exact timeframes.

Who can complete a falls risk assessment?

Screening tools are typically completed by nursing staff. The comprehensive assessment and resulting care plan involve the broader clinical team — nursing, GP, physiotherapy, pharmacy — because the interventions span medications, mobility, environment and care routines.

Does a high falls risk score mean the resident needs constant supervision?

No — it means the risk factor review and action plan matter more. Interventions are matched to the specific factors found: medication review, strength and balance work, toileting routines, environmental changes, and targeted monitoring such as bed exit sensing for the highest-risk windows like overnight.

Do sensor mats or bed sensors replace a falls risk assessment?

No. Assessment identifies who is at risk and why; monitoring technology is one intervention among several, best targeted at the risks the assessment found — typically unassisted bed exits overnight — and connected to the nurse call system so alerts reach staff the same way every other call does.

This article is general information for care providers, not clinical advice — follow your organisation's clinical policies and your residents' individual care plans. Peninsula Smart Care is a licensed Melbourne electronic security and healthcare communications integrator. We supply and integrate falls monitoring — sensor mats and bed exit sensing — with Sedco, JCT and IP nurse call systems across Victoria. Call 03 7504 7011.