Community-based falls prevention for older adults with diabetes

Falls among older Australians with diabetes are often treated as an inevitable part of ageing, yet many occur where prevention and timely treatment can change the outcome. Diabetes can reduce sensation in the feet, alter vision and affect blood pressure, while glucose-lowering medicines may cause hypoglycaemia. A near-miss can follow an ordinary walk to the shops, a change of position after sitting, or a slippery step at home. These everyday scenarios often reveal more than a single clinical score.

The 2023 APEC Conference on Promoting Community-based Non-Communicable Diseases Integrated Care Model placed community-led action at the centre of chronic disease care. Its official site brought together the agenda, speaker biographies, registration guidance, venue details, downloadable slides, program book and a hybrid participation format. Applied to falls prevention, this integrated approach connects clinical care with the places where people live, move and socialise. It also recognises that sustainable prevention depends on local services, trusted leaders and practical support.

Why diabetes changes fall risk

Diabetes increases exposure to several pathways that can lead to falls. Peripheral neuropathy can blunt awareness of uneven ground, peripheral arterial disease may encourage painful or altered walking, and retinopathy may reduce confidence in busy or dim spaces. Autonomic neuropathy can contribute to dizziness when standing, while insulin or sulfonylureas can cause hypoglycaemia, particularly when a meal is delayed. Poorly fitted footwear adds friction or instability to each of these risks.

Assessment should separate modifiable hazards from issues requiring medical treatment. Balance, leg strength, gait speed, vision, medication effects, orthostatic symptoms and home hazards belong in one review, rather than in isolated appointments. People who have already fallen may also reduce their activity because they fear recurrence. A community programme can address that response by building confidence gradually through supervised practice, familiar settings and achievable goals.

A community prevention pathway

A useful pathway begins with brief screening followed by individual assessment. Participants can be asked about previous falls, medication changes, dizziness, hypoglycaemia, foot problems and confidence in walking. Those with unstable glucose, active foot ulcers, new neurological symptoms or recurrent falls need prompt clinical review. Suitable participants can then enter supervised strength, balance and education sessions, with home assessments and medical referrals supporting the same plan.

The pathway works best when general practitioners, diabetes educators, physiotherapists, occupational therapists, pharmacists, optometrists and podiatrists share clear responsibilities. Community health workers and local exercise leaders may provide reinforcement between clinical appointments. Evidence from adjacent chronic-disease work is available through related research resources, while program books and conference presentations can help teams adapt established approaches without duplicating materials. Each referral should identify who will act, how progress will be monitored and when the participant will be contacted again.

Exercise that fits Australian life

Strength and balance activities should reflect what participants already do. Walking to the shops, gardening, taking public transport or moving around a high-rise building can become opportunities for supervised practice when balance challenges are added carefully. Suitable options include progressive leg strengthening, sit-to-stand exercises, supported walking, tai chi and functional practice that rehearses standing from a chair or turning safely. Qualified health professionals can adjust intensity for frailty, joint pain and neuropathy.

In Sydney, Melbourne and Brisbane, neighbourhood walking groups can use parks, flat urban routes and community centres, while indoor options help during extreme heat, heavy rain or poor air quality. Groups in regional and remote towns may rely more heavily on telehealth, local trainers and culturally safe gathering places. The conference’s featured speakers can help local teams compare approaches to mobility, behaviour change and community engagement. Participation in a hybrid session can also allow rural health workers to ask questions without a long journey to the venue.

Partnerships that keep referral pathways open

Community falls prevention should sit within, rather than compete with, primary care. A general practice can identify higher-risk patients, review glucose-lowering medicines and coordinate referrals, while allied health professionals design individual activity plans. Pharmacists can contribute to medication reviews and reinforce signs of hypoglycaemia. Diabetes educators can connect glucose monitoring with food timing and daily movement, ensuring that an exercise invitation does not create avoidable episodes of low blood glucose.

Australia’s mixed health market creates both opportunities and gaps. Medicare rebates and general practice chronic disease management pathways can support eligible allied-health care, but access varies with income, transport and private costs. Community health centres, pharmacies, senior groups and local councils often reach people who do not attend specialist clinics. A community-health approach to hypertension case study illustrates how accessible local services can combine screening, follow-up and practical support. Falls services can use the same referral infrastructure and community trust.

Education that supports safer choices

Safety education should be practical and delivered more than once. Participants need to understand how hypoglycaemia, dehydration, dizziness and visual changes can affect walking, as well as the importance of suitable footwear, lighting, clutter-free routes and supportive footwear habits. Medication reviews should consider whether dizziness or low glucose could be reduced through dose timing or other clinical decisions. Education must never suggest that people should stop prescribed treatment without advice from their treating team.

Trusted local settings can make that information more useful. Pharmacies can display short self-assessment prompts and direct people to falls screening. Churches, mosques, temples and other faith communities can support awareness campaigns, exercise sessions and peer encouragement, as described in faith-based NCD partnerships. Aboriginal and Torres Strait Islander community-controlled health services, migrant health organisations and interpreter networks can also shape messages and delivery methods that respect language, culture, family responsibilities and community priorities.

Measuring outcomes and protecting equity

Evaluation should track both falls and the conditions that influence them. Useful measures include the number of falls, injuries requiring hospital care, balance and leg-strength changes, activity levels, medication reviews, completed home modifications and participant confidence. Hypoglycaemic events, footwear access and reasons for withdrawal may reveal whether the programme is safe and relevant. Results should be compared with baseline findings and reported over time, while adverse events and successful participant stories provide essential context.

Equity and data governance should be built into the programme. Participants from low-income areas, outer suburbs, rural communities and culturally diverse backgrounds may need different transport, language or scheduling arrangements. The Privacy Act 1988 (Cth), together with applicable state and territory health-records legislation, sets important limits on how identifiable health information can be collected, shared and stored. Teams should collect only necessary data, use secure systems and explain how findings will guide service improvement. Conference slides, virtual backgrounds and downloadable resources can support staff training without requiring every site to create its own materials.

Turn conference evidence into community action

Moving from conference insight to local action requires a defined team, a referral pathway and a small programme that can be adjusted over time. A local partnership might combine a general practice, allied health providers, a community health centre, a pharmacy and an older people’s organisation to screen residents and deliver supervised sessions. The team should agree on referral criteria, emergency procedures, equipment, transport support and methods for contacting participants. Conference agenda items and speaker insights can guide these decisions, while local data determine which barriers require immediate attention.

Download the program book and presentation slides, review the agenda with local partners, and contact the relevant speakers before service design begins. Then convene a multidisciplinary team to design, pilot and evaluate a community-based falls prevention programme for older adults with diabetes, with clear referral routes and regular review of safety, participation and mobility outcomes.