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Summary

Adults :: Falls :: Summary

A fall is defined as 'an event whereby an individual comes to rest on the ground or another lower level with or without the loss of consciousness' (American Geriatric Society, 2001).

Falls are an increasingly significant public health issue due to our ageing population. Older people have the highest incidence of falls and the greatest susceptibility to injury. Up to 35% of people aged 65 and over fall each year increasing to up to 42% for those aged 70 years and above. [1]

Falls may result in loss of independence, injuries such as fractures and head injuries (20% of fallers sustain serious injury such as hip fracture), mobility loss, pressure related injuries, infection and sometimes injury–related death. The most common serious consequence of falling is a hip fracture (fractured neck of femur). Often the elderly will require hospital admission and rehabilitation following a fall. In the UK there were 647,721 Accident and Emergency (A&E) attendances and 204,424 hospital admissions for falls–related injuries in those aged 60 years or above in 1999. [2] Falls and fractures in the >65s account for four million hospital bed days/year in England.

Older people who fall are likely to fall again, usually requiring further use of health and social care services. Recurrent fallers are also more likely to have a fall–related fracture. [3] Half of people suffering a hip fracture never return to their previous level of independence and experiencing falls is a strong predictor of needing placement in a nursing or care home in the future. [4]

Osteoporosis, a condition characterised by a reduction in bone mass and density, increases fracture risk when an older person falls. Osteoporotic fractures are increasing in the UK, a trend which is likely to continue as the elderly population increases. It is estimated that 3 million people in the UK have osteoporosis and that around 230,000 osteoporotic fractures occur in the UK each year. In 2001, the combined NHS and social care costs for a single hip fracture in the UK were estimated to be ?20,000 with an estimated total of more than ?1.73 billion per year for all UK hip fractures.

The financial impact of falls and fractures on health and social care is substantial. As the rate of falls is expected to rise with an ageing population, developing effective interventions to prevent falls becomes increasingly important as they will have significant implications for health and social services.

The Department of Health published “Falls and Fractures. Effective interventions in health and social care” in 2009, the aim of which was to improve NHS falls and fracture services and care for older people. Four key objectives were set out within the document, prioritised in the size of health gain, which commissioners should consider in the context of local services for falls, falls prevention and fractures (figure 1).

Figure 1: Department of Health: Systematic Approach to Falls and Fracture Prevention.
Figure 1: Department of Health: Systematic Approach to Falls and Fracture Prevention— Four Key Objectives.

Key issues and gaps


• Falls are a public health problem nationally due to an ageing population. Medway's 50+ population is expected to increase by 16% from 2013 to 2021. The number of people over 85 will grow by 27% over the same time period.
• Osteoporosis is common, especially in older females, and is a major cause of fractures in fallers. Osteoporosis prevalence is likely to increase with Medway's ageing population.

• Hospital admissions for hip fractures following falls are expected to rise by 29% from the 2010–2012 baseline by 2021 in those aged 50 years and above. For all falls–related admissions in Medway patients aged 50 years and above the expected increase from baseline is 27% by 2021. By far the greatest burden in Medway of hip fracture following falls occurs within the 85+ age group.
• The highest rates of falls related Medway admissions in 2012 were for non–hip fractures (“other fracture”) and injuries other than fractures (“other injury”). In 2012, Hip fractures accounted for just 11.4% of all falls–related admissions in Medway compared to 52.6% of admissions where no fracture took place. The remaining 36% of falls related admission in 2012 were for non–hip fractures.
• Directly standardised hospital admission rates for all falls in those aged over 50 years saw a general upward trend from 2007–2011, with a similar trend in admission rates for hip fractures following falls. An unexpected situation can be noted for Medway where admissions for all falls and for hip fractures has declined over the last couple of years following the earlier rise. Although data from subsequent years is required in order to determine whether this decline is an enduring trend, its possible causes are worthy of further investigation.
• Mean length of stay for hip fracture admissions was 16.1 days (median 12 days) for Medway in 2012: lower than the 2012 national mean of 20.2 days. [5]
• The total number of admissions coded as “other diagnoses” involving no injury such as Senility, Urinary Tract Infections, Pneumonia etc. saw a striking increase of 51% from 2007 to 2011, followed by a fall of 53% from 2011 to 2012. The cause of this pattern is unclear and needs further investigation.

Recommendations for commissioning


• Projected increases in the burden of falls and falls–related injury together with fewer resources available for health and social care mean that falls and falls prevention should be a priority issue for commissioners and providers.
• A Medway Falls Strategy should be developed and implemented as a framework for consideration of the whole falls care pathway by commissioners.

• Falls should continue to be included as a topic within the JSNA and the findings should be brought to the attention of the Health and Wellbeing Board.
• Effective falls prevention schemes can be implemented at little cost with the involvement of professionals working in health, social care and in the community. The majority of falls in Medway occur in the home or in residential care settings, highlighting the need to examine the existing provision of home safety information in the community and the need for a better understanding of falls prevention activities within care settings. All care homes should have falls prevention strategies in place, the objectives of which should include more robust recording and reporting of data on falls.
• Commissioning of the enhanced falls pathway and falls fast track clinic
• Service users should have greater involvement in service development and monitoring.
• Audit of the accuracy/ appropriateness of coding for falls related admissions
• Further in depth analysis of falls data, including data on A&E attendances and locations of falls in the community, is required in order to achieve a better understanding of the pattern of falls across different groups and different settings in Medway.
• Detailed mapping of all falls services delivered across all sectors and organisations in Medway, including the voluntary sector, should be undertaken.

• Falls Prevention should also consider the wider environment, for example, through partnership working with town planners to ensure that the risk of falls to older people is taken into account.


References

[1]   World Health Organisation. WHO Global Report on Falls Prevention in Older Age 2007; World Health Organisation. http://www.who.int/ageing/publications/Falls_prevention7March.pdf .
[2]   National Institute for Health and Care Excellence. The assessment and prevention of falls in older people 2013; http://www.nice.org.uk/Guidance/cg161
[3]   NHS Confederation. Falls Prevention 2012; NHS Confederation. http://www.nhsconfed.org/Publications/Documents/Falls_prevention_briefing_final_for_website_30_April.pdf .
[4]   Mary E Tinetti, Christianna S Williams M. Falls, injuries due to falls, and the risk of admission to a nursing home New England Journal of Medicine 1997; 337 (18): 1279-1284.
[5]   National Hip Fracture Database. National Hip Fracture Database National Report 2012; National Hip Fracture Database. http://www.nhfd.co.uk/003/hipfractureR.nsf/luMenuDefinitions/CA920122A244F2ED802579C900553993/$file/NHFD%20National%20Report%202012.pdf?OpenElement .