Falls and mobility

This page is currently under review and a new narrative is due in July 2016.

Introduction

Falls are a major cause of disability and are the leading cause of mortality (as a result of injury) in people aged 75 and over in the UK. The Department of Health state that 35% of people aged 65 and over experience one or more falls on an annual basis. This percentage increases with age. About 45% of those aged 80 and over and living in the community will fall each year. 10% to 25% of people suffering a fall will sustain a serious injury. Hip fractures are the most frequent fragility fractures caused by falls and are the most common cause of accident-related death.

Risk factors fall into intrinsic and extrinsic factors. Intrinsic factors are to do with the person, for example advanced age, previous fall history, muscle weakness or presence of a chronic condition such as  arthritis. Extrinsic factors are to do with the person’s environment, such as trip hazards, no stair rail, dim lighting, slippery surfaces and psychoactive medication.                            

Injuries due to falls are measured as part of the Public Health Outcomes Framework.

Facts, figures and trends

Based on modelled estimates from the Health Survey for England 2005 (volume 2, table 2.1: prevalence and number of falls in last 12 months, by age and sex) it is estimated that 4,354 people aged 65 and over will have a fall in 2015 in Bracknell Forest. This is predicted to increase to 6,864 by 2030 (Projecting Older People Population Information System, 2015). 

It is estimated that 2,847 people aged 65 and over in Bracknell Forest are unable to manage at least one mobility activity on their own (for example going out doors and walking down the road, getting up and down the stairs, getting around the house on the level, getting to the toilet and getting out of bed). This figure is predicted to increase to 4,751 by 2030 (Projecting Older People Population Information System, 2015).

Injuries due to falls

Data from the Public Health Outcomes Framework shows that the rate of hospital admissions for injuries due to falls in people aged 65 and over increased from statistically significantly better than the national average in 2010/11 to statistically significantly worse in 2011/12 (2290 per 100,000 compared to the national average of 2035). This has been decreasing since, with a rate of 1982 per 100,000 population shown in 2013/14. This is similar to the national average.

Figure 1. Age-sex standardised rate of emergency hospital admissions for injuries due to falls in persons aged 65+ per 100,000 population, Bracknell Forest, 2010/11 to 2013/14.

Source: Public Health Outcomes Framework, 2015

Hip fractures

Data from the Public Health Outcomes Framework shows that between 2010 and 2014 the crude rate of admissions for hip fractures was highest in 2011/12 at 650 per 100,000 population over 65. This was an increase of 83 per 100,000 population on the previous year. Data for 2013/14 shows that this rate has decreased since 2011/12 to 468 per 100,000 population over 65. This is similar to the national average and is in the top quartile in England.

Figure 2. Emergency hospital admission rate for fractured neck of femur per 100,000 population aged 65+ (age standardised rate), Bracknell Forest, 2010/11 to 2013/14.

Source: Public Health Outcomes Framework, 2015

Falls prevention has been included as a priority for Bracknell Forest within our JSNA summary. Future actions for falls prevention can be categorised under 3 sections:

  1. Improving data collection methods, ensuring that all data is complete and up to date. This is important for both scoping the size of the issue and in monitoring progress in reducing future falls.
  2. Improving risk identification systems in order to prevent falls from occurring to begin with. We are currently reviewing literature and working with the CCG, primary care and social care to implement methods with higher sensitivity and specificity.
  3. Improving and expanding existing falls services using a multi-tier system of service provision, by auditing and reviewing services against current NICE guidelines and the estimated need for falls services within the local population.

National and local strategies (current best practices)

National Institute of Health and Clinical Excellence’s published clinical guidance in 2013 about The assessment and prevention of falls in older people

NHS Evidence provides topic information about falls

Department of Health published guidance in 2009 about Falls and fractures: developing a local joint strategic needs assessment

What are the key inequalities?

Falls are much more common for older people and the consequences of falls are more severe.  

Recommendations for consideration by other key organisations

Ensuring that people aged 65 and over are routinely asked if they have had a fall when they come into contact with a health professional would be beneficial.

We recommend that patients aged 65 and over who present to a health professional after a fall should be offered a multifactorial falls risk assessment.

 

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