Falls and mobility

Introduction

Falls are the largest cause of emergency hospital admissions for older people, with significant negative impact on long-term health and wellbeing. Hip fracture is a major public health issue because of an increasing ageing population and the associated health and social care costs.

The highest risk of falls is in those aged 65 and above and it is estimated that about 30% people (2.5 million) aged 65 and above living at home and about 50% of people aged 80 and above living at home or in residential care will experience an episode of fall at least once a year.

Most falls don't result in serious injury but falls that result in injury can be very serious - approximately 1 in 20 older people living in the community experience a fracture or need hospitalisation after a fall.  Hip fractures are the most frequent fragility fractures caused by falls and are the most common cause of accident-related death.

In addition to the physical and psychological distress and loss of independence, falls and fractures in those aged 65 and above account for over 4 million bed days per year in England alone, at an estimated cost of £2 billion.

Key inequalities and risk factors

Anyone can have a fall, but older people are more vulnerable and likely to fall, especially if they have a long-term health condition.

Data shows that age, deprivation and gender are risk factors in likelihood of falls. Falls are much more common for older people and the consequences of falls are more severe.

Other risk factors include: previous fall history, muscle weakness or presence of a chronic condition such as arthritis. Environmental factors include presence of trip hazards, inappropriate or lack of adaptations, equipment or assistive technologies, dim lighting, slippery surfaces and psychoactive medication.

Facts, figures and trends

The Health Survey for England 2005 focused specifically on older people’s health. It found that the proportion of men and women who had fallen increased with age, with a sharp rise among those aged 80 and over.  Age remains a significant factor in the rate of falls in 2015/16:

In 2005, the prevalence of falls was higher for women than men for each age group and this remains the case in 2015/16:



Potential impact

Projecting Older People Population Information System (POPPI), 2015 data estimates:

  • 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
  • 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



Injuries due to falls

Injuries due to falls for all people aged 65 and over, people aged 65 to 79 and people older than 80 years of age are measured as part of the public health outcomes framework and recorded from hospital admission data.

The rate of hospital admissions for injuries due to falls in people aged 65 in Bracknell Forest increased in 2014/15 (as it did across Berkshire with the exception of Slough and the Royal Borough of Windsor and Maidenhead).  The figure is the first time hospital admissions have been statistically higher than the England average since 2011/12:



Hip fractures

Hip fracture is a debilitating condition.  Only one in three sufferers return to their former levels of independence and one in three ends up leaving their own home and moving to long-term care.

According to 2015 NICE guidance, hip fractures are almost as common and costly as strokes and the incidence is rising. In the UK, about 75,000 hip fractures occur annually at an estimated health and social cost of about £2 billion a year. The incidence is projected to increase by 34% in 2020, with an associated increase in annual expenditure.

Data for 2015/16 from the public health outcomes framework underlines this will rates of hip fractures higher in people aged 80 years or older compared to the 65 to 79 age group:

Hospital admission statistics show the mean average age of a person with hip fracture in 2015/16 was 79 years of age (83 in 2014/15).

The rate is also higher in women than in men across all age groups (with 69% of consultant episodes being for women), but is particularly marked in people aged 80+.

Data on hip fractures due to falls for all people aged 65 and over from the public health outcomes framework shows that despite an increase in 2015/16, historical rates in Bracknell Forest statistically similar to the national averages:



Mortality

The National Hip Fracture Database records  a high prevalence of comorbidity in people with hip fracture and reports that mortality from hip fracture is high - about one in ten people with a hip fracture die within 1 month and about one in three within 12 months.



Appropriate Discharge

The Royal College of Physicians National Hip Fracture Database (NHFD) annual report 2015 responded to concerns about premature discharge and mortality.  It concluded that whilst people discharged to care homes before 10 days appeared to be at increased risk, this was likely to be due to the frailty of individuals and early discharge was unlikely to be a causative factor in their death.

NICE note that an important outcome for a person who has had an acute hip fracture episode is returning to their usual place of residence and successful discharge should in all instances be planned and appropriate to the patient, their family and the multidisciplinary team that supports them.



Prevention, Care and Support

There are a range of services within Bracknell Forest relevant to falls prevention, care and support.

The Helping You Stay Independent Guide is published by the Bracknell and Ascot Clinical Commissioning Group and Bracknell Forest Council with a range of information about prevention, help and support regarding falls.

The Falls Prevention Advisory Service is both a preventative and support service for anyone aged 65 or over who believes they may be at risk of falling or who is recovering from a fall.  Individuals can access the falls clinic without seeing a doctor or social care practitioner to arrange an in-depth home assessment to identify fall risks and changes that might be made to make it safer. The service also offers well balanced classes, which are a programme of strength and balance classes that lasts for 12 weeks and helps to improve mobility.

Service providers or commissioners will find the 2015-2015 Joint Commissioning Strategy for Intermediate Care of interest as it sets out the model for intermediate care in Bracknell Forest to avoid unnecessary hospital admission, reduce unnecessarily long hospital stays and help patients to improve and maintain independence and reduce readmissions to hospitals.

The Community Response and Reablement Team, delivers intermediate care in people’s homes and own communities as well as in the local bed based service in the Bridgewell Centre. Services such as community hospitals, Rapid Access Community Services, Community Health Clinics, specialist nurses, GP services, district nursing, physiotherapaists and social care teams also have a role in intermediate care.

Costs

In 2013-14 there were 81,046 hospital admissions with a main diagnosis of fracture of femur.  Of all consultant episodes, approximately 3/5ths were for women and 61% were emergency admissions.  The majority of consultant episodes (89%) were for people aged 65 and above:

The 2014 figures for England showed an average acute length of stay (LOS) for hip fractures to be 15.5 days which, when combined with 3.8 days of post-acute stay, gave an overall LOS of 19.3 days. This is slightly improved from 19.8 days in 2013 according to the National Hip Fracture Database annual report 2015.



Want to know more?

Falls and fractures: developing a local joint strategic needs assessment (Department of Health, 2009) – analysis of impact of falls and fractures and key measures for commissioning successful falls prevention and care services.

Falls in older people: assessing risk and prevention (NICE, 2013) – guidance on preventing falls in older people aged 65 or older with new recommendations about preventing falls in older people during a hospital stay and for people aged 50 to 64 who are admitted to hospital and are judged by a clinician to be at higher risk of falling because of an underlying condition.

Hip fracture: management (NICE, 2011 updated 2014) - evidence-based advice and guidance on the management of hip fracture from admission to secondary care and through to final return to the community and discharge from specific follow-up.  Includes comprehensive guide on commissioning services.

Joint Commissioning Strategy for Intermediate Care 2012-2015 (Bracknell Forest Council and Bracknell and Ascot Clinical Commissioning Group, 2012) - sets out the model for intermediate care in Bracknell Forest which seeks to avoid unnecessary hospital admission, reduce unnecessarily long hospital stays, help patients to improve and maintain independence and reduce readmissions to hospital following discharge.

National Service Framework for Older People (Department of Health, 2001) - sets out the government commitment and expectation of multi-agency approach to reduce the number of falls which result in serious injury and ensure effective treatment and rehabilitation for those who have fallen.

Occupational therapy in the prevention and management of falls in adults - Practice guideline (College of Occupational Therapists, 2015) - evidence-based resource to support occupational therapists working with adults in the prevention and management of falls.

The National Hip Fracture Database (NHFD) - a clinically led, web-based audit of hip fracture care and secondary prevention covering case mix, care and outcomes, patient pathways, evidence reviews, reports, literature reviews, business cases, models of care and other resources for professional and public audiences.

 

 

This page was created on 27 February 2014 and updated on 20 July 2017.  Next review date June 2018:

Cite this page:

Bracknell Forest Council. (2017). JSNA – Falls and Mobility. Available at: jsna.bracknell-forest.gov.uk/ageing-well/living-well/falls-and-mobility (Accessed: dd Mmmm yyyy)

 

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