March 2012: Next Review September 2012

Transcription

1 9.13 Falls Falls, falls related injuries and fear of falling are crucial public health issues for older people. Falls are the most common cause of accidental injury in older people and the most common cause of accidental death in the over 75 year population. Most falls are linked to some kind of problem: even if a fall is not classed as serious, it may have resulted from an underlying problem such as a dizzy spell, balance or eyesight problems or simply a problem with the surrounding environment (e.g. loose carpet). Some falls can lead to serious problems such as fractures and even death, particularly in high risk /vulnerable people, usually elderly people. Many falls are preventable, by dealing with background problems such as those listed above. Measuring falls is difficult as many falls are not recorded or reported. To quantify the magnitude of the issue at a local level, we rely on: Available proxy measures : often it is the more serious results of falls that are measured and reported (fractures, hospital admissions etc). Some risk factors such as age are also well recorded. Projections from national estimates and models. It is useful to think in terms of current and future need as need is likely to increase with the ageing of the population. It is also useful to consider the cost of falls to NHS and Social Services. The rates of falls for community dwelling people are around 30% for those aged over 65 years and over 40% for those over 75 years in a year. 50% of falls are in people who fall twice or more in a year. About 6% of falls in those over 65 years result in a fracture, including 1% in the hip. Having falls is the commonest cause for older people to attend A and E and being admitted to hospital. Injury is more likely to occur in frailer people and those with osteoporosis. The National Institute for Health and Clinical Excellence (NICE), suggests a number of intrinsic factors most predictive of falling these are considered separately for community dwelling older people and people cared for in extended care settings(nice, 2004). Factors include: Community dwelling for older people falls history gait deficit balance deficit mobility impairment fear visual impairment cognitive impairment urinary incontinence. People cared for in extended care settings falls history gait deficit balance deficit visual impairment cognitive impairment

2 Targeted prevention of serious falls is possible, by identifying high risk people such as those that have already had a fall, and focusing efforts around them (Secondary prevention). Hospital admission data 65% of all falls in the period 2007/ /11 in people (registered with a Trafford GP) were in the over 65s age group. Hospital bed days for falls far exceed those for heart disease, heart failure, stroke and other major disease areas. Falls in persons over 65 years of age There were 4,458 hospital admission episodes of Trafford people aged 65 years and over (registered with a Trafford GP) due to falls over the 2007 to 2011 period (01/04/ /03/2011) i.e. over a thousand admissions per year Gender The rate of falls is significantly higher in females. In 69% of the hospital admission relating to falls the patient was female. Gender Number of admissions % of admissions Female % Male % Grand Total % Age In 45% of the hospital admission episodes in patients over 65, the patient was over the age of 85. Age group Total Female 6.0% 9.7% 15.0% 20.9% 48.5% 100.0% Male 11.1% 12.1% 19.5% 21.1% 36.3% 100.0% Total 7.6% 10.5% 16.4% 20.9% 44.7% 100.0%

3 Deprivation Hospsital admission episodes due to falls in persons aged 65 years and over in Trafford (Primary or secondary diagnosis W00 - W19) DASR per 100,000 population By deprivation quintile in Trafford (IDM 2010) Rate per 100,000 population Least Fourth most Third most Deprivation quintile Second most Most There is no social gradient in hospital admission episodes due to falls in persons aged over 65 years and there are slightly less in the most quintile in Trafford Hospital admission episodes relating to falls in males and females aged 65 years and over in Trafford (Primary or secondary diagnosis W00 - W19) DASR per 100,000 population By deprivation quintile in Trafford (IDM 2010) Rate per 100,000 population Males Females Least Fourth most Third most Second most Most Deprivation quintile There are also no statistically significant differences between the deprivation quintiles when split by gender. As noted previously, the rate of hospital admissions due to falls are significantly higher in females, and is so in all quintiles apart from the most.

4 Falls by ward Hospital admission rates for over 65s for falls are greatest in Urmston and Altrincham. Although the chart shows that there are significantly less hospital admission episodes due to falls (in patients registered with a Trafford GP) in Clifford it should be noted that 34% of Clifford residents are registered with a GP outside of Trafford and therefore are not included in this dataset. The demand: How many people are accessing services because of falls and their consequences? Hospital spells due to Fractured Neck of Femur (Hip fracture) Fractures of the Neck of Femur in elderly people are associated with high levels of morbidity and mortality, as well as a high financial cost. 50% of those with hip fractures have had an earlier fragility fracture. People with osteoporosis are more at risk of fragility fractures. The graph below shows the number of hospitals spells due to Fractured Necks of Femur for people aged 75 and over in Trafford in 2008/09 and 2010/11. There were a total of 122 spells in 2008/09. Of those discharged home, many have reduced independence, increased social isolation and reduced physical activity. The graph shows higher levels in the winter months: it is important to address winter health issues (e.g. Fuel Poverty) in a prevention strategy.

5 25 FNoF Spells Mean Control Limits Mean 11/12 UCL 11/12 LCL 11/ Apr 08 May 08 Jun 08 Jul 08 Aug 08 Sep 08 Oct 08 Nov 08 Dec 08 Jan 09 Feb 09 Mar 09 Apr 09 May 09 Jun 09 Jul 09 Aug 09 Sep 09 Oct 09 Nov 09 Dec 09 Jan 10 Feb 10 Mar 10 Apr 10 May 10 Jun 10 Jul 10 Aug 10 Sep 10 Oct 10 Nov 10 Dec 10 Jan 11 Feb 11 Mar 11 Apr 11 May 11 Jun 11 No. of Spells What does this mean? What are the implications of this? The number of people aged 75 and above in Trafford is predicted to increase by 43% from 2010 to A corresponding increase in number of falls associated with this group is to be expected if no preventative action is taken. In terms of risk factors for falls in Trafford, there were 11,550 people aged 50 and over at risk of Osteoporosis. This number is predicted to rise by 24.2% by 2031, equivalent to a total of 14,350 people. (See table below). Hospital admissions for Fracture types associated with falls In 2008/09, there were a total of 622 hospital admissions (not attendances: not all attendances require admission, therefore admissions is likely to be an underestimate of demand) for factures associated with falls in Trafford, with an associated NHS cost of 3,505,815. The economic costs to the NHS and local government associated with the management of falls are considerable. The cost of hip fractures alone ( the most severe of fractures related to falls) in Trafford can be estimated using the University of York Economic cost of Hip Fracture in the UK model, adjusted for 2008/09 tariffs. These estimates show that a total cost of 4 million with 2.7million was incurred by providers of social care in Trafford during 2008 due to hip fractures only and hospital costs of 1.25milliion. No. of Patients Cost Estimated 2008 cost Total Cost Hospital costs 164 4,760 7,616 1,249,024 Ambulance cost ,435 GP ,972 Social care , ,516 2,708,558 Total 4,007,989

6 Population at risk of falling - percentage increase (2009 baseline) Source: ONS 2006-based sub national population projections Persons Age At risk of osteoporosis > 50yrs % 13.8% 24.2% At risk of osteoporosis >70yrs % 13.6% 37.7% At risk of osteoporosis >80yrs % 22.2% 57.7% What are we doing now? What do we need to do? Work has been undertaken through the Trafford Joint Commissioning Board on falls treatment and prevention plans. The DH systematic approach to falls and fracture care and prevention has four key objectives. NHS Trafford has led a gap analysis with health and social care representatives to compare Trafford against national guidance.

7 The following projects have been identified and currently being implemented:- Prevent fragility, preserve bone health and reduce accidents Identify individuals at high risk of first fragility fracture or other injurious fall Non-hip fragility patients respond to first fracture, prevent the second Best practice care for hip fracture patients This work has involved the engagement of local people through the 50+ network as part of the Integrated Care services project. Should this issue be a priority? This issue should be a priority because of the significant impact on the health of older people and use of NHS and LA resources Recommendations for future action To continue with the Work undertaken by the Trafford Integrated Care Services programme.