Falls prevention
Where are we now?
National position
Falls and fall-related injuries are a common and serious problem for older people, particularly those who have underlying conditions. People aged 65 and older have the highest risk of falling; around a third of people aged 65 and over, and around half of people aged 80 and over, fall at least once a year (1).
The latest data in the Public Health Outcomes Framework shows that in 2021/22, there were around 223,101 emergency hospital admissions due to falls in people aged 65 and over in England. Around 146,934 (65.9 percent) of these were in people aged 80 and over.
Not only are older people at higher risk of falling, but the risk of serious injury (fractures, head trauma, hip fractures) is also higher in this cohort. Short and long-term outlooks for people are generally poor following a hip fracture, with an increased one-year mortality of between 18 percent and 33 percent and negative effects on daily living activities such as shopping and walking. A review of long-term disability found that around 20 percent of hip fracture patients entered long-term care in the first year after fracture (1).
Falls in hospitals are the most commonly reported patient safety incident with more than 240,000 reported in acute hospitals and mental health trusts in England and Wales (1).
A survey commissioned by Age UK in 2018 found that for 4.3 million older people the fear of falling was top of their list of concerns. Of this number, older women were more concerned about falling than men (45 percent vs 26 percent). Older people who lived on their own were the most worried about falling (2).
Local position
Forecasts using 2018 mid-year estimates predict that the number of people aged 65 or above will increase by 44 percent from 72,900 in 2018, to almost 105,000 in 2038. By 2038, 28 percent of Cheshire West and Chester residents will be aged 65 or older (21 percent in 2018) (3).
The number of people in Cheshire West and Chester aged 85 or above will more than double, increasing from 9,400 in 2018, to around 19,400 in 2038(3).
In Cheshire West and Chester, the rate for emergency hospital admissions due to falls in people aged 65 and over has been significantly higher than England for much of the last decade, with the trend showing no significant change in recent years (4).
The latest data in the Public Health Outcomes Framework shows that in 2021/22, 1,945 Cheshire West and Chester residents aged 65 and over were admitted to hospital as an emergency as a result of a fall. Over two thirds of these admissions (66.8 percent), were people aged 80 years and over (4).
Local analysis of 2021/22 Hospital Episode Statistic data shows that the rates of emergency admissions were highest in the east area of the borough in Northwich and Winsford. The lowest rates were seen in the rural locality.
In 2021/22, 19% of people aged 80 and over admitted to hospital following a fall in Cheshire West and Chester were treated for a fractured neck of femur (hip fracture).
Why are people falling in west Cheshire?
Evidence suggests that that in Cheshire West and Chester, two thirds more women are admitted to hospital than men. One of the factors contributing to these admissions may be in relation to bone health. Women are more likely to experience osteoporosis (a disease that weakens bones to the point that the break easily), than men. People with osteoporosis are at much greater risk of fragility fractures (a fracture that occurs in a bone weakened by the disease). The risk of osteoporosis starts to increase in women after the menopause. There are other increased risks of osteoporosis including a genetic link and the side effects of some medications such as steroids.
Levels of physical activity fell during COVID-19, in particular a reduction in strength and balance activity in people aged 65 and over, resulting in an increase in deconditioning. Deconditioning, a change of physical fitness due to inactivity, can occur rapidly in older adults and has a range of negative health impacts, including falls, depression, and cardiovascular disease (5).
The most immediate outcome of deconditioning is likely to present as an increase in falls. Evidence suggests that this increase in deconditioning may result in an additional 250,000 falls per year. This in turn leading to costs in the health and social care system of £210 million incurred over a two-and-a-half-year period (5). Assumptions based on the usual health pathway for falls suggest that in England (5):
- nearly 26,000 of these additional falls will require a GP visit
- 30,000 will require an ambulance call out
- over 14,000 will require an inpatient stay
- over 12,000 will require a care home package
Our response
There are key interventions which can help reduce an individual’s risk of falls, for example, regularly completing strength and balance exercises can help to improve an individual’s strength and balance, and therefore reduce their risk of falling. Guidance from the National Institute of Health Care Excellence (NICE) recommends that people who are at risk of falls have access to strength and balance exercise as part of the local falls prevention pathway (6).
Developing a shared understanding regarding which risk factors are driving falls in the population of Cheshire West and Chester can determine what types of interventions might be most effective at preventing falls and hospitalisation in the population as a whole. By reviewing local data and current service provision, we can better understand why people are falling. For example, recent research findings highlight the concern raised by older residents regarding their fear of falling when outside of the home; the maintenance of pavements was of particular concern (7).
