The problem and prevalence of falls
Falls are a major health issue in the community with around 30% of adults over 65 experiencing at least one fall per year. This is set to increase as Australia’s population ages with the proportion of people aged over 65 predicted to increase from 14% (3 million people) in 2010 to 23% (8.1 million people) in 2050. With a stable incidence rate the cost of falls is expected to rise to around $1.4 billion by 2051.
In NSW, the estimated population of people aged 65 and over is expected to rise from 1.27 million people in 2017 to 2.27 million people in 2051, increasing the cost of hip fractures from an estimated $139-209 million in 2017 to $321-482 million by 2051.
Falls prevention programs need to be developed in order to reduce falls incidence rates to prevent a huge strain being placed on the medical system.
The cost of falls
Further to the financial cost of falls on the medical system there will also be a greater need for hospital beds. From 2010 (240000 bed days per year) to 2051 (450000 bed days per year) the number of hospital bed days per year needed due to falls will nearly double. The utilisation of nursing homes due to falls has also been predicted to rise from around 800000 beds in 2010 to nearly 1.8million by 2051.
Falls are physically very costly. Falls are the leading cause of injury-related hospitalisation in persons aged 65 years and over and account for four percent of all hospital admissions in this age-group. The incidence of hospital admissions increases exponentially with age. Beyond 40 years, the admission rate due to falls increases consistently by 4.5% per year for men (doubling every 15.7 years) and by 7.9% per year for women (doubling every 9.1 years). In those aged 85 years and over, the levels have climbed to 4% per annum in men and 7% per annum in women.
Injuries from falls
Falls account for 40% of injury-related deaths and one percent of total deaths in this age group. Depending on the population under study, between 22-60% of older people suffer injuries from falls, 10-15% suffer serious injuries, 2-6% suffer fractures and 0.2-1.5% suffer hip fractures. The most commonly self-reported injuries include superficial cuts and abrasions, bruises and sprains. The most common injuries that require hospitalisation comprise femoral neck fractures, other fractures of the leg, fractures of radius, ulna and other bones in the arm and fractures of the neck and trunk.
In terms of morbidity and mortality, the most serious and costly of these fall-related injuries is fracture of the hip. Elderly people recover slowly from hip fractures and are vulnerable to post-operative and bed rest complications. In around 25% cases, hip fractures result in death and of those who survive, around one third of them never regain complete mobility. There was an estimated 19,000 admissions from hip fracture among Australians aged over 50 years in 2011 to 2012. An increase of 22% since 2002 to 2003.
Another consequence of falling is the “long lie” – remaining on the ground or floor for more than an hour after a fall. The long lie is a marker of weakness, illness and social isolation and is associated with high mortality rates among the elderly. Time spent on the floor is associated with fear of falling, muscle damage, pneumonia, pressure sores, dehydration and hypothermia.
A reduction in quality of life and fear of falling
Falls can also result in restriction of activity and fear of falling, reduced quality of life and independence. Even falls that do not result in physical injuries can result in the “post-fall syndrome” – a loss of confidence, hesitancy, tentativeness with resultant loss of mobility and independence. It has been found that after falling, 48% of older people report a fear of falling and 25% report curtailing activities. Finally, falls can also lead to disability, decreased mobility which often results in increased dependency on others and hence an increased probability of being admitted to an institution.
Fall prevention interventions
A number of falls prevention strategies have been shown to reduce the incidence and risk of falls in the community. Multiple component group exercise, multiple component home exercise, tai chi and a multi factorial intervention which includes individual risk assessment all have been found to reduce the risk and rate of falls over a number of trials.
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