Hospital admissions due to falls by older people set to reach nearly 1,000 a day

The number of hospital admissions due to an older person falling is set to rise to nearly 1,000 a day by the end of the decade, according to figures obtained by the Local Government Association.


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The worrying forecast has prompted renewed calls by council leaders for more funding for adult social care to invest in cost-effective prevention work to reduce falls, which can have devastating and life-threatening consequences on a person’s health and wellbeing.

New research shows that falls prevention programmes run by councils reduce the number of falls requiring hospital admission by nearly a third (29 per cent) and produces a financial return on investment of more than £3 for every £1 spent.

The LGA, which represents 370 councils in England and Wales, says that extra government funding for councils to scale up this prevention work to address a rising older population would help the NHS by reducing the need for people to be admitted to hospital after a fall and cut costs to the public purse.

Falls are said to cost the NHS more than £2 billion a year – the amount needed to plug the annual funding gap that councils face in adult social care by 2020.

Councils, many of which already offer comprehensive advice and guidance to help older people stay on their feet, want to invest more in prevention work but are being restricted due to government funding reductions.

The LGA says many falls can be avoided and is calling for:

  • Greater awareness raising among the public around fall prevention
  • The Government to fully address the adult social care funding gap, which will reach more than £2 billion by 2020
  • For adult social care to be put on an equal footing to the NHS.

Latest figures show that in England in 2016/17 there were 316,669 hospital admissions of people aged 65 and over due to falling, amounting to two thirds of all fall-related admissions. Around a fifth of these were as a result of slipping, tripping or stumbling.

The number of fall-related hospital admissions among older people has increased by 9 per cent over four years, and based on this trend, will continue to rise to around 350,000 by 2020/21, the equivalent of approximately 950 cases every day. In contrast, the number of admissions for those aged under 65 has remained constant.

Falls have a significant impact on older people, as well as adult social care and health services. They can lead to considerable distress, pain, injury, loss of confidence, loss of independence and even death.

The reasons for older people falling vary but can include poor eyesight; dizziness due to medication; poor physical health; long-term conditions, such as Parkinson’s Disease or stroke; badly fitted carpets; clutter in the home, and trying to hurry to answer the door or get to the toilet.

A few simple changes to a person’s lifestyle and home can help to reduce the risk of tripping, such as making sure rugs are correctly fitted, stairs are well lit and have handrails, replacing worn-out slippers, keeping active, or talking to a GP about any dizziness caused by taking multiple medications.

Cllr Izzi Seccombe, Chairman of the LGA’s Community Wellbeing Board, said:

“It is deeply saddening that someone can fall over, including in their own home, and have to go to hospital as a result.

“Not only is this traumatic and upsetting for the individual concerned and their families, but this has a significant impact on health and social care as well, which are already overstretched as a result of unprecedented demand.

“The fact these shocking figures are set to soar even higher in the next few years, will heap further strain on local services.

“The LGA has previously called for a prevention fund to invest in proven interventions, such as falls, and new research backs up the value of this work. Council-run fall prevention schemes, such as home assessment and modification programmes, have shown to significantly reduce the number of falls requiring hospital admission and to offer a good return on investment, saving money from the public purse.

“But some councils are being forced to stop such fall prevention services due to funding reductions, which has seen spending on prevention work from adult social care budgets reduced by more than £60 million in the past year.

“To reduce demand and cost pressures on the NHS, the Government needs to switch its focus from reducing delayed discharges from hospital to preventing admissions in the first place and put adult social care and the NHS on an equal footing.

“Older people may be at a greater risk of falling but in many cases falls can be prevented by making a few simple changes either to a person’s lifestyle or in the home. This could be anything from having regular eye tests, checking a rug is fitted correctly, replacing a pair of worn out slippers or doing moderate exercise.

“Councils want to raise awareness of these straightforward prevention tips to help reduce trips and falls, including while at home, and the unwanted consequence of ending up in a hospital bed.”

Errol Taylor, Chief Executive of the Royal Society for the Prevention of Accidents, said:

“A fall can have a devastating effect on an older person, bringing physical consequences and associated loneliness, isolation and loss of independence. We also know that falls are putting a tremendous strain on health and social care services, and one that is set to rise unless co-ordinated action is taken.

“The good news is that falls are not an inevitable part of ageing. Prevention initiatives can bring results very quickly and we’re pleased to be supporting local areas to develop strategic approaches to falls prevention across England. Falls are also due to be a key priority in the National Accident Prevention Strategy, which will be published this year.”

Case studies

Hertfordshire County Council
Hertfordshire County Council staff running chair-based exercise classes have started to use sensors and tablets to assess the falls risk of clients and helping them tailor exercise programmes. The assessment method provides information far quicker than a conventional detailed assessment which can take more than 30 minutes. The devices are strapped just below the knees during a quick walking assessment and are able to measure criteria such as gait and stride length. The data is then compared to average data for someone of that height, age and weight to assess them for falls risk. A bespoke exercise programme can then be developed to build up the strength of residents and reduce the risk of falls. In the first pilot the falls risk reduced in 15 of the 19 care homes for residents who took part in more than half of the classes. Their confidence and wellbeing also saw an upturn, with residents reporting feeling happier as a result of the classes and progress made. The programme is now being tested in community settings.

Blackburn with Darwen Borough Council
Blackburn with Darwen Borough Council is using assistive technology through its telecare service to help more than 2,500 people live independently. The service uses both monitored and stand-alone devices. Monitored includes falls pendants, alarms and bed sensors that are linked to the monitoring and response centre run by current provider, Tunstall. When an alarm is triggered the individual is connected through to the Tunstall team who triage to find out what help is needed and then alert either the service user’s named responder, the council’s social care crisis service or, if it is a medical emergency, the ambulance service. The stand-alone technology - which is only connected to a family member or friend - includes GPS tracking technology that is provided to people with dementia, and includes medication reminders and bed occupancy sensors that alert when a person gets up during the night.

1. Data sourced from a Royal Society for the Prevention of Accidents’ analysis of Hospital Episode Statistics for England, published by NHS Digital. The figures relate to episodes of admitted patient care under a hospital consultant. 

Hospital admissions (admitted patient episodes), all ages

 

2013/14

2014/15

2015/16

2016/17

Total

Fall on same level from slipping, tripping, and stumbling

92,679

94,332

93,287

94,065

374,363

All falls

449,364

462,871

470675

475,710

1,858,620

 

Hospital admissions (admitted patient episodes), over-65s

 

2013/14

2014/15

2015/16

2016/17

Total

Fall on same level from slipping, tripping, and stumbling

65,472

67,314

66,734

67,359

266,879

All falls

290,395

304,064

312,511

316,669

1,223,639

 

Hospital admissions (admitted patient episodes), 0-64 year olds

 

2013/14

2014/15

2015/16

2016/17

Total

Fall on same level from slipping, tripping, and stumbling

 

31,228

 

30,631

 

29,913

 

29,555

 

121,327

All falls

 

158,510

 

158,222

 

157,460

 

155,706

 

629,898

2. NICE guidance - Falls in older people. Falls cost the NHS £2.3 billion a year

3. Falls account for more than 4 million hospital bed days and are the most common cause of death from injury in people who are over 65 years old - (Page 10 & 53)

4. Falls prevention programmes based on home assessment and modification schemes for elderly people have shown to reduce the number of falls requiring hospital admission over two years by an estimated 29 per cent. They also produce a financial return on investment of £3.17 for every £1 spent, and a societal (quality of life) return of £7.34 for every £1 spent. - (Page 44)

5. Councils provide community equipment to help people stay safe in their homes and sometimes, in addition, occupational therapy support is offered though this if often not accessible unless people meet eligibility thresholds so preventative action is often not available until after a fall has happened.

6. When older people fall, their injuries can be more serious due to an increased likelihood of brittle bones which often results in admission to hospital. Hip fractures require major surgery while fractures of any kind often need an ongoing social care support package setting up after the person leaves hospital. 

7. Spend on prevention in 2017/18 forms 6.3 per cent of adult social care budgets, or £890 million. This is a smaller proportion of the budget than last year (7.1 per cent), and a decrease in cash terms from last year (£954 million). -(Page 15)

8. The LGA is calling for a £531 million reduction in a government public health grant to be reversed. The previous Government reduced councils' public health grant by £331 million from 2016/17 to 2020/21. This followed a £200 million in-year reduction in 2015/16.

9. Get up and go guide to staying steady 

10. RoSPA is currently running Stand Up, Stay Up – a three-year falls prevention programme funded by the Department of Health

 

1. Data sourced from a Royal Society for the Prevention of Accidents’ analysis of Hospital Episode Statistics for England, published by NHS Digital. The figures relate to episodes of admitted patient care under a hospital consultant.

Hospital admissions (admitted patient episodes), all ages

 

2013/14

2014/15

2015/16

2016/17

Total

Fall on same level from slipping, tripping, and stumbling

92,679

94,332

93,287

94,065

374,363

All falls

449,364

462,871

470675

475,710

1,858,620

Hospital admissions (admitted patient episodes), over-65s

 

2013/14

2014/15

2015/16

2016/17

Total

Fall on same level from slipping, tripping, and stumbling

65,472

67,314

66,734

67,359

266,879

All falls

290,395

304,064

312,511

316,669

1,223,639

Hospital admissions (admitted patient episodes), 0-64 year olds

 

2013/14

2014/15

2015/16

2016/17

Total

Fall on same level from slipping, tripping, and stumbling

 

31,228

 

30,631

 

29,913

 

29,555

 

121,327

All falls

 

158,510

 

158,222

 

157,460

 

155,706

 

629,898

2. NICE guidance - Falls in older people. Falls cost the NHS £2.3 billion a year

3. Falls account for more than 4 million hospital bed days and are the most common cause of death from injury in people who are over 65 years old - (Page 10 & 53)

4. Falls prevention programmes based on home assessment and modification schemes for elderly people have shown to reduce the number of falls requiring hospital admission over two years by an estimated 29 per cent. They also produce a financial return on investment of £3.17 for every £1 spent, and a societal (quality of life) return of £7.34 for every £1 spent. - (Page 44)

5. Councils provide community equipment to help people stay safe in their homes and sometimes, in addition, occupational therapy support is offered though this if often not accessible unless people meet eligibility thresholds so preventative action is often not available until after a fall has happened.

6. When older people fall, their injuries can be more serious due to an increased likelihood of brittle bones which often results in admission to hospital. Hip fractures require major surgery while fractures of any kind often need an ongoing social care support package setting up after the person leaves hospital.

7. Spend on prevention in 2017/18 forms 6.3 per cent of adult social care budgets, or £890 million. This is a smaller proportion of the budget than last year (7.1 per cent), and a decrease in cash terms from last year (£954 million). -(Page 15)

8. The LGA is calling for a £531 million reduction in a government public health grant to be reversed. The previous Government reduced councils' public health grant by £331 million from 2016/17 to 2020/21. This followed a £200 million in-year reduction in 2015/16.

9. Get up and go guide to staying steady

10. RoSPA is currently running Stand Up, Stay Up – a three-year falls prevention programme funded by the Department of Health