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The eChartbook The Clinical Excellence Commission


ACUTE AND OTHER SERVICES' INDICATORS
CEC eChartbook
Fall-related hospitalisations
For more information about this CEC program, click here
 


Why is this important?


In 2016-2017, there were:
Fall-related total hospitalisations

  • All ages: 87,597 a rate of 961/100,000 population (compared with 82,357 a rate of 916/100,000 population in 2015/16)
  • 65 years and over : 54,213 a rate of 4,162/100,000 population (compared with 50,455 a rate of 3,936/100,000 population in 2015/16)

Fall-related injury total hospitalisations
  • All ages: 69,637 a rate of 772/100,000 population (compared with 66,199 a rate of 744/100,000 population in 2015/16)
  • 65 years and over: 40,889 a rate of 3,126/100,000 population (compared with 38,487 a rate of 2,993/100,000 population in 2015/16)

Fall-related deaths
In 2015, there were:
  • All ages: 757 a rate of 7.4/100,000 population
  • 65 years and over: 696 a rate of 52.7/100,000 population

Between 2013/14 and 2016/17 the rate of fall-related hospitalisations for people 65 years and over has steadily increased from 3,830 to 4,162/100,000 population. The greatest increase was in people aged 85 years and over (HealthStats NSW).

The fall-related hospitalisations with injury in primary diagnosis were used for this report. Older people had the highest rates, with more than half of all fall-related hospitalisations with injury were of patients aged 65 years or over.


Rates of overnight hospitalisations for falls among persons aged 65 years and over have been increasing for the last 15 years for both males and females. While rates for females were consistently higher over this period compared with males, there was a greater increase in rates over the period for males (59 per cent increase) compared with females (32 per cent increase). This represents an overall burden of injury from falls on the hospital system which is influenced not only by the rate of new injuries from falls in the community but also from factors such as the medical consequences of these falls.  (HealthStats NSW). Patients may also require long periods of rehabilitation after acute care.


In a recent study it was reported that there were 314,041 occasions of fall-related ambulance use by older adults and 331,311 fall-related hospitalisations, of which 69 per cent (n = 227,753) were for injurious falls. Fractures accounted for 57 per cent of injurious hospitalisations. Slips and trips were the most common mechanism of falls requiring hospitalisation (52 per cent). Residents of aged care facilities had a greater proportion of fall injury hospitalisations compared with people living in the community (85% and 65%, respectively), (Paul et al 2017).


References

[1] Centre for Epidemiology and Evidence.  HealthStatistics New South Wales.  Sydney: NSW Ministry of Health. Available at:  http://www.healthstats.nsw.gov.au. Accessed 16 May 2018.
[2] Paul S, Harvey LA, Ryan T, Qiang L, Boufous S, Priddis A, Tiedemann A, Clemson L, Lord  SR, Muecke, S, Close  JCT, Lo S, Sherrington C. Trends in fall-related ambulance use and hospitalisation among older adults in NSW from 2006 to 2013: a retrospective, population-based study. Public Health Research and Practice, 2017 October 2107; Vol. 27(4):e27341701


Findings


Chart FL01 shows that the age-standardised rate for fall-related injury hospitalisations in NSW residents aged 65 years and over, increased from 2,890 per 100,000 population in 2012-13 to 3,126 in 2016-17. The rates of fall-related injury hospitalisation varied across local health districts (LHDs). In 2016-17, rates ranged from 2,422 separations per 100,000 in Hunter New England LHD to 3,563 in Northern Sydney LHD. A similar hospitalisation pattern was observed for males and females (Charts FL02 & FL03). For male residents of NSW, the rate increased from 2,328 per 100,000 population in 2012-13 to 2,650 in 2016-17. During this time, rates for females increased from 3,314 to 3,516 per 100,000 population.


Implications


Effective strategies to prevent falls-related injuries include:

  • Identifying and managing risk factors for falls and falls-related injury   (including osteoporosis) among older people at risk of falls.
  • Preventing the development of fall risk factors, through the promotion of appropriate physical activity (balance and strength exercises) and nutrition (including vitamin D and calcium supplementation, where appropriate), medication and vision review.
  • Health services implementing opportunistic identification and integrate the management/ referral of people with high risks (past history of falls and presence of balance and gait abnormalities).
  • Integrated care pathways with community health & primary care settings for multidisciplinary follow-up.


What we don't know


Better information is needed about the patient journey beyond the hospital, following a fall. More robust data is needed about falls occurring in residential aged care facilities and other health care facilities.


FL01 - Age standardised fall-related injury hospital separations rate
 

Rate per 100,000 population for persons aged 65 years and over by LHD, NSW, 2012-13 to 2016-17


eChartbook
Source: Centre for Epidemiology and Evidence. HealthStats NSW. Sydney: NSW Ministry of Health.
Available at: www.healthstats.nsw.gov.au. Accessed (16-May-2018).
FL02 - Age standardised fall-related injury hospital separations rate for males
 

Rate per 100,000 population for males aged 65 years and over by LHD, NSW, 2012-13 to 2016-17


eChartbook
Source: Centre for Epidemiology and Evidence. HealthStats NSW. Sydney: NSW Ministry of Health.
Available at: www.healthstats.nsw.gov.au. Accessed (16-May-2018).
FL03 - Age standardised fall-related injury hospital separations rate for females
 

Rate per 100,000 population for females aged 65 years and over by LHD, NSW, 2012-13 to 2016-17


eChartbook
Source: Centre for Epidemiology and Evidence. HealthStats NSW. Sydney: NSW Ministry of Health.
Available at: www.healthstats.nsw.gov.au. Accessed (16-May-2018).


End Matter


Contributors

Content: Content: CEC NSW Falls Prevention Program

Data analysis by: CEC eChartbook team
Edited by: CEC eChartbook team

Suggested citation
Clinical Excellence Commission [access year]. eChartbook Portal: Safety and Quality of Healthcare in New South Wales. Sydney: Clinical Excellence Commission. Available at: http://www.cec.health.nsw.gov.au/echartbook/acute-and-other-services-indicators/falls-related-hospitalisations Accessed (insertdate of access).

© Clinical Excellence Commission 2018
This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may be reproduced without prior written permission from the Clinical Excellence Commission (CEC). Requests and enquiries concerning reproduction and rights should be directed to the Director, Information Management, Locked Bag 8, Haymarket NSW 1240.

Evidence-base for this initiative
Gillespie et al. Interventions for preventing falls in older people living in the community (Review)
The Cochrane Library, 2009, Issue 4
http://www.mnfallsprevention.org/downloads/Review-Interventions-for-preventing-falls.pdf

Reported elsewhere
Health Statistics New South Wales - www.healthstats.nsw.gov.au


Definitions


Chart: FL01

Admin Status: Current, Jun 2017

Indicator Name: Fall-related injury hospitalisations all persons aged 65 years and older

Description: Age standardised fall-related injury hospital separations per 100,000 population for all persons aged 65 years and over, by local health district of residence, 2012-13 to 2016-17

Dimension: Appropriateness

Clinical Area: Population Health and Primary Care

Data Inclusions: Any 'Injury' - Principal diagnosis (ICD 10 Codes: S00-T75 or T79) with 'Falls' as an- 'External cause' (ICD 10 Codes: W00-W19, considered first external cause only)

Data Exclusions: Persons resident outside NSW

Numerator: Persons aged 65 years and older diagnosed with fall-related injury

Denominator: NSW estimated residential population for all persons aged 65 years and over

Standardisation: Direct age and sex standardisation to the 2001 Australian mid-year Estimated Resident Population (ERP)

Data Source: Centre for Epidemiology and Evidence. HealthStats NSW. Sydney: NSW Ministry of Health. Available at: www.healthstats.nsw.gov.au. Accessed (16-May-2018).

Comments: None
 
Chart: FL02

Admin Status: Current, Jun 2017

Indicator Name: Fall-related injury hospitalisations, males aged 65 years and older

Description: Age standardised fall-related injury hospital separations per 100,000 population for males aged 65 years and over, by local health district of residence, 2012-13 to 2016-17

Dimension: Appropriateness

Clinical Area: Population Health and Primary Care

Data Inclusions: Any 'Injury' - Principal diagnosis (ICD 10 Codes:S00-T75 or T79) with 'Falls' as an- 'External cause' (ICD 10 Codes: W00-W19, considered first external cause only)

Data Exclusions: Residents outside NSW

Numerator: Males aged 65 years and older diagnosed with fall-related injury

Denominator: NSW estimated residential population for males aged 65 years and over

Standardisation: Direct age and sex standardisation to the 2001 Australian mid-year Estimated Resident Population (ERP)

Data Source: Centre for Epidemiology and Evidence. HealthStats NSW. Sydney: NSW Ministry of Health. Available at: www.healthstats.nsw.gov.au. Accessed (16-May-2018).

Comments: None
 
Chart: FL03

Admin Status: Current, Jun 2017

Indicator Name: Fall-related injury hospitalisations, females aged 65 years and older

Description: Age standardised fall-related injury hospital separations per 100,000 population for females aged 65 years and over, by local health district of residence, 2012-13 to 2015-16

Dimension: Appropriateness

Clinical Area: Population Health and Primary Care

Data Inclusions: Any 'Injury' - Principal diagnosis (ICD 10 Codes: S00-T75 or T79) with ‘Falls’ as an- ‘External cause’ (ICD 10 Codes: W00-W19, considered first external cause only)

Data Exclusions: Residents outside NSW

Numerator: Females aged 65 years and older diagnosed with fall-related injury

Denominator: NSW estimated residential population for females aged 65 years and over

Standardisation: Direct age standardisation to the 2001 Australian mid-year Estimated Resident Population (ERP)

Data Source: Centre for Epidemiology and Evidence. HealthStats NSW. Sydney: NSW Ministry of Health. Available at: www.healthstats.nsw.gov.au. Accessed (16-May-2018).

Comments: None