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The Clinical Excellence Commission The eChartbook


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


Why is this important?


Falls are the most common causes of injury and poisoning hospitalisations (87,886/197,473=44.5 per cent) in NSW 2013-14 [1]. Of the 87,886 hospitalisations in which a fall was the main external contributor to the need for hospitalisation, 63,518 sustained an injury as a result of fall. The latter was defined as fall-related hospitalisations with injury in primary diagnosis, and was used throughout this report. Its corresponding rate was 747.0 per 100,000 population (all ages) [2]. Older people have the highest rates, with more than half (36,289 or 57 per cent) of all fall-related hospitalisations with injury in primary diagnosis were of patients aged 65 years or over [2]. Between 1998 and 2012 the rate of fall-related hospitalisations for older people has increased by an average of 2.5 per cent per year, with the greatest increase in people aged 85 years and over [3]. Recent statistics from NSW Institute of Trauma and Injury Management indicated that falls accounted for 40 per cent (7,252/17,982=40.3 per cent) of patients who sustained major trauma injuries in NSW between 2010 and 2014 [4].


No other single cause of injury, including road trauma, costs the health system more than falls-related injury. The total cost of healthcare associated with falls in older people in NSW in 2006-07 has been estimated at $558.5 million [5]. Around one in three older people living in the community are estimated to fall each year and many fall more than once [6]. In Australia, 58.6 per cent of all fall injuries among older people which result in hospitalisation occur in the home, with a further 27.3 per cent in residential aged care facilities [7].


In 2013, a fall was recorded as either the underlying or associated cause of death in 1153 NSW residents, a rate of 17.8 per 100,000 population [8]. Between 1999 and 2013, the rate of confirmed deaths related to falls in NSW increased from 12.2 to 17.8 per 100,000 population (all ages) [9]. In the same period, the greatest increase was observed in people aged 65 years and over, from 73.3 to 126.8 per 100,000 population [8].


Falls injuries in older people place a heavy burden on the hospital system, because of the number of affected patients and the long average length of stay. Patients may also require long periods of rehabilitation after acute care. In Australia eight out of ten falls resulting in hospitalisation of older people occur either in the home, or in aged care facilities [6]. Population studies have shown that hip fractures are the most serious falls-related injury in older people, with 15 per cent dying in hospital and one-third not surviving beyond one year [9].



References

[1] Centre for Epidemiology and Evidence. Health Statistics New South Wales. Sydney: NSW Ministry of Health. Available at: http://www.healthstats.nsw.gov.au. Accessed: 9 May, 2016.
[2] Centre for Epidemiology and Evidence. Health Statistics New South Wales. Sydney: NSW Ministry of Health. Available at: http://www.healthstats.nsw.gov.au. Accessed: 9 May, 2016.
[3] Harvey LA and Close JCT. Trends in fall-related hospitalisations, persons aged 65 years and over, NSW, 1998-99 to 2011-12. Sydney: Falls and Injury Prevention Group, Neuroscience ResearchAustralia, 2013.
[4] NSW Institute of Trauma and Injury Management. Falls resulting in major trauma, Infographic. Sydney: NSW, NSW Institute of Trauma and Injury Management, 2016. Available at: http://www.aci.health.nsw.gov.au/networks/itim/projects/infographics .
[5] Watson W, Clapperton A, Mitchell R. The burden of fall-related injury among older persons in New South Wales. Aust N Z J Public Health, 2011, 35(2), 170-175.
[6] Bradley C. Trends in hospitalisations due to falls by older people, Australia 1999–00 to 2010–11. Injury research and statistics no. 84. Cat. no. INJCAT 160, 2013, Australian Institute of Health and Welfare (AIHW), Canberra.
[7] NSW Department of Health. New South Wales Falls Prevention Baseline Survey: 2009 Report. Sydney: NSW, Department of Health, 2010.
[8] Centre for Epidemiology and Evidence. Health Statistics New South Wales. Sydney: NSW Ministry of Health. Available at: http://www.healthstats.nsw.gov.au
[9] McClure R, Turner C, Peel N, Spinks A, Eakin E, Hughes K. Population-based interventions for the prevention of fall-related injuries in older people. Cochrane Database Syst Rev, 2005, 25(1).
[10] NSW Department of Health . Prevention of Falls and Harm from Falls among Older People 2011-2015 (PD2011_029). Sydney: NSW, Department of Health, 2011. Available at: http://www.health.nsw.gov.au/policies/pd/2011/PD2011_029.html


Findings


Chart FL01 shows that the age-standardised rate for fall-related injury hospitalisations in NSW residents aged 65 years and over, increased from 2,885 per 100,000 population in 2011-12 to 3,064 in 2014-15. The rates of fall-related injury hospitalisation varied across local health districts (LHDs). In 2014-15, rates ranged from 2,140 separations per 100,000 in Western NSW LHD to 3,664 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 2,252 per 100,000 population in 2011-12 to 2,465 in 2014-15. During this time, rates for females increased from 3,358 to 3,532 per 100,000 population. The majority of LHDs in urban areas had higher rates compared to the state average. The reverse was true for their regional counterparts. This may be because higher proportions of elderly populations live in urban LHDs.


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.

The rate of hospitalisation for fall injuries in older males and females has been increasing for the past 10 years [1, 2, 3]. They may be affected by both the actual rate and other factors, such as hospital admission and discharge practices. The NSW Health policy [10], Prevention of Falls and Harm from Falls among Older People: 2011-2015, describes the actions that NSW Health will undertake to support the prevention of falls and falls-related harm among older people. They will take place in three key domains: Population Health, Community which includes NSW Health clinical services and NSW Health residential aged care services. The policy aims to reduce the incidence and severity of falls among older people and to reduce the social, psychological and economic impact of falls on individuals, families and the community.


References

[1] Centre for Epidemiology and Evidence. Health Statistics New South Wales. Sydney: NSW Ministry of Health. Available at: http://www.healthstats.nsw.gov.au. Accessed: 9 May, 2016.
[2] Centre for Epidemiology and Evidence. Health Statistics New South Wales. Sydney: NSW Ministry of Health. Available at: http://www.healthstats.nsw.gov.au. Accessed: 9 May, 2016.
[3] Harvey LA and Close JCT. Trends in fall-related hospitalisations, persons aged 65 years and over, NSW, 1998-99 to 2011-12. Sydney: Falls and Injury Prevention Group, Neuroscience Research Australia, 2013.
[10] NSW Department of Health . Prevention of Falls and Harm from Falls among Older People 2011-2015 (PD2011_029). Sydney: NSW, Department of Health, 2011. Available at: http://www.health.nsw.gov.au/policies/pd/2011/PD2011_029.html


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, which are not included in the NSW admitted patient data collection.


FL01 - Age standardised fall-related injury hospital separations rate
 

Rate per 100,000 population for persons aged 65 years and over by LHD, NSW, 2011-12 to 2014-15


eChartbook
Source: SAPHaRI, Centre for Epidemiology and Evidence, NSW Ministry of Health.
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, 2011-12 to 2014-15


eChartbook
Source: SAPHaRI, Centre for Epidemiology and Evidence, NSW Ministry of Health.
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, 2011-12 to 2014-15


eChartbook
Source: SAPHaRI, Centre for Epidemiology and Evidence, NSW Ministry of Health;


End Matter


Contributors
Drafted by: Richard Gilbert, Dr Kim Sutherland, CEC eChartbook team
Data analysis by: CEC eChartbook team; and Falls and Injury Prevention Group, Neuroscience Research Australia
Reviewed by: Dr Lara Harvey, Falls and Injury Prevention Group, Neuroscience Research Australia
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 2016
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, Corporate Services, 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

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, 2011-12 to 2014-15

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: SAPHaRI: Admitted Patient Data Collection (APDC) stored in AP_HView_EOC between Jul-2011 and Jun-2015, NSW ERPs by 5-year age groups, data extracted on 22-Jul-2016

Comments: SAPHaRI: Secure Analytics for Population Health Research and Intelligence (SAPHaRI) is the NSW Ministry of Health population health data warehouse. As APDC comprise data from public & private hospitals, no imputation was performed on the last 2 years (2013-14 and 2014-15) of this study period.
 
Chart: FL02

Admin Status: Current

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, 2011-12 to 2014-15

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: SAPHaRI: Admitted Patient Data Collection (APDC) stored in AP_HView_EOC between Jul-2011 and Jun-2015, NSW ERPs by 5-year age groups, data extracted on 22-Jul-2016

Comments: SAPHaRI: Secure Analytics for Population Health Research and Intelligence (SAPHaRI) is the NSW Ministry of Health population health data warehouse. As APDC comprise data from public & private hospitals, no imputation was performed on the last 2 years (2013-14 and 2014-15) of this study period.
 
Chart: FL03

Admin Status: Current

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, 2011-12 to 2014-15

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: SAPHaRI: Admitted Patient Data Collection (APDC) stored in AP_HView_EOC between Jul-2011 and Jun-2015, NSW ERPs by 5-year age groups, data extracted on 22-Jul-2016

Comments: SAPHaRI: Secure Analytics for Population Health Research and Intelligence (SAPHaRI) is the NSW Ministry of Health population health data warehouse. As APDC comprise data from public & private hospitals, no imputation was performed on the last 2 years (2013-14 and 2014-15) of this study period.