Injuries due to falls in people aged 65 and over

Why this fact is important:

Falls are the largest cause of emergency hospital admissions for older people, and significantly impact on long term outcomes, e.g. being a major precipitant of people moving from their own home to long-term nursing or residential care.

The highest risk of falls is in those aged 65 and above and it is estimated that about 30% people (2.5 million) aged 65 and above living at home and about 50% of people aged 80 and above living at home or in residential care will experience an episode of fall at least once a year. Falls that results in injury can be very serious - approximately 1 in 20 older people living in the community experience a fracture or need hospitalisation after a fall. Falls and fractures in those aged 65 and above account for over 4 million bed days per year in England alone, at an estimated cost of £2 billion.

Things to note:

Hospital admissions have been used as a proxy of the prevalence of falls injuries, these are only the tip of the iceberg in relation to the health and well-being burden of falls. Inpatient hospital admissions are a proportion of falls incidents, more may present to A&E and GPs, not all of which will lead to hospital admission.

This indicator only counts falls that have been coded in the cause field and Injuries in primary diagnosis field. It has been observed that there are situations where falls (ICD10 W00-W19) and Injuries (S00-T98) are coded in secondary diagnosis fields. This may result in underestimation of falls resulting in injuries.

Interpretation of Results

Hospital Episode Statistics (HES) and Office for National Statistics (ONS) - Mid Year Population Estimates.
http://webarchive.nationalarchives.gov.uk/20170106081009/http:/www.apho.org.uk/resource/item.aspx?RID=48457

Things to consider about data source

HES inpatient data are generally considered to be complete and robust. However, there may be a question regarding the quality of external cause coding and differences in admission thresholds. There may be variation between Trusts in the way hospital admissions are coded. There may be variation in data recording completeness. Injury information could potentially be missing in the admission episode record but added instead to a subsequent episode record. In addition, some transfers which are also coded as episode order 1 (epiorder 1) and emergency could lead to double counting.

Data source

Calculated by Public Health England (PHE) from using Hospital Episode Statistics (HES) Copyright © 2019, Re‐used with the permission of NHS Digital. All rights reserved.

Time period

2017/18

Further information

Hospital admissions have been used as a proxy of the prevalence of falls injuries, these are only the tip of the iceberg in relation to the health and well-being burden of falls. Inpatient hospital admissions are a proportion of falls incidents, more may present to A&E and GPs, not all of which will lead to hospital admission.

This indicator only counts falls that have been coded in the cause field and Injuries in primary diagnosis field. It has been observed that there are situations where falls (ICD10 W00-W19) and Injuries (S00-T98) are coded in secondary diagnosis fields. This may result in underestimation of falls resulting in injuries.

Values relating to City of London and Isles of Scilly have been combined with Hackney and Cornwall respectively due to the requirement to suppress HES counts between 1 and 5. All values between 1 and 5 have been suppressed and, where necessary, other LAs and comparators have also been suppressed in order to prevent possible disclosure and disclosure by differencing.

Where the observed total number of admissions is less than 10, the rates have been suppressed as there are too few admissions to calculate directly standardised rates reliably. The cut-off has been reduced from 25, following research commissioned by PHE and in preparation for publication which shows DSRs and their confidence intervals are robust whenever the count is at least 10.

This indicator is available via the Public Health Outcomes Framework - http://www.phoutcomes.info/