Ageing Well - Health
Falls
Introduction
Falls can happen to anyone, but falls and fall-related injuries are a frequent occurrence and a serious problem for older people. Three out of every 10 people over the age of 75 in England (about 2.5 million) will have at least one fall every year, and half of all those over the age of 80 will have a fall (Source: NICE).
Falls destroy confidence and reduce independence. From this many people suffer from increased isolation and move into residential care as a direct result of a fall. After a hip fracture, 50 per cent of people can no longer live independently, and may lead to death in some cases. Falling can also affect family members and carers. The cost of falls to the NHS is estimated to be more than £2 billion per year. Therefore falling impacts not only on quality of life and individual health but also on wider healthcare costs (Source: NICE Guideline Falls in older people: assessing risk and prevention [CG161]).
Falls are commonly associated with frailty, but falls are not an inevitable part of old age. Falls can be prevented with services working with an individual and their carers.
Effective falls prevention and management requires co-ordination and collaboration across health and social care, as well as housing providers and the third and independent sectors. The integration of health and social care, and closer working with housing providers, presents an opportunity to strengthen the planning and delivery of an integrated multiagency pathway.
A person is more likely to fall in their own home, although hospitals, care homes or roads are also hotspots for falls. The risk of falls at home can be reduced by maintaining a clutter free environment, using non-slip rugs and mats and good lighting. The risk of falls can also be reduced with sight tests, strength and balance training, and medication. (Source: NHS Choices – falls prevention).
Falls
Emergency hospital admissions due to falls in people aged 65 years or older are at their lowest level for eight years in Hartlepool.
Hartlepool’s rate of 1,762 per 100,000 people is the second lowest rate in the north east and the 16th lowest in England. Hartlepool’s rate has declined year on year for the last three years, and has been significantly lower than both the England and north east averages during this three year period. Both England and the north east saw their rates increase in the 2017/18 figures. This has resulted in the gap between the Hartlepool rate and England and north east rates being at their largest in the eight year reporting period. The gap between Hartlepool and England is 408 per 100,000 and between Hartlepool and the north east is 558 per 100,000. When this figure is broken down to the age brackets 65-79 years and 80+ years, we can see that, while both rates are lower than the England average, the 80+ years rate has driven the three year decline in the overall Hartlepool rate.
While the 65-79 years rate has seen a continual decline for three years, it remains similar to the England average, whereas the 80+ years rate fell heavily in 2015/16 to a position significantly better than the England average, and has maintained this standing across the last three years.
Even though the number of hospital admissions due to falls has decreased for three years, the rate of hip fractures in those aged 65+ years has not followed the same pattern.
Hip fractures for the over 65s in Hartlepool are at a 4 year high, and are at a level significantly worse than the England average. Hartlepool’s rate in in 2017/18 was the 4th highest in England, and up by 10% on the 20116/17 level. When broken by gender, male hip fractures in the over 65s is at an eight year low and very similar to the England average.
At the same time, the female rate is at a four year high, and in 2017/18 was the 2nd highest rate in England.
For females 65 and over in Hartlepool, the gap between the Hartlepool rate and the England average has not be larger across the eight year reporting period. The 2017/18 rate for over 65 females in Hartlepool jumped up by 17.8% on the 2016/17 rate.
If the figures are broken down by age range rather than gender, then the 65-79 years and 80+ years groups look very different.
The rate of hip fractures for those aged 65-79 years in Hartlepool fell by 45 in 2017/18, compared to the 2016/17 level. The rate has been similar to England for the last five years, and similar to the north east average for the last 8 years. This is in contrast to the rate for those aged 80+ years in Hartlepool.
The 2017/18 rate was an increase of 17.7% on the 2016/17 rate. This is just 0.1% lower than the increase for females in Hartlepool. Hartlepool is statistically worse than the England average for the 2nd time in 5 years, and occurs against a backdrop of a decline in both the England and north East averages for 2017/18.
The proportion of the Hartlepool population aged 65 years or over has increased year on year for the last three years.
This steady increase of between 0.1-0.2% means that this issue is going to become a concern for an increasingly large proportion of the Hartlepool population, and so while hospital admissions for falls may be declining, the severity and repercussions of those falls appear to be increasing.
Current Services
Falls Prevention
The team is based within the community in Hartlepool and is made up of occupational therapy staff from a variety of backgrounds and bring to the service a number of wide and varied skills.
The primary aim of this service is to offer residents within Hartlepool the opportunity to have access to a falls prevention plan to reduce the risk of falls, either within the home, or the local community.
We are aware there are a number of reasons that people fall and that this can lead to people not being confident to be a part of their local community and may lead to social isolation or a decline in health needs. With this in mind, Public Health and Adult Social Care have worked closely together to develop a holistic service, that looks at the causes of falls, but also provides a vital link to a variety of low level intervention services, along with giving you the necessary tools to keep safe, keep active and reduce the risk of falls. People can self-refer following a fall as can any other professionals or persons with a concern. Aside from this and in line with true prevention, everyone who enters Adult Care will automatically be assessed and provided with a falls prevention plan if they are in agreement.
The Falls Prevention Service has also worked tirelessly for the last 3 years with all Residential and Nursing Homes within the Hartlepool area. The aim is to help the home to have a more pro-active approach to the prevention of falls rather than being reactive. The support includes providing training to all care home staff in completion of falls risk assessment tools and along with this, all staff experiencing use of the aging simulation suit. In conjunction with this, the team have linked into the Tees-wide Alliance Training which is offered across the region on a rolling programme. A large amount of work has also been undertaken within the Extra Care Facilities within the town seeing their staff adopt the same approach to falls prevention as in care homes and training and support is provided again on a rolling programme.
