Falls in Bristol’s residential and nursing care

Rob Benington Injury Prevention Manager Bristol Public Health

Falls are the leading external cause of death for the over-75s

Hospital Episode Statistics….

 Public Health Outcome Indicators  Admissions, postcodes  Occupancy and rates  Confidentiality

Falls admissions of all Bristol residents Emergency admissions Bristol residents aged 65+ due to falls in 2011/12

398 1158 1556

2.9% All Bristol (65+) residents

Hip fractures Other fall related injury 4.2 admissions every day % of all 65+ Bristol residents admitted following a fall

Falls admissions of all Bristolians resident in care homes, etc Falls admissions from ECH, Care Homes, CH with Nursing, sheltered accommodation (2011/12)

Extra Care Housing Care Homes with Nursing Residential care homes Supported housing

Total

54 129 107 91

381

8.4% (One in 12) 39% % of 65+ care home residents admitted Of all Bristol’s 65+ falls admissions are from 7,082 beds

Variation of falls admission rates (residential and nursing homes) by home

Of 15 wi13 with sig higher than city av ad rates, 12 are residential homes

Falls by accommodation type

 Residential on average smaller than nursing homes (33 beds vs 57 beds)  Older building / conversions  Risk = hazard x exposure

Variation by type (Nursing Homes)

Variation by type (Residential care)

Dementia

 4 year admission rate CHwNursing

= 6.7%

 4 year average rate residential care

=12.2%

 Average admission rate from homes for people with dementia

=15.7%

Factors affecting variation in falls rates

Housing type Client group (frailty, medical condition) Management practices?

Relationship with and quality of local services?

Staff turnover? ( Correlated with decreases in nursing care , Castle and Engberg, 2005 ).

Falls in the future (in Bristol)

PROJECTION of Rates of emergency admissions for fall related injuries per 10,000 population in 50+ and 65+ age groups

800 700 600 500 400 300 200 100

20 07 /0 8 20 08 /0 9 20 09 /1 0 20 10 /1 1 20 11 /1 2 20 12 /1 3 20 13 /1 4 20 14 /1 5 20 15 /1 6 20 16 /1 7 20 17 /1 8 20 18 /1 9 20 19 /2 0 20 20 /2 1 20 21 /2 2 20 22 /2 3 20 23 /2 4 20 24 /2 5 20 25 /2 6 20 26 /2 7

50+ LCL 50+ 65+ UCL 50+ LCL 65+ UCL 65+

Main Personal Risk Factors

Medication Balance Other medical conditions Blood Pressure Vision

Environmental Risk Factors

Trip Hazards Footwear Risky Behaviour Slippery Surfaces

Biggest risk factor?

Having had a fall in the last 12 months.

“If you’re 65 or older, your health professional or practitioner should regularly ask whether you’ve had a fall in the past year. And if you’ve had a couple of falls, you should see your doctor anyway, even if you feel okay.

This is because someone who has already had a fall is more likely to fall in the future. But there are ways of helping a person avoid having a fall so they can feel more confident in their daily lives, and perhaps live independently for longer”.

NICE Clinical Guideline 21, 2004.

Hip Fracture

NHS Bristol strategy

Reduce adverse consequences of hip fractures and other serious injuries. This will involve reducing: Incidence; prevalence; costs of treatment and readmission rates and improving recovery and long term health

Non hip fragility fracture patients

Invest in the Fracture Liaison Service to help improve care and prevent subsequent fractures in people who have already suffered fall-related injury. FLS links closely with community based services.

Individuals at high risk of 1st fragility fracture or other injurious fall People currently at relatively low risk Identify people vulnerable to injurious

falls and fractures. Case finding will involve a wide range and large number of organisations in referring and signposting to services on the falls care pathway. Enable people at relatively low risk to identify individuals at higher risk of injurious fall and to refer or signpost effectively. This includes enabling self