Content last reviewed: 12 April 2016
Falls are a major cause of disability and the leading cause of mortality resulting from injury in people aged over 75 in the UK (Scuffham & Chaplin, 2002). They account for half of all accident related hospital admissions, up to a quarter of ambulance callouts, and have been estimated to cost the NHS in England more than £2bn a year in direct healthcare costs alone.
This chapter considers falls predominantly in adults aged 65 years and over as the key issue of concern is not simply the high incidence of falls in older people, but the combination of a high incidence and a high susceptibility to injury.
Definition: A fall can be defined as “a sudden, unintentional change in position causing an individual to land at a lower level, on an object, the floor or the ground, other than as a consequence of a sudden onset of paralysis, epileptic seizure or overwhelming external force” (Feder et al, 2000).
Approximately 35% of people aged 65 years and over, living in the community, are likely to fall at least once a year, and this rises to 50% of adults over 80 who are either at home or in residential care (DoH, 2009). Half of fallers are likely to have a further fall within the next 12 months.
Falls are not an inevitable result of ageing but they are more likely to occur as people get older. They can be a symptom of an underlying health problem and tests should be undertaken to rule these out, particularly if the falls are unexplained.
Most falls do not result in serious injury. However the consequences of falling, or of not being able to get up after a fall, can be devastating. Consequences can include:
- Fear of falling and loss of confidence to move around safely
- Loss of mobility, leading to social isolation and depression
- Increase in dependency and disability
- Pressure related injury
The relationship between falls and Osteoporosis
Osteoporosis is a condition that affects bone strength and over a third of women and one in five men in the UK have one or more bone fractures because of osteoporosis in their lifetime (NOS, 2013). Women lose bone material more rapidly than men, especially after the menopause when their levels of oestrogen drop.
Osteoporosis risk factors
- Genes: higher risk if a parent has broken a hip
- Age: older adults are at higher risk
- Gender: women are at higher risk
- Race: people from black Afro-Caribbean origin are at lower risk because they have bigger and stronger bones
- Low body weight: body mass index (BMI) of below 19g/m2
- Previous fracture
- Certain medical conditions rheumatoid arthritis, thyroid conditions and conditions such as Crohns Disease that affect absorption
- Certain medications corticosteroids, some cancer treatments, anti-epileptic drugs
- Lifestyle factors: smoking, alcohol, diet and exercise
Falls and osteoporosis are inextricably linked, both in their consequences and in the patient group who most suffer these outcomes. Approaches to fracture prevention must address both the force of the fall, the incidence of falling and bone fragility (see diagram 1).
The Fracture Prevention Triangle
The incidence of falls is increasing at around 2% per annum and this is expected to continue as the population ages. Up to 10% of falls result in serious injury, of which 5% are fractures (DoH, 2009).
The Relationship between Osteoporosis and Fractures
Most falls result in no serious injury, but annually approximately 5% of older people living in the community who fall, experience a fracture or need hospitalisation. Falls and fractures in people aged 65 and over account for over 4 million hospital bed days each year in England alone (RCP, 2011).
In excess of 95% of hip fractures are fall related and over 90% of hip fractures occur in older people with osteoporosis (see diagram 2).
The relationship between falls and hip fractures
Hospital costs following hip fracture are high and mostly occur in the first year after the index hip fracture; estimated hospital costs are £14,163 and £2,139 in the first and second year following fracture. Having a hip fracture increased hospital costs by £10,964 compared to the year before the fracture (Leal et al, 2015). These costs must then be adjusted to include rehabilitation and social care.
One in every 12 patients who sustains a hip fracture will die in the first month following injury and three in every 10 will die within the first year. Approximately half of those people who were previously independent become partly dependent following a hip fracture, with one third becoming totally dependent. An estimated 10% of older people that suffer a hip fracture are likely to require admission to a care home as a result of their injury (DoH, 2009).
Secondary fractures appear to occur rapidly after incident fracture. The Glasgow Fracture Liaison Service found that 80% of re-fractures that occur over a 3 year follow-up period happen during the first year, with 50% occurring during the first 6-8 months – dependent of whether the incident fracture was hip (6 months) or non-hip (8 months).
Last updated Friday, 22nd April 2016