Summary
Falls are common among older people and often result in fractures or other serious injuries. This report examines Australian hospital data pertaining to fall injuries in people aged 65 years and older in 2003-04.
Four subsets of fall-related hospitalisations are examined:
- Fall injury incident cases,
- Inward transfer separations for fall injuries;
- Fall-related follow-up care separations; and,
- 'Other fall-related' separations.
The number of fall injury incidents (events) for people aged 65 years and older which led to hospitalisation in 2003-04 was estimated to be 60,497. The age-standardised rate of fall injury incidents in people aged 65 years and older was 2,295.3 per 100,000 population.
Age-specific rates of fall injury incidents increased exponentially from the age of 75 years and peaked in the 90-94 years age group at 9,653.7 fall injury incidents per 100,000 population. Females aged 65 years and older constituted a larger proportion of fall injury incidents than males (72.3%). Females also had a much higher age- standardised rate of falls (2,751.5 per 100,000) than males (1,623.8 per 100,000).
For both males and females, the most frequent type of injury sustained in a fall injury incident was an injury to the hip and thigh (33.5% of fall injury incidents, n=20,292). Injuries to the elbow and forearm and head injuries were also common types of injuries resulting from a fall injury incident. Females sustained a higher proportion of injuries to the elbow and forearm (12.2%) than males (5.5%), while males sustained a higher proportion of head injuries (21.2%) than females (12.7%). Two thirds (66.7%, n=40,357) of all hospitalised fall injury incidents for people aged 65 years and older in 2003-04 resulted in at least one fracture diagnosis.
The most common type of fall event was a fall on the same level due to slipping, tripping or stumbling (W01-34.3% of fall injury incidents, n=20,737). The next most common types of fall event were 'unspecified falls' (W19-28.5%) and 'other falls on the same level' (W18-18.9%). These types of falls were also the most common types of falls recorded in fall injury inward transfers, fall-related follow-up care separations and 'other fall-related' separations. The types of fall events affecting males and females were very similar, but males were observed to suffer far more falls on or from ladders (4.8%, n=800) than females (0.5%, n=238). Seven out of every ten fall injury incidents occurred in the home or in an aged care facility (n=42,362) and for six of every ten fall injury incidents, the activity being undertaken at the time of the falls event was unspecified.
The most common type of procedures listed in fall injury incident records were 'non- invasive, cognitive and other interventions, not elsewhere classified' procedures, which include health assessments, diagnostic tests, counselling, therapeutic interventions, anaesthesia and allied health interventions such as physiotherapy. Seven in ten procedures conducted due to fall injury incidents were procedures such as these (67.9% of listed procedures, n=111,078). Procedures involving the musculoskeletal system (15.8%, n=25,803) and imaging services (9.9%, n=16,196) were also common.
The total number of fall-related hospitalisations for people aged 65 years and older in 2003-04 was 101,644, which represents 4.3% of all hospital separations for any cause for this population. The total burden of fall-related hospitalisations for people aged 65 years and older in 2003-04 was disproportionately higher, with 1,246,214 bed-days representing 10.9% of all hospital bed-days for this population in this year. Dividing this number of bed-days by the estimated incidence of 60,497 cases for 2003-04 results in an estimated average total number of hospital bed-days per incident case of 20.6 days. However, as the role of falls injury for 'other fall-related' separations is not entirely clear, a more appropriate estimate of the estimated average total number of hospital bed-days per incident case, including only the bed-days attributable to fall incidents, inward transfers and fall-related follow-up care, is 15.3 days. While lower, this is significantly longer than the estimate for incident cases only and better describes the burden on hospitals due to serious falls.
The cost of hospitalised fall injury and other fall-related separations in older people for the financial year 2003-04 was estimated by applying Australian Refined Diagnosis Related Groups (AR-DRG) v5.0 cost weights to records coded as acute episodes of care. For this year, private hospital cost weights were not published, so public hospital cost weights were also applied to private admissions to approximate expenditure. The total cost of fall-related acute episodes of care was estimated to be $566.0 million. As costs could not be estimated for separations coded as rehabilitation, and other non-acute episodes of care, in addition to the lack of accurate costs for private admissions, this cost estimate is thought to underestimate the total cost of fall-related hospitalisations for people aged 65 years and older. Further, this estimate does not include the cost of post-hospital care and other indirect costs incurred by falls. However, based on these estimates, it is likely that the annual 'lifetime' cost of falls in older people exceeds the $1 billion cost suggested by Moller (1998).