A fall is an event which results in a person coming to rest inadvertently on the ground or floor or other lower level (WHO).
In Australia, this type of fall is the leading cause of injury deaths accounting for 37% of all deaths (AIHW p142) and in 2014-15, falls were the main cause of hospitalised injuries (41%) (AIHW p 143).
The rates of falls are increasing each year. In 2016-17 over 100,000 people were hospitalised due to a fall. That is 273 people every day. The causes of falls are slipping, tripping and stumbling on the same level. Fifteen percent of falls were related to a household object such as a bed, chair, stairs or ladder. These falls resulted in injuries to the hip and thigh (22%) and the head (26%) (AIHW)
The Australian Institute of Health and Welfare’s report on the health of Australia 2018 lists falls resulting in patient harm in hospitals over a ten year trend as unfavourable (p 27). A fall in hospital resulting in harm is an ‘adverse event’. In 2015-16, there were about 34,000 falls in hospital, this is a rate of 4.6 per 1,000 hospitalisations for public hospitals (p7). The rate of falls in hospitals in Queensland is 3.9 per 1,000 separations (AIHW 2015-16).
Falls statistics help us understand how many falls occur, how and where fall occur and the impact that falls and falls injuries have across the continuum of health, this information will help us to keep people on their feet. Download the Queensland facts on falls information sheet.
|Victoria Falls and Ambulance|
- Between 2010 and 2017 EMS attended 324,060 elderly falls patients, which represents 9.7% of EMS attended workload in Victoria.
|New South Wales - Epidemiology of ambulance responses to older people who have fallen in|
- There were 42 331 responses to people aged 65 years or older, constituting 5.1% of total emergency workload.
|New South Wales - Characteristics of fall-related injuries attended by an ambulance in Sydney|
- 70% of fall related calls among people of all ages occurred at home or in a residential institution
|Falls-related ambulance attendances for Queenslanders aged 65 years and over, 2018-2019|
- During 2018-2019, there was a total of 41,968 Queensland Ambulance Service (QAS) attendances to patients aged 65 years and older who had fallen (56.2 per 1,000 population).
- This overall rate of falls-related attendances amongst persons aged 65 years and over is increased from 44.5 cases per 1,000 population in 2007-08.
- The rate of attendance increased with age – the highest being 158.0 attendances per 1,000 population for adults aged 85 years and over.
- The majority of patients attended were treated at scene (96.2%) and transported (68.3%).
- The majority (83.1%) of patients aged 65 years and over attended for falls only presented to QAS once.
|Falls-related ambulance attendances for Queenslanders aged 65 years and over, 2007-08|
- Queensland Ambulance Service provided 22,744 attendances to adults aged 65 years and older who had fallen, with more attendances in the cooler months (May to July). The rate of attendance increased with age, with the highest rate being for adults aged 85 years and over.
- Most attendances were inside private residences (56%), followed by nursing homes (24%).
|Falls resulting in injury in Queensland Hospitals Admitted Patient Data, 2013-2014|
- During 2013-2014, there were 3,318 separations in public and private hospitals in Queensland where a fall resulted in patient injury, an average of 9 falls every day resulting in patient harm.
- The majority of patients were adults aged over 65 years (78%).
- Of these in-hospital falls, around 11% resulted in a fracture and around 89% resulted in non-fracture injuries.
- The rate of in-hospital falls resulting in injury among adults aged 65 years and over in Queensland was 3.26 per 1,000 separations, or 1.01 per 1,000 total patient days. These rates are higher than the last reported rates (2007-2008).
- A fall resulting in patient injury is likely to increase the length of stay for the patient and increase the overall treatment cost.
|Readmission rates for fall-related injuries||
Unplanned hospital readmissions are considered an outcome indicator reflecting quality of care, of which discharge planning is a component. The Unplanned readmission rates (risk adjusted) for fall-related fractures among Queensland residents aged 50 years or older who had a previous fall-related fracture
and were admitted to Queensland facilities within two years of fall-related fractures occurring during the period 2008/09 to 2009/10 ranged between 7.6% to 21.8%.
Emergency department presentations
|Fall-related emergency department presentations for older Queenslanders, 2007-08|
- A total of 1,118 fall-related presentations were recorded for adults aged 65 years and over, with five times that number likely to have presented statewide.
- The rate of fall-related presentations increased with age.
- More females presented across all age groups.
- Most falls occurred at home (58%) or in residential aged-care facilities (10%).
- Most falls were a slip or trip on the same level (40%), while there were also falls from less than one metre (13%) and falls caused by stumbling on same level (12%).
- Injuries following a fall were to the head (15%), hip (11%) and forearm (9%)
- Fractures were the most common type of fall-related injury (30%).
- Most cases were triaged as Category 4 'semi urgent' (47%) or Category 3 'urgent' (42%).
- Most presentations were discharged following treatment in the ED (68%), however 27% were admitted to hospital for further treatment.
|AIHW Trends in hospitalised injury due to falls in older people 2007–08 to 2016–17|
- The rates of falls are increasing each year. In 2016-17 in Australia over 100,000 people were hospitalised due to a fall. That is 273 people every day. The causes of falls are slipping, tripping and stumbling on the same level or 15% were related to a household object such as a bed, chair, stairs or ladder. These falls resulted in injuries to the hip and thihg (22%) and the head (26%).
|Rate and cost of hospital admissions due to fall-related injuries among older Queenslanders, 2007-08|
- There were 13,028 admissions to public and private hospitals in Queensland due to fall-related injuries among people aged 65 years and over. The majority of public hospital admissions came via the emergency department (83%).
- Expenditure on hospital admitted patient services due to fall-related injuries among people aged 65 years and over was estimated to be $106.0 million - almost 70% was spent on treating women and more than 40% on treating those aged 85 years and over.
- Hip fractures were the most frequent type of fall-related injury. 3,572 people aged 65 years (around ten people every day) were admitted with a hip fracture. At an average cost of $15,046 per episode, hip fractures accounted for around 50% of the total estimated expenditure for all fall-related admissions.
Hospital patient falls
|Fall-related clinical incidents reported in Queensland Health facilities, 2007-08|
- There were 11,928 fall-related clinical incidents, with 14 incidents resulting in death or serious and permanent patient harm and 322 incidents resulting in temporary loss of function. Around two-thirds of the remaining incidents resulted in no harm. The greatest prevalence of fall incidents was among adults aged 80-89 years of age.
- Most reported falls occurred in acute hospital or multipurpose facilities (73%) or residential aged care facilities (RACF) (22%). Most reported falls were not witnessed by staff (80%) and occurred during walking or sitting to standing activities. Most reported falls in hospital occurred in bathroom or bedside areas, while most reported falls in RACF occurred in communal or bedroom areas.
|Falls resulting in injury in Queensland Hospital Admitted Patient Data, 2007-08 (public and private hospitals)
- Queensland public and private hospitals reported 2,205 falls resulting in injury among patients aged over 65 years (80%). This is a rate of 0.79 in-hospital falls in this age group per 1,000 patient days.
- Most of these in-hospital falls resulted in non-fracture injuries (84%) while around 16% resulted in a fracture.
Cost of falls
|Cost of hospitalisations due to fall-related injuries among people aged 65 years and over in Queensland, 2006-07 to 2008-09|
- Admissions to Queensland public and private hospitals due to fall-related injuries among people aged 65 years and over increased by almost 7% per annum between 2006-07 (12,398 admissions) and 2008-09 (14,168 admissions).
- Expenditure on hospital admitted patient services due to fall-related injuries among people aged 65 years and over was estimated to be $118.9 million in 2008-09 - an annual rise of around 11% since 2006-07.
- Hip fractures were the most frequent type of fall-related injury, and accounted for almost 50% of the estimated expenditure for all fall-related admissions.
- Almost 70% of the estimated expenditure for all fall-related admissions was spent on treating women and more than 40% on treating those aged 85 years and over.
Falls related deaths
|Falls-related deaths in Queensland, 2007|
- 493 Queensland residents died due to an unintentional fall
- People aged 65 years and over accounted for nearly 95% of the total fall-related deaths, with the highest fall-related mortality rate among persons aged 85 years and over
The total cost of hospitalisations due to fall-related injuries among people aged 65 years and over in Queensland is projected to double to over $240 million by 2015, based on projected estimates of cost, population growth and the rate of falls-related admissions.
- it is projected that one in four Queenslanders will be aged 65 years or older
- the number of hip fractures among older Australians is expected to increase fourfold, based on current incidence rates 216
- more than 500 additional hospital beds and 850 residential aged care places will be needed as a result of falls in older people [Moller, 2003 3].
Unless effective preventative strategies are put in place, the cost of care and services associated with fall related injury in older people will absorb a significant proportion of the increased spending on the health of older people 3. The Public Health Association of Australia Policy Position Statement on Fall Injury Prevention in older people states that effective action requires a national cross continuum response.