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
All Bristol (65+) residents
398
Hip fractures
1158
Other fall related injury
1556
4.2 admissions every day
2.9%
% 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
54
Care Homes with Nursing
129
Residential care homes
107
Supported housing
91
Total
381
8.4% (One in 12)
% of 65+ care home residents admitted
39%
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 fallrelated injuries per 10,000 population in 50+ and 65+ age
groups
800
700
Rates
600
500
400
300
200
20
07
20 /08
08
20 /09
09
20 /10
10
20 /11
11
20 /12
12
20 /13
13
20 /14
14
20 /15
15
20 /16
16
20 /17
17
20 /18
18
20 /19
19
20 /20
20
20 /21
21
20 /22
22
20 /23
23
20 /24
24
20 /25
25
20 /26
26
/2
7
100
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
Slippery Surfaces
Risky Behaviour
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.
NHS Bristol strategy
Hip
Fracture
Non hip fragility
fracture patients
Individuals at high risk
of 1st fragility fracture
or other injurious fall
People currently at
relatively
low risk
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
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.
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