Falls are the most commonly reported safety incident in UK hospitals. Why do we worry about them; what is the effect; and why should trusts improve their risk management?
The number of people in the UK aged 65 and over is projected to rise by over 40% in the next 17 years to 16 million. It is estimated that 30% of people over this age will fall at least once a year. This figure rises to as high as 55% for over 80s in a hospital or care setting. When older people are admitted to hospital, clearly this is with a range of conditions, but frequently they are in a confused or anxious state. Those patients are less likely to appreciate that they are at risk of falling, and may be unable to comprehend even simple instructions such as the use of a call bell or the danger of mobilising unassisted, which may explain this further rise in risk. In 2015/16 this amounted to around 250,000 falls in various care settings within the NHS.
Of those patients who fall, injuries are reported in up to 44%. We know that elderly patients have lower bone density than younger patients, and more women suffer from low bone density than men. In 5% of falls, patients suffer a fracture of some sort. Already, therefore, we are looking at a very high potential number of people who suffer significant injury as a result of a fall in hospital or care. Some basic maths means that this is approximately 110,000 fall related injuries, and 12,500 fractures.
A large proportion of these will require surgical fixation, and older patients suffer a much higher incidence of adverse effects when they undergo general anaesthesia. Again looking at those over 80, delirium will occur in around 35% of patients. It is estimated that the mortality rate in the first year for patients fracturing a hip in hospital is 30%, and around 20% of patients are admitted to care within a year of suffering such a fracture. There will be other factors in play, of course, but a fractured hip will reduce mobility, with a resulting deleterious effect on both physical and mental health.
So, the impact of falls can be severe for the individual, and there is a knock on effect on demands on the NHS and social services, with associated costs – it was estimated that the cost to the NHS of ‘incident’ falls in healthcare settings was £2.6 billion in 2010. Hip fractures alone cost the NHS around £2 billion a year.
The obvious upshot of this is therefore that it is of benefit to all to prevent falls where possible. Can this be done effectively? While it is accepted that not all falls can be prevented, it has been demonstrated that having a robust falls prevention strategy in place can reduce falls by at least 24%, so again, looking at the overall numbers of people affected, and the costs to the individual and society, simply having a strategy will reap significant benefits.
Lucie Prothero, a senior associate in Penningtons Manches’ clinical negligence team, said: “We see time and time again the devastating effect that a fall can have on an elderly patient, both mentally and physically. These statistics demonstrate why it is so important that patients are properly assessed and managed for their risk of falling. Even looking at the bare statistics, the savings to the NHS of simply putting into place well proven prevention strategies could be in the hundreds of millions of pounds, not to mention the reduction in fatalities, and improvement in quality of life for thousands of patients. Sadly, we continue to see the false economies of understaffed wards and rushed risk assessments. It should be apparent to all trusts that time and budgeting for a comprehensive falls strategy and adequate staffing levels will be of universal benefit and will save costs in the long run.”