1. Falls in Bristol’s residential and nursing care Rob Benington Injury Prevention Manager Bristol Public Health

2. Falls are the leading external cause of death for the over-75s

3. Hospital Episode Statistics…. Public Health Outcome Indicators Public Health Outcome Indicators Admissions, postcodes Admissions, postcodes Occupancy and rates Occupancy and rates Confidentiality Confidentiality

4. Falls admissions of all Bristol residents Emergency admissions Bristol residents aged 65+ due to falls in 2011/12 All Bristol (65+) residents 398Hip fractures 1158Other fall related injury 15564.2 admissions every day 2.9% % of all 65+ Bristol residents admitted following a fall

5. Falls admissions from ECH, Care Homes, CH with Nursing, sheltered accommodation (2011/12) Extra Care Housing54 Care Homes with Nursing129 Residential care homes107 Supported housing91 Total381 8.4% (One in 12)% of 65+ care home residents admitted 39% Of all Bristol’s 65+ falls admissions are from 7,082 beds Falls admissions of all Bristolians resident in care homes, etc

6. 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

7. Falls by accommodation type

8. Residential on average smaller than nursing homes (33 beds vs 57 beds) Residential on average smaller than nursing homes (33 beds vs 57 beds) Older building / conversions Older building / conversions Risk = hazard x exposure Risk = hazard x exposure

10. Variation by type (Nursing Homes)

11. Variation by type (Residential care)

12. Dementia 4 year admission rate CHwNursing 4 year admission rate CHwNursing = 6.7% 4 year average rate residential care =12.2% 4 year average rate residential care =12.2% Average admission rate from homes for people with dementia Average admission rate from homes for people with dementia=15.7%

13. 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 ).

14. Falls in the future (in Bristol)

15. Medication Vision Blood Pressure Balance Main Personal Risk Factors Other medical conditions

16. Risky Behaviour Trip Hazards Slippery Surfaces Footwear Environmental Risk Factors

17. 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. Biggest risk factor?

18. NHS Bristol strategy 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. Hip Fracture Nonhip fragility fracture patients Individuals at high risk of 1st fragility fracture or other injurious fall 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. People currently at relatively low risk 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