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Injuries from falls are increasing in older adults

Study
Results
Facing the future
Implications for the UK
People are living longer, and the baby-boomers of the late 1940s and early 1950s are well into their 'Sanatogen' years. Living longer does not mean sitting quietly in a corner, and the over 50s, over 70s, and even over 80s are travelling more than ever, and are more active then ever. Their health may be at least as good, if not better than ever before.

But age brings some physical deficits, and a downside of all this is that falls are becoming more common, and the risk of injury from falls is increasing. There is evidence that about a third of the over 65s living in the community and half those living in institutions fall every year. These trends, and some projections for the future, come from splendid studies of falls and hip fractures in Finland [1, 2].

Study


Because they do these things well in Scandinavia, and Finland in particular, there is a system which identifies all fall-induced injuries resulting in hospital admission, or death, in the whole Finnish population (about five million) with a high degree of accuracy. A fall was defined as a descent from one metre or more. Only the over-50 population was included, and only hospital admission and not emergency department visits not requiring admission. Injuries included fractures, soft tissue bruises and contusions, and soft tissue wounds and lacerations. Data were available from 1970/1, and were analysed up to 1995 (falls) and 1997 (hips).

Results


From the mid-70s onwards there was a continual year-on-year increase in the number of fall-induced hospital admissions in men and women (Table). The average annual increases were 12% for women and 10% for men. The age-adjusted incidence increased from 494 to 1398 per 100,000 between 1970 and 1995, a 183% increase.

The total number of deaths each year also increased (Table). The average annual increases were 2.4% for women and 4.9% for men. The age-adjusted incidence in fall-induced death was unchanged over most of the time between 1970 and 1995.
Fall-induced injuries, deaths and hip fractures in over-50s in Finland (population about 5 million)
    1970 1995/7
Total number of fall-induced hospital admissions Women 3,659 14,767
  Men 1,963 6,810
Age-adjusted incidence (per 100,000) Women 648 1,469
  Men 434 972
Total number of fall-induced deaths Women 279 441
  Men 162 352
Age-adjusted incidence (per 100,000) Women 65 38
  Men 41 48
Total number of hip fractures All 1,857 7,122
Age-adjusted incidence (per 100,000) Women 292 467
  Men 112 233

There was a steady increase in hip fracture numbers from 1857 in 1970 to 7122 in 1997, an average annual increase of 11% a year (Table). The age-adjusted incidence increased for both men and women by 60% for women and 108% for men.

Facing the future


The authors projected the trends in this study forward into the next century. Assuming that the linear trend continued to increase, and putting that with the projected increase in the population of over 50s in Finland, the number of fall-induced hospital admissions would peak at about 61,000 fall-induced hospital admissions and 19,000 broken hips in about 2030 - about three times the burden in 1995/7 (Figure).

Figure: Historical and projected fall-induced hospital admissions and hip fractures in Finland


Implications for the UK


There is every reason to think that these figures for Finland are, if anything, conservative. What would these figures mean if they were applicable to the UK?

The UK population is about 12 times that of Finland, so on a nation-wide basis the burden would be expected to be about 430,000 in 2010 and 730,000 in 2030, of which about 130,000 and 230,000 would be fractured hips. At its peak, and making a simple assumption that each hospital visit would be about three days, this is equivalent to about 15 400-bed hospitals occupied full-time.

The average primary care group (PCG) with 100,000 population has now about 35,000 people aged over 50 years. If the Finnish incidence is approximately that in the UK, that means there are now 420 people admitted to hospital in any one year due to a fall, and 140 will be hip fractures. By 2030 that could rise to 1,200 falls needing a hospital admission, with 400 hip fractures.

These are big figures of public health and resource concern. About 5% of falls result in a fracture, and serious injury in another 5-10%. The severity of injury and incidence increases with age, and the crystal ball here is telling us of major problems to come. Bandolier 20 reported on a meta-analysis on randomised studies in hospitals and community-dwelling elders in the USA.

Reference:


  1. P Kannus et al. Fall-induced injuries and deaths among older adults. JAMA 1999 281: 1895-99.
  2. P Kannus et al. Hip fractures in Finland between 1970 and 1997 and predictions for the future. Lancet 1999 353: 802-5.
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