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Tackling the devastating impact of falls

Dr Lynn Mcvey, Research Fellow - Applied Health

By Dr Lynn Mcvey

The cost of falls

According to the 2020 National Audit of Inpatient Falls, falls are the most frequently reported incident affecting hospital inpatients, with 247,000 falls occurring in English inpatient settings every year. Underreporting may mean the true incidence of falls is even higher.

Reported falls among older patients are more likely to result in harm and, where harm occurs, it’s three times more likely to be severe.  During 2018, the National Hip Fracture Database recorded 2,439 hip fractures in England and Wales in hospital inpatients, and 12.7% of those patients went onto die within 30 days.

The financial cost of falls to the NHS is huge: NHS Improvement has estimated that inpatient falls cost the NHS and social care an estimated £630 million annually, but this is dwarfed by the devastating physical, emotional and relational costs to the people who fall and their families and friends, whose lives may never be the same again.

This is conveyed very clearly and movingly by Jamil Abdulkader, one of the project’s lay researchers, who generously tells about his mum’s falls in hospital. Falls also take a terrible toll on the NHS staff who work so hard to avoid them.

NICE guidelines

In response, NICE guidelines recommend that all hospital inpatients aged 65 and over, and patients aged 50-64 at higher risk of falling, receive a comprehensive risk assessment that identifies their individual risk factors for falling, as well as interventions tailored to address those risk factors.

This approach is called multifactorial risk assessment and intervention, and it’s estimated that it could reduce the incidence of inpatient falls by 25-30% and the annual cost of falls by up to 25%. However, there is unexplained variation between hospitals in adherence to this guideline, and limited high-quality research on preventing patient falls in hospital that explains why.

What we're doing

That’s why this study exists: to produce evidence that hospitals can draw on to inform their own fall risk assessment and prevention strategies, with the potential to reduce the frequency and severity of falls in older adults.

We started work a few months ago and are currently reviewing the literature to develop explanations about what supports and constraints routine use of multifactorial risk assessments and interventions in acute hospitals.

Later, we’ll test these explanations by comparing them with practice in hospitals.

We are extremely fortunate, in this work, to have input from a knowledgeable and experienced group of lay and academic researchers and clinicians in our Lay Research Group, Project Management Group and Study Steering Committee, whose members – like Jamil - are all committed to reducing the devastation caused by falls in hospitals.

Together with the hospitals that have generously agreed to be part of the research, we’re determined to make a difference.