One in three people aged over 65, and half of those aged over 80, fall at least once a year. Falls cost the NHS more than £2 billion per year. With the number of people aged 65 and over predicted to increase by 2 million by 2021, these costs are set to rise further.
One way to help design better services with more integrated treatment and rehabilitation for falls patients is to look more closely at where the costs of treating patients are incurred across health, community and social care services. This paper uses Torbay’s unique patient-level linked data set to explore the NHS and social care costs of the care pathway for older people in the 12 months before and after being admitted to hospital as a result of a fall.
On average, the cost of hospital, community and social care cost services for each patient who fell were almost four times as much in the 12 months after admission for a fall as the costs of the admission itself.
Comparing the 12 months before and after the fall, the most dramatic increase was in community care costs (160 per cent), compared to a 37 per cent increase in social care costs and a 35 per cent increase in acute hospital care costs.
While falls patients in this study accounted for slightly more than 1 per cent of Torbay’s over-65 population, in the 12 months that followed a fall, spending on their care accounted for 4 per cent of the whole annual inpatient acute hospital spending, and 4 per cent of the whole local adult social care budget.
There was evidence of significant under-coding of co-morbidities for falls patients, particularly for dementia.
The majority of the costs of caring for patients after a fall in Torbay were outside the acute hospital setting. These findings should encourage commissioners to consider the system-wide costs of providing integrated services for falls patients.
If cost data patterns are to be helpful in identifying and targeting patients for preventive falls services we need to tackle the major barrier of under-coding of co-morbidities in falls patients.