Exploring the system-wide costs of falls in older people in Torbay

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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.

Key findings

  • 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.

Policy implications

  • 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.

Comments

Rebecca Mollart

Position
Chief Executive,
Organisation
erosh
Comment date
22 August 2013
Erosh champions quality housing and support for older people including sheltered housing. Our members provide environments and support which reduce the risk of falls amongst older people as well as implementing specific falls prevention strategies. When falls do happen they also respond quickly which can avoid costly ambulance costs as well as hospital stays. One of our members in the Midlands developed a fantastic first response service which saved thousands; unfortunately it didn't survive funding cuts despite demonstrating significant cost savings.

Dr Helen Lewis

Position
Medical sociology researcher,
Organisation
n/a
Comment date
22 August 2013
Policy implications are also for government via local authorities to fund improvements to pavements, social services and sheltered housing initiatives etc. These are as important in falls prevention as NHS initiatives.

Adrian Scaife

Position
Programme Manager,
Organisation
Tunstall Healthcare
Comment date
23 August 2013
Interesting to compare some of the economics with those in a case study produced by Rospa in partnership with PHE on Bristol's falls strategy
http://www.rospa.com/about/currentcampaigns/publichealth/info/hs3-casestudy2-bristol-falls.pdf

Charles Lowe

Position
President-elect, Telemedicine Section,
Organisation
Royal Society of Medicine
Comment date
31 August 2013
I am naturally sorry that my original comment on this paper was not published, as it was intended very much in good faith. This was a suggestion that a little further analysis be done as to whether the costs of falling were reduced for those fallers who were Torbay Lifeline users as conventional wisdom is that the cost is very dependent on the length of time someone remains on the ground before being rescued. More detail is at http://telecareaware.com/falling-in-torbay-a-mine-of-useful-information-uk/#sthash.3SgnkVXZ.dpuf which also has two detailed comments on how the analysis might best be done.

Ross Hedley

Position
Evidence and Service Impact Officer,
Organisation
RNIB
Comment date
19 September 2013
RNIB are hosting our annual Research Day on 21st October, at our Judd Street office in London. The theme this year is 'Falls and sight loss'. Confimed speakers so far are Dr. Tammy Boyce, and Sarah Buchanan of Thomas Pocklington Trust. The day will be a good opportunity to hear the latest research in this area, and to have some fruitful discussions along this theme. Admission is free. Please contact ross.hedley@rnib.org.uk if you would like to attend.

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