This report describes the findings of the Derby and Derbyshire falls needs assessment 2017. It focuses on the needs of older people aged 65 years or over who have fallen in their home, in the community, in residential or nursing care homes and in hospitals. The outcome of this assessment will help identify gaps in or changes to existing service provision that can be addressed through commissioning, and will help agree priorities for future resource allocation to prevent and reduce the impact of falls, improve health and reduce inequalities. The work to develop this report has involved: a stakeholder conference to inform the JSNA and its recommendations; a literature review of published evidence; use of modelled data and actual data sourced from East Midlands Ambulance Service, A&E Departments and service providers such as Derbyshire Community Health Services, to identify the impact of falls on the local population; identification of local services; economic modelling of interventions to reduce falls and their impact.
Analysis of the epidemiological data shows that falls are one of the largest causes of emergency hospital admissions for older people and create a significant demand for ambulance services. Around one third of older people (70,100) will fall each year and as a consequence there are around 11,000 ambulance call outs. In Derby and Derbyshire around 60% of fallers are conveyed to hospital. In 2014/15 there were 6,000 hospital admissions due to falls and approximately 6% (4500) were coded as injurious (broadly in line with the published evidence). The data shows that the risk of injurious falls increases with age and females are at greater risk than males. Across the City and County around 1100 older people sustain a hip fracture as a result of falls. As the population of Derby and Derbyshire ages, the projected number of falls is expected to increase.
In Derbyshire around 4.5% of older people reside in care or nursing home, but in 2014/15 they accounted for a 18.4% (816) of injurious falls and 22.5% of hip fractures (250) reflecting an older, frailer population with complex multi morbidities. Derbyshire has similar or worse admissions from injurious falls and hip fractures across the range of indicators, compared to England and the comparator CIPFA group. Chesterfield, Southern Derbyshire and High Peak districts are significantly worse than the England average for injurious falls. Chesterfield is also worse than the England average for hip fractures. Derby performs similar or worse on injurious falls, and similar or better on hip fractures compared to England. They are somewhere of the middle of the comparator CIPFA group.
A literature review found that falls are not an inevitable consequence of aging and there is strong evidence supports the notion that one third of falls are preventable by identifying those at highest risk, ensuring that they receive a multi-factorial assessment and implementing appropriate interventions such as strength and balance exercise etc. Economic modelling work that has been undertaken found that these interventions are cost effective and implementation of the key interventions could deliver net savings to the public sector of between £590K - £4m.