Falls and older people: understanding why people fall

Globally, falls are the second most common cause of accidental or unintended injury mortality, with those over 65 years of age having the greatest number of fatal falls (World Health Organization (WHO), 2018). Of course, most falls are not fatal, but they may require a healthcare intervention, and some cause ongoing disability and, as such, they are a cause of significant cost to the NHS and other health systems (Florence et al, 2018). One in three people aged over 65 years living in the community experience at least one fall a year, with some suffering multiple falls (National Institute for Health and Care Excellence (NICE), 2013). Therefore, falls in older people are a major public health issue and a concern for district nursing teams.

Public Health Outcomes Framework 2019/20 (Public Health England (PHE), 2019) reported that there were approximately 220 150 emergency hospital admissions of people aged 65 years and over related to falls, with two-thirds of these admissions being for people aged 80 years and over. In England, fall hazards in the home are estimated to cost the NHS £435 million, to which needs to be added the annual cost of fractures in the UK, which is estimated at £4.4 billion (£2.0 billion for hip fractures and more than £1.0 billion for social care). Further, hip fractures are associated with increased one-year mortality (18–33%) as well as reduced independent activities of daily living, such as walking and shopping, and life satisfaction and, for some, a hip fractures is a precursor to entering long-term care. Indeed, the impact at the personal level can be significant, as a fall may lead to a loss of confidence due to fear of falling and withdrawal from normal activities with consequent social isolation and loneliness.