Annual risk of falls resulting in emergency department and hospital attendances for older people: an observational study of 781,081 individuals living in Wales (United Kingdom) including deprivation, frailty and dementia diagnoses between 2010 and 2020

Abstract

Background falls are common in older people, but associations between falls, dementia and frailty are relatively unknown. The impact of the COVID-19 pandemic on falls admissions has not been studied. Aim to investigate the impact of dementia, frailty, deprivation, previous falls and the differences between years for falls resulting in an emergency department (ED) or hospital admission. Study Design longitudinal cross-sectional observational study. Setting older people (aged 65+) resident in Wales between 1 January 2010 and 31 December 2020. Methods we created a binary (yes/no) indicator for a fall resulting in an attendance to an ED, hospital or both, per person, per year. We analysed the outcomes using multilevel logistic and multinomial models. Results we analysed a total of 5,141,244 person years of data from 781,081 individuals. Fall admission rates were highest in 2012 (4.27%) and lowest in 2020 (4.27%). We found an increased odds ratio (OR [95% confidence interval]) of a fall admission for age (1.05 [1.05, 1.05] per year of age), people with dementia (2.03 [2.00, 2.06]) and people who had a previous fall (2.55 [2.51, 2.60]). Compared with fit individuals, those with frailty had ORs of 1.60 [1.58, 1.62], 2.24 [2.21, 2.28] and 2.94 [2.89, 3.00] for mild, moderate and severe frailty respectively. Reduced odds were observed for males (0.73 [0.73, 0.74]) and less deprived areas; most deprived compared with least OR 0.75 [0.74, 0.76]. Conclusions falls prevention should be targeted to those at highest risk, and investigations into the reduction in admissions in 2020 is warranted.

Association of Frailty Status with Risk of Fall among Hospitalized Elderly Patients: A Cross-Sectional Study in an Acute Geriatric Unit

“…In The Netherlands, data from the Longitudinal Aging Study Amsterdam which looked at 311 community-dwelling participants, aged 75 years and older who participated in the three-year longitudinal study, showed that the risk of falling was higher in frail compared with non-frail adults, but no effect modification was seen for frailty on the association between physical activity and falls [ 21 ]. An observational and longitudinal study of 781,081 individuals living in Wales was conducted between 1 January 2010 and 31 December 2020 and found similar results with frailty increasing the risk of falling [ 22 ].…”

Access to Ambulance Services for People with Dementia: A Comprehensive Review of Facts, Challenges, Strategies and Future Scopes

“…Dementia can progressively impact a person's ability to safely navigate their environment, leading to increased risks of injuries and medical emergencies [20,[24][25][26]. There are also unique needs of these patients, attributed to several factors such as the complex nature of dementia, challenges in recognizing and managing medical emergencies, and the need for specialized care in the pre-hospital setting.…”

Protocol for a scoping review of climate change and the impact on health of people living with dementia

“…Health promotion and proactive measures can have signi cant impact on the quality of life of this population in all levels of disease. More advanced stages of dementia are characterized by functional disability requiring assistance with basic activities of daily life (28-30), impaired mobility (31,32), and a predisposition to falls (33,34). Susceptibility to the negative effects of climate change in people living with dementia is related to the stage of disease and associated factors such as co-morbidities and frailty.…”