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Conflicting trends in fall-related injury hospitalisations among older people: variations by injury type

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Abstract

Summary

Despite advances in prevention, fall-related hospitalisation rates among older people are still increasing. Rates between 1998/1999 and 2008/2009 for non-facture-related injuries increased by 6.1% while fracture injuries declined by −0.4%. Varying trends in rates of different injury types makes it difficult to provide a definitive explanation for these changes.

Introduction

Despite advances in fall prevention research and practice, the rate of fall-related hospitalisations continues to increase. However, hip fracture rates appear to be declining. An examination of trends in types of injuries that contribute to the overall fall injury rate is required to establish which injuries are driving the falls admission rate. The aim of this paper is to examine trends in fall-related injury hospital admissions by injury type in New South Wales (NSW), Australia.

Methods

A retrospective review of fall-related injury hospitalisations in NSW among individuals aged 65+ years, by injury type, was conducted from 1 July 1998 to 30 June 2009. Direct age-standardised admission rates were calculated. Negative binomial regression was used to examine the statistical significance of changes in trend over time of different hospitalised fall-related injuries.

Results

The fall-related hospitalisation rate increased by 1.7% each year (p < 0.0001; 95% confidence interval (CI), 1.3–2.1%). However, the rate of fracture declined by −0.4% (p < 0.03; 95% CI, −0.8–0.0%); whereas, the non-fracture rate increased by 6.1% (p < 0.0001; 95% CI, 5.5–6.7%) annually. Rates for severe head injuries, rib and pelvic fracture increased while those for hip and forearm fracture declined.

Conclusions

It appears that while fall prevention efforts in NSW are not yet affecting the overall rate of injury hospitalisation, there has been a significant decline in the rates of some fractures. Opposing trends in the rates of other fracture admissions and a significant increase in the rate of non-fracture injuries associated with falls makes a definitive explanation for these changes difficult.

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Acknowledgements

W. Watson was supported by the NSW Health Department. R. Mitchell was partially supported by the NSW Health Department and by an ARC-linkage post-doctoral fellowship (LP0990057).

The authors wish to thank the Centre for Epidemiology and Research at the NSW Health Department for providing access to the Health Outcomes and Information Statistical Toolkit (HOIST) to obtain data analysed in this study. The HOIST system refers to a data access, analysis and reporting facility established and operated by the Centre for Epidemiology and Research, Population Health Division, NSW Department of Health.

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Authors and Affiliations

  1. NSW Injury Risk Management Research Centre, The University of New South Wales, Kensington, NSW, 2052, Australia

    W. L. Watson & R. Mitchell

  2. School of Aviation, The University of New South Wales, Kensington, NSW, 2052, Australia

    R. Mitchell

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  1. W. L. Watson
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  2. R. Mitchell
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Correspondence to W. L. Watson.

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Watson, W.L., Mitchell, R. Conflicting trends in fall-related injury hospitalisations among older people: variations by injury type. Osteoporos Int 22, 2623–2631 (2011). https://doi.org/10.1007/s00198-010-1511-z

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