Injury

Introduction

Injury is a major cause of preventable mortality and morbidity, first recognised as a national health priority in 1986. When compared with other health interventions, the lead-time between an intervention for injury prevention and a result from that intervention is shorter. Injury, therefore, is an important demonstration area for population health, and ongoing monitoring of injury among the population is needed to support intervention strategies.[1]

Since 1989, falls have been the leading cause of injury-related hospitalisation among males and females. Most falls occur among people aged 65 years and over, and the most common types of falls are those that occur on the same level.[2] In New South Wales, no other single cause of injury, including road trauma, costs the health system more than fall-related injury.[3] In Australia, it has been projected that, because of the ageing of the population, the total health cost of fall-related injury will increase threefold by 2051.[4]

In 2006, the New South Wales Population Health Survey asked respondents aged 65 years and over: In the last 12 months have you had a fall? Respondents who answered yes were then asked the following questions: How many times did you fall in the last 12 months? In the last 12 months have you had a fall that required medical treatment for injuries? Were you admitted to hospital as a result of any of your falls in the last 12 months? Have you made any changes to your home or lifestyle to prevent you from falling? Are you afraid of falling?

Results

Falls in the last 12 months

Overall, in 2006, 24.3 per cent of adults aged 65 years and over had a fall in the last 12 months. A significantly higher proportion of females (29.4 per cent) than males (18.1 per cent) had a fall in the last 12 months. Among males, a significantly lower proportion of adults aged 65-69 years (10.9 per cent), and a significantly higher proportion of adults aged 80 years and over (28.7 per cent), had a fall in the last 12 months, compared with the overall male population aged 65 years and over. Among females, a significantly lower proportion of adults aged 65-69 years (23.4 per cent) had a fall in the last 12 months, compared with the overall female population aged 65 years and over.

A significantly lower proportion of adults aged 65 years and over in rural areas (21.3 per cent) than urban areas (26.0 per cent) had a fall in the last 12 months. A higher proportion of adults in the South Eastern Sydney & Illawarra Health Area (30.9 per cent), and a lower proportion of adults in the North Coast Health Area (18.3 per cent), had a fall in the last 12 months, compared with the overall adult population aged 65 years and over. There was no variation by level of socioeconomic disadvantage. There has been no significant variation in the proportion of adults aged 65 years and over who had a fall in the last 12 months between 2003 and 2006.

Among those adults aged 65 years and over who had a fall in the last 12 months, 28.7 per cent required medical treatment. A significantly higher proportion of females (31.8 per cent) than males (22.7 per cent) required medical treatment for a fall. There was no significant variation among age groups, between rural areas and urban areas, or by level of socioeconomic disadvantage; however, a lower proportion of adults aged 65 years and over in the North Coast Health Area (15.2 per cent) required medical treatment for a fall. There was no significant variation in the proportion of adults requiring medical treatment for a fall in the last 12 months, between 2003 and 2006.

Among those adults aged 65 years and over who had a fall that required medical treatment in the last 12 months, 32.1 per cent required hospitalisation. There was no significant variation between males and females, or among age groups. A significantly higher proportion of adults aged 65 years and over in rural areas (45.5 per cent) than urban areas (26.2 per cent) required hospitalisation for a fall. A higher proportion of adults in the Hunter & New England Health Area (60.8 per cent), and a lower proportion of adults in the Northern Sydney & Central Coast Health Area (13.5 per cent), required hospitalisation for a fall. A lower proportion of adults in the most disadvantaged quintile (12.9 per cent) required hospitalisation for a fall. There was no significant variation in the proportion of adults requiring hospitalisation for a fall in the last 12 months, between 2003 and 2006.

Action taken to prevent falls

Overall, in 2006, 25.7 per cent of adults aged 65 years and over took action to prevent falls. A significantly higher proportion of females (31.7 per cent) than males (18.4 per cent) took action to prevent falls. Among males, a significantly lower proportion of adults aged 65-69 years (8.9 per cent) and 70-74 years (12.0 per cent), and a significantly higher proportion of adults aged 80 years and over (42.3 per cent), took action to prevent falls, compared with the overall male population aged 65 years and over. Among females, a significantly lower proportion of adults aged 65-69 years (18.7 per cent), and a significantly higher proportion of adults aged 80 years and over (46.3 per cent), took action to prevent falls, compared with the overall female population aged 65 years and over.

There was no significant variation between rural areas and urban areas; however, a higher proportion of adults aged 65 years and over in the South Eastern Sydney & Illawarra Health Area (32.1 per cent), and a lower proportion of adults in the Sydney West Health Area (17.5 per cent) took action to prevent falls, compared with the overall adult population aged 65 years and over.

The most common actions taken to prevent falls include: installing hand rails (70.2 per cent), removing mats or rugs (14.0 per cent), other house structure modifications (12.4 per cent), getting a walking stick or frame (11.5 per cent), replacing steps with ramps (11.4 per cent), removing clutter from the house (8.8 per cent), purchasing or modifying or repairing unsafe furniture (7.2 per cent), and getting eyes checked or changing medications (6.2 per cent).

Fear of falling

Overall, in 2006, 26.6 per cent of adults aged 65 years feared falling. A significantly higher proportion of females (33.8 per cent) than males (17.9 per cent) feared falling. There was no significant variation by age group.

A higher proportion of adults aged 65 years and over in the second most disadvantaged quintile (32.5 per cent) took action to prevent falls, compared with the overall adult population aged 65 years and over. A significantly lower proportion of adults in rural areas (23.8 per cent) than urban areas (28.2 per cent) feared falling. A lower proportion of adults in the North Coast Health Area (20.8 per cent) feared falling.

References

National Health and Medical Research Council. Paradigm Shift, Injury, From problem to solution.
Canberra: Commonwealth of Australia, 1999. Available online at www.nhmrc.gov.au/publications/subjects/injury.htm (accessed 13 May 2007).
Injury Risk Management Research Centre. Trends in falls hospitalisations in New South Wales (NSW). Sydney: Injury Risk Management Research Centre, 2006. Available online at www.irmrc.unsw.edu.au/Publications/factsheets.asp (accessed 10 May 2007).
Population Health Division. The health of the people of New South Wales: Report of the Chief Health Officer, 2006. Sydney: NSW Department of Health, 2006. Available online at www.health.nsw.gov.au (accessed 10 May 2007).
Moller J. Projected costs of fall related injury to older persons due to demographic change in Australia. Canberra: Australian Government Department of Health and Ageing, 2003. Available online at www.aodgp.gov.au/internet/wcms/publishing.nsf/content/health-pubhlth-publicat-document-falls_costs-cnt.htm (accessed 10 May 2007).

Graphs

Source:	New South Wales Population Health Survey 2006 (HOIST). Centre for Epidemiology and Research, NSW Department of Health.
Print version:	Although this page can be printed directly from your web browser, a higher quality version is available as a PDF file that can be printed or viewed on screen.
Produced by:	Centre for Epidemiology and Research, Population Health Division, NSW Department of Health.
Last updated on:	1 July 2007