The increasing complexity of health care needs goes hand in hand with ageing, and, in turn, increasing demand for allied health services can be expected from an ageing population.
In women, balance begins to steeply decline post-menopause [i] and in men approximately a decade later.[ii] Beyond 65 years, the admission rate due to falls increases exponentially for both sexes, with a nine-fold increase in the rate of falls in males and females between the ages of 65 and 85 years.[iii]
After the age of 65, there is a decline in sensory system function (vision, vestibular and somatosensation), motor function (specific leg muscle strength, flexibility, coordination and endurance) and cognitive/sensory-motor integration, speed of reactions and multi-tasking ability.[iv] [v]
Although poor balance has been identified as one of the main factors contributing to falls in the people over 65 [vi] and the factor most amenable to therapy,[vii] [viii] falls can often be multi-factorial in nature, and attributed to low vision, urinary urgency, delirium or poly-pharmacy.
Falls are commonly experienced in populations with neurological conditions such as MS, Parkinson’s disease and stroke. Self-reported mobility problems are the most common unmet long-term clinical needs after stroke.[ix]
Whatever the cause of the fall, the potential for a low-impact fall to result in serious injury is much greater when the faller has low bone density. With an alarming increase in the prevalence of osteopenia and osteoporosis in Australia, the situation is going from bad to worse.
Falls are the cause of a substantial number of injury-related deaths in Australia, more numerous now than transport crash fatalities.[x]
74 million Australians over 50 years of age have osteoporosis (22%) or osteopenia (78%). Although this accounts for 66% of people in this age bracket, most do not know they have the disease and are only diagnosed after their first fracture.[xi]
By 2022, it is estimated there will be 6.2 million Australians over the age of 50 with osteoporosis or osteopenia. That is a 31% increase from 2012. 11
Osteoporotic bones are at high risk of fracture from the impact of a fall, however, they also fracture spontaneously, particularly in the vertebrae. Spontaneous vertebral body fractures are incredibly painful and debilitating. 11
Approximately 1 in 2 women and 1 in 3 men will experience an osteoporotic fracture. 11
Osteoporotic fractures are the leading cause for women to be admitted to hospitals in UK and USA. There is no reason why this would not hold true in Australia, if such data were available. [xii]
In 2013 there was a fracture every 3.6 minutes in Australia. This equates to 395 fractures per day or 2,765 fractures per week. This compares to a fracture every 8.1 minutes in 2001.
In 2022 it is expected there will be a 30% increase in the annual number of fractures, amounting to 1.6 million fractures in the next 10 years. Hip fractures, the most fatal and costly of all fractures, are increasing at a rate of 40% each decade. 11
Costs to Government, the community and to individuals
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Inevitably, falls and fractures lead to increased consumption of health services, increased dependence on carers and community services for ADL assistance, and reduced quality of life for individuals. One year after hip fracture, 30% of people are unable to walk independently, 60% have difficulty with at least one activity of daily living, and 80% are limited in activities such as driving and shopping.[xiii]
In 2012, the total costs of osteoporosis and osteopenia in Australians over 50 years of age were $2.75 billion. It is predicted that in 2022, the annual total costs will be $3.84 billion (2012$). These costs include ambulance services, hospitalisations, emergency department and outpatient services, rehabilitation, aged care and community services.11
The total cost of non-health community care services in 2012 attributable to fractures alone was estimated at $33.4 million, which is 1.4% of the total direct cost. 76% of the community care cost was in the older age group of 70 years and older. Women accounted for 89% of all community care costs attributable to fractures. 11
Research across all settings has shown that, in the face of an ageing population, if nothing more is done to prevent falls by 2051 an additional 2500 hospital beds will be permanently allocated to treating injuries from falls and an additional 3320 residential aged care facility places will be required.[xiv]
To maintain the current proportion of GDP allocated to the provision of health services by 2051, there will need to be a 66% reduction in the incidence of falls.[xv]
Next Step Health is committed to developing falls and fracture prevention models of care that individuals and community service providers can access. We currently deliver a fun and effective falls & fracture prevention class which incorporates evidence-based resistance exercises for bone density and evidence based balance exercises for falls prevention. We are also innovating with the development of assistive technology for balance retraining and falls prevention.
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Although we are currently doing what we can to help individuals at a community level, in the future we seek to collaborate with government departments, health services, aged care agencies and not-for-profit service providers to initiate programs that will proactively tackle the falls & fracture crisis at a population level.
[i] Nitz, J. C., Choy, N. L., & Isles, R. C. (2003). Medial–lateral postural stability in community dwelling women over 40 years of age. Clinical Rehabilitation, 17(7), 765-767.
[ii] Nolan, M., Nitz, J., Choy, N. L., & Illing, S. (2010). Age-related changes in musculoskeletal function, balance and mobility measures in men aged 30-80 years. The Aging Male, 13(3), 194-201.
[iii] Cripps R and Carman J (2001). Falls by the elderly in Australia: trends and data for 1998, Injury Research and Statistics Series, Australian Institute of Health and Welfare, Adelaide.
[iv] Woolacott M (2000). Systems contributing to balance disorders in older adults. J GerontolA Biol Sci Med Sci, 55, M424-8.
[v] Horak F. (2006). Postural orientation and equilibrium: what do we need to know about neural control of balance to prevent falls? Age Ageing, 35 Suppl 2, ii7-ii11.
[vi] Lord S. & Castell S. (1994). Physical activity program for older persons: effect on balance, strength, neuromuscular control, and reaction time. Arch Phys Med Rehabil, 75, 648-52.
[vii] Rubenstein, L. Z., & Josephson, K. R. (2006). Falls and their prevention in elderly people: what does the evidence show?. Medical Clinics of North America, 90(5), 807-824.
[viii] Panel on Prevention of Falls in Older Persons, American Geriatrics Society and British Geriatrics Society. Summary of the updated american geriatrics Society/British geriatrics society clinical practice guideline for prevention of falls in older per-sons. Journal of the American Geriatric Society. 2011;59(1):148-157.),
[ix] McKevitt C, Fudge N, Redfern J, Sheldenkar A, Crichton S, Rudd AR, et al. Self-reported long-term needs after stroke. Stroke 2011;42:1398-403.
[x] Australian Bureau of Statistics (2012). Causes of death 2010. ABS cat. no. 3303.0. Canberra: ABS.
[xi] Watts, J. J., Abimanyi-Ochom, J., & Sanders, K. M. (2013). Osteoporosis costing all Australians: a new burden of disease analysis–2012 to 2022.
[xii] Gauthier, A., Kanis, J. A., Jiang, Y., Martin, M., Compston, J. E., Borgström, F., & McCloskey, E. V. (2011). Epidemiological burden of postmenopausal osteoporosis in the UK from 2010 to 2021: estimations from a disease model. Archives of osteoporosis, 6(1-2), 179-188.
[xiii] Cooper C (1997). The crippling consequences of fractures and their impact on quality of life. American Journal of Medicine 103:12S–7S.
[xiv] Sambrook PN, Seeman E, Phillips SR, Ebeling PR (2002) Preventing osteoporosis: outcomes of the Australian Fracture Prevention Summit. Med J Aust 176 Suppl:S1.
[xv] DoHA (Australian Government Department of Health and Ageing) (2003). Projected Costs of Fall Related Injury to Older Persons Due to Demographic Change in Australia, Department of Health and Ageing, Australian Government, Canberra.
[xi] Watts, J. J., Abimanyi-Ochom, J., & Sanders, K. M. (2013). Osteoporosis costing all Australians: a new burden of disease analysis–2012 to 2022.
