Download - TIIG Greater Manchester Themed Report/media/phi-reports/pdf/2014_06_falls_in_old… · 2011/12 – 2012/13. May 2014 KEY FINDINGS Between April 2011 and March 2013, there were 38,152

TIIG Greater ManchesterThemed ReportFalls in older people in Greater Manchester (2011/12 to 2012/13)

June 2014

Jennifer Brizell, Mark Whitf ieldCentre for Public HealthFaculty of Educati on, Health and CommunityLiverpool John Moores UniversityHenry Cott on Campus15-21 Webster StreetLiverpoolL3 2ET

TIIG Greater Manchester Themed Report Page 1

TIIG Greater Manchester Themed Report: Falls in older people 2011/12 – 2012/13. May 2014

CONTENTS

Foreword ............................................................................................................................................................................................. 2

Acknowledgements ............................................................................................................................................................................. 2

Key Findings ......................................................................................................................................................................................... 3

Greater Manchester area profile ......................................................................................................................................................... 4

Area description .............................................................................................................................................................................. 4

Levels of deprivation ....................................................................................................................................................................... 5

Living status ..................................................................................................................................................................................... 6

Health and wellbeing ....................................................................................................................................................................... 7

Services for older people in Greater Manchester ........................................................................................................................... 9

Data from Accident and Emergency Departments (ED) .................................................................................................................... 12

EDs in Greater Manchester ........................................................................................................................................................... 12

Table of injury groups collected .................................................................................................................................................... 12

Falls in older people across Greater Manchester; an analysis of ED data ......................................................................................... 12

Demographics ................................................................................................................................................................................ 13

Number of Falls in older people by LSOA with LA boundaries; ED data (April 2011 to March 2013) ........................................... 15

Location ......................................................................................................................................................................................... 19

Source of Referral .......................................................................................................................................................................... 19

Arrival Mode .................................................................................................................................................................................. 20

Disposal method ............................................................................................................................................................................ 20

Falls in older people across Greater Manchester; an analysis of Ambulance data ........................................................................... 21

Number of Falls in older people by LSOA with LA boundaries; NWAS data (April 2011 to March 2013) ...................................... 22

Appendices ........................................................................................................................................................................................ 23

Appendix 1 Greater Manchester residents aged 65 and over who live alone crude rates ........................................................... 23

Appendix 2 Greater Manchester residents aged 65 and over with Dementia crude rates ........................................................... 23

Appendix 3 Greater Manchester residents aged 65 and over with Mobility Problems crude rates ............................................. 23

TIIG Greater Manchester Themed ReportPage 2


FOREWORD

Greater Manchester (GM) currently has in excess of 400,000 residents aged 65yrs and over. Due

to increasing life-‐expectancy, by 2021 this is projected to increase by around 20% (32% for those

aged 85yrs and over). The comparative projected increase for those aged less than 65yrs is around

5%. Numerous older GM residents live with conditions such as dementia and mobility problems.

Many (particularly females) live alone and compared to the national average a greater proportion

of older GM residents are income deprived. All of these factors are associated with a greater risk

of falls-‐related injury and the concomitant likelihood of attending an Emergency Department (ED)

and/or being hospitalised/placed in residential care following a fall.

Whilst society pays the financial costs of providing care following a fall, the individual often pays an emotional one. Shock and

the distress caused by unexpected extraction from everyday routines are all common experiences for an older person suddenly

finding their self in unfamiliar surroundings, be they for a few hours in the ED or weeks on a ward. Mental health and well-‐being

can affect physical recovery times, thus potentially adding to the time and resources need to recover from a fall.

The older community is best served when the risk of a fall is reduced and there is high quality care following a fall. To achieve

both of these objectives it is essential to gather robust data and intelligence on a number of measures, covering the physical,

social and emotional consequences of a fall. The Trauma and Injury Intelligence Group (TIIG) injury surveillance system at The

Centre for Public Health, Liverpool John Moores University gathers ED attendance data from across the GM footprint. In this

report these data have been cross-‐referenced with intelligence on GM community and voluntary resources for the older

population to provide a detailed description of this issue across the region. Such data are essential to any strategy aimed at

encouraging people to maintain active and independent lives well into their old age.

Kirstie Haines

Greater Manchester Public Health Network Programme Director

ACKNOWLEDGEMENTS

With thanks to the A&E departments involved and the North West Ambulance Service for their collection of this data and the

Greater Manchester Public Health Network for their comments and contributions, in particular Kevin Sanderson-‐Shortt. Thanks

also go to Karen Critchley, Jane Harris and Stuart Cole for help in preparing this report.



KEY FINDINGS

Between April 2011 and March 2013, there were 38,152 attendances to a Greater Manchester Emergency Department (ED)

made by people aged 65 and over who had fallen. Of these, 35,974 (94%) were made by Greater Manchester residents.

• The highest number of attendances made by Greater Manchester residents were to Royal Oldham Hospital (5,586),

North Manchester General Hospital (5,228) and Wythenshawe Hospital (4,606).

• The largest number of attendances came from residents living in Rochdale (4,987), Manchester (4,842) and Stockport

(4,809).

• The highest number of attendances came from residents living in the Lower Super Output Areas (LSOAs) Bury 013D

(324), Rochdale 017F (187) and Bury 025B (172).

• There were more female (24,084) than male (11,890) attendances.

• The highest number of attendances were aged 85 and over (14,017), followed by 13,557 who were aged between 75

and 84 years. Only 8,400 were aged between 65 and 74 years.

• The vast majority of patients were of White ethnicity (33,492).

• The majority of falls took place in the home (21,055).

• A high number of patients were admitted into hospital following a fall (14,677) and the proportion of patients

admitted into hospital increased as the age of the patient increased.

Between April 2011 and March 2013, there were 51,417 ambulance call outs made due to falls in people aged 65 and over

across Greater Manchester.

• More females (33,135) than males (18,273) made a callout after falling.

• The highest number of callouts came from those aged 85 and over (22,893).

• The largest number of callouts was to Manchester local authority (7,132).

• The highest number of callouts came from the LSOAs Manchester 054E (206), Rochdale 017F (201) and Salford 016F

(200).



GREATER MANCHESTER AREA PROFILE

AREA DESCRIPTION

Greater Manchester is a metropolitan county within the north west of England which, using the mid population 2012 estimates,

has a population of approximately 2.69 million people (ONS, 2013). Of these, approximately 406,000 residents in Greater

Manchester are aged 65 years and over. Within Greater Manchester, there are ten local authorities.

TABLE 1. Demographic breakdown of Greater Manchester residents aged 65 and over by gender and local authority (Mid-‐

2012 Population Estimates)

Age group 65-‐74 75-‐84 85+ Total Gender Male Female Male Female Male Female Male total Female total

Bolton 12275 12921 6012 7736 1856 3583 20143 24240 Bury 8381 9016 4234 5727 1268 2455 13883 17198 Manchester 12052 13445 6712 9675 2107 4441 20871 27561 Oldham 9120 10157 4559 6242 1339 2887 15018 19286 Rochdale 8559 9241 4458 6032 1275 2663 14292 17936 Salford 8872 9621 4814 6391 1442 3177 15128 19189 Stockport 13345 14748 7878 10255 2361 4652 23584 29655 Tameside 9875 10542 4907 6401 1367 2900 16149 19843 Trafford 8976 10180 5684 7420 1789 3470 16449 21070

Wigan 16007 16437 7255 9105 1805 3858 25067 29400 Total 107462 116308 56513 74984 16609 34086 180584 225378

Source: Mid-‐2012 Population Estimates, Office for National Statistics, (2013). Accessed from; http://www.ons.gov.uk/ons/publications/re-‐reference-‐tables.html?edition=tcm%3A77-‐310118

The Older People’s Health and Wellbeing Atlas can be used to estimate the proportion of those aged 65 and over by local

authority (using mid-‐2010 population estimates) and this can then be compared to the national average. Using these estimates,

the proportion of people aged 65 years and over in England is 16.5%. Table 2 shows the proportion of those aged 65 and over in

Greater Manchester by local authority and how this relates to the England average. Most local authorities in Greater

Manchester have a lower than average proportion of residents aged over 65. This is with the exception of Wigan (16.6%) which

has an almost identical proportion to the national average and Stockport (17.9%) which has a higher than average older

population.

TABLE 2. Proportion of the population aged 65 and over in Greater Manchester (using Mid-‐2010 Population Estimates)

Local authority Proportion Significance in relation to national average

Bolton 15.8 Low Bury 16.0 Low Manchester 10.1 Low Oldham 15.0 Low Rochdale 14.9 Low Salford 14.6 Low Stockport 17.9 High Tameside 15.8 Low Trafford 16.2 Low Wigan 16.6 None

Source: Older People’s Health and Wellbeing Atlas, (2012). Accessed from; http://www.wmpho.org.uk/olderpeopleatlas/atlas/atlas.html



LEVELS OF DEPRIVATION

INDICES OF MULTIPLE DEPRIVATION

In terms of deprivation, local authorities within Greater Manchester fall, on the whole, at the more deprived end of the scale in

England. In the Indices of Multiple Deprivation (IMD 2010), seven out of ten local authorities within Greater Manchester are

ranked in the most deprived quintile, these being; Bolton, Manchester, Oldham, Rochdale, Salford, Tameside and Wigan. Bury is

ranked in the 2nd most deprived quintile and Stockport and Trafford in the 3rd.

OLDER PEOPLE – INCOME DEPRIVED

The Older People’s Health and Wellbeing Atlas can be used to estimate the proportion of those aged 60 and over who are

income deprived, i.e. they are living in pension credit (guarantee) households by local authority (using mid-‐2009 population

estimates). Using these estimates, the proportion of people aged 60 and over in England and living in pension credit (guarantee)

households is 18.1%. Table 3 shows the proportion of those aged 60 and over in Greater Manchester by local authority who are

income deprived and how this relates to the England average. Many local authorities in Greater Manchester have a higher

proportion of over 60’s living in pension credit (guarantee) households than the England average, namely Bolton, Bury,

Manchester, Oldham, Rochdale, Salford, Tameside and Wigan.

TABLE 3. Proportion of the population aged 60 and over in Greater Manchester who are income deprived (using Mid-‐2009

Population Estimates)

Local authority Proportion Significance in relation to national average

Bolton 23.6 Worse

Bury 18.9 Worse

Manchester 37.1 Worse

Oldham 23.1 Worse

Rochdale 24.9 Worse

Salford 27.9 Worse

Stockport 16.3 Better

Tameside 23.4 Worse

Trafford 17.3 Better

Wigan 21.8 Worse

Source: Older People’s Health and Wellbeing Atlas, (2012). Accessed from; http://www.wmpho.org.uk/olderpeopleatlas/atlas/atlas.html



LIVING STATUS

LIVING ALONE

Projection Older People Population Information system (POPPI) collates data on older people living in England. Data on the

proportion of people aged 65 and over is projected from the General Household Survey (2007). The projections given in Table 4

are for the year 2012. Females (101,289; 69%) make up the majority of people aged 65+ in Greater Manchester who are living

alone and the local authority with the highest number of over 65s living alone is Stockport (19,654).

TABLE 4. People aged 65 and over living alone by age group and gender (using General Household Survey 2007 projections

for 2012)

Age group 65-‐74 75+ Total

Gender Male Female Male Female Male total Female total

Bolton 2460 3870 2686 6954 5146 10824

Bury 1660 2670 1836 5002 3496 7672

Manchester 2400 4050 3060 8540 5460 12590

Oldham 1820 3060 2040 5551 3860 8611

Rochdale 1700 2790 1972 5307 3672 8097

Salford 1780 2880 2108 5795 3888 8675

Stockport 2660 4410 3434 9150 6094 13560

Tameside 1960 3180 2142 5673 4102 8853

Trafford 1780 3030 2550 6588 4330 9618

Wigan 3200 4920 3094 7869 6294 12789

Total 21420 34860 24922 66429 46342 101289

Source: POPPI (2012). Accessed from; http://www.poppi.org.uk

Using the populations provided in Table 1, the areas with the highest rates (per 100,000) of people aged 65 and above who live

alone are Trafford (37,176), Stockport (36,917) and Salford (36,609). Wigan (35,036) has the lowest rate of people aged 65 and

above living alone1.

RESIDENTIAL CARE ADMISSIONS

The Health and Social Care Information Centre (HSCIC) provides information on the number of people aged 65 and over who

have been admitted to council supported permanent residential and nursing care (2012/13). Table 5 shows these figures by local

authority and also the crude rate per 100,000 as provided by the HSCIC. Bury (900.9) and Salford (900.4) had the highest rates

per 100,000 of older people in residential and nursing care.

1 See Appendix one for a breakdown of crude rates of those aged 65 and over who live alone, and confidence intervals for each local authority in Greater Manchester.



TABLE 5. People aged 65 and over living alone by number of over 65s admitted to residential and nursing care

Local authority Number Rate

(per 100,000)

Bolton 350 793.1

Bury 280 900.9

Manchester 400 821.8 Oldham 225 653.0

Rochdale 240 750.9

Salford 310 900.4

Stockport 400 753.2

Tameside 250 700.2

Trafford 255 685.0

Wigan 395 728.9 Source: HSCIC (2012). Accessed from; https://indicators.ic.nhs.uk/webview/

HEALTH AND WELLBEING

DEMENTIA

The projections given in Table 6 are for the year 2012 and derived from Dementia UK. Stockport local authority has the highest

number of people aged 65 and over with dementia (3,756), followed by Manchester (3,474) and Wigan (3,259).

TABLE 6. People aged 65 and over in Greater Manchester with dementia (using Dementia UK 2007 projections for 2012)

Age group 65-‐74 75-‐84 85+ Total

Bolton 474 1168 1283 2925

Bury 322 829 874 2025

Manchester 484 1401 1589 3474

Oldham 363 913 1024 2300

Rochdale 333 895 963 2191

Salford 351 948 1091 2390

Stockport 529 1537 1690 3756

Tameside 381 953 1016 2350

Trafford 359 1112 1234 2705

Wigan 608 1360 1291 3259

Total 4204 11116 12055 27375


Using the populations provided in Table 1, the areas with the highest rates (per 100,000) of people aged 65 and above with

dementia are Trafford (7,210), Manchester (7,173) and Stockport (7,055). Wigan (5,983) has the lowest rate of people aged 65

and above with dementia2.

2 See Appendix two for a breakdown of crude rates of those aged 65 and over with dementia and confidence intervals for each local authority in Greater Manchester.



MOBILITY

The projections given in Table 7 are for the year 2012 and derived from the Living in Britain Survey (2001). Figures reflect the

number of people aged 65 and over who are unable to manage at least one mobility activity on their own. Activities can include

getting up and down the stairs, getting in and out of bed or getting around the house on the level. Stockport local authority has

the highest number of people aged 65 and over with mobility problems (9,799), followed by Wigan (9,156) and Manchester

(9,014).

TABLE 7. People aged 65 and over in Greater Manchester with mobility problems (using Living in Britain Survey 2001

projections for 2012)

Age group 65-‐74 75-‐84 85+ Total

Bolton 2639 2776 2465 7880

Bury 1799 1989 1670 5458

Manchester 2706 3338 2970 9014

Oldham 2032 2178 1940 6150

Rochdale 1867 2124 1805 5796

Salford 1953 2258 2040 6251

Stockport 2956 3638 3205 9799

Tameside 2140 2270 1940 6350

Trafford 2012 2625 2380 7017

Wigan 3373 3253 2530 9156

Total 23477 26449 22945 72871


Using the populations provided in Table 1, the areas with the highest rates (per 100,000) of people aged 65 and above with

mobility problems are Trafford (18,703), Manchester (18,612) and Stockport (18,406). Wigan (16,810) has the lowest rate of

people aged 65 and above with mobility problems3.

HOSPITAL ADMISSIONS FOR FALLS

The Older People’s Health and Wellbeing Atlas provides figures on the number and crude rate of emergency hospital admissions

for falls in people aged 65+. Accidental falls are defined by external cause field ICD10 W00-‐W19. Table 8 shows these figures

(2010/11) by local authority, the crude rate per 100,000 as provided by the Older People’s Health and Wellbeing Atlas and how

this relates to the national average. Only Bolton and Tameside were better than the national average (2,475 per 100,000) and

Bury showed no real difference to the national average for number of over 65s admitted to hospital from a fall.

3 See Appendix three for a breakdown of crude rates of those aged 65 and over with mobility problems and confidence intervals for each local authority in Greater Manchester.



TABLE 8. People aged 65 and over in Greater Manchester admitted to hospital for falls (2011/12)

SERVICES FOR OLDER PEOPLE IN GREATER MANCHESTER

Within Greater Manchester, there are many services designed and geared towards older people. Below is a breakdown of

services which are available to older people living in Greater Manchester by local authority. Please note, this is not a

comprehensive list and uses information available from a report published by Age Concern Salford (North West Regional Review

of Voluntary Sector Support for Older People) (http://bit.ly/OVux0s) and the Voluntary Sector Health resource

(http://www.voluntarysectorhealth.org.uk).

BOLTON

Via Bolton Council’s website (http://www.bolton.gov.uk/) is a link which directs to services for older people. This includes

information on moving to a residential or nursing home, day care centres for people aged over 65 years and how to access

community meals, e.g. meals on wheels services. Other services within Bolton include;

• Age UK Bolton

• Bolton Community and Voluntary Services (target action group – age)

• Bolton and District over 50’s Federation

BURY

Via Bury Council’s website (http://www.bury.gov.uk/) is a link which directs to services for older people. This includes

information on care link (24 hour monitoring system to allow older people to live safely in their own home), day care centres for

people aged over 65 years and how to access community meals, e.g. meals on wheels services and community care. Other

services within Bury include;

• Age UK Bury

• Bury Older People’s Forum

• Age of Opportunities Programme Board

Local authority Number Rate (per 100,000) CI Significance in relation to national average

Bolton 1186 2310 2173-‐2453 Better

Bury 933 2559 2388-‐2739 None

Manchester 2313 3547 3392-‐3707 Worse

Oldham 1147 2816 2645-‐2994 Worse

Rochdale 1144 2942 2763-‐3128 Worse

Salford 1741 3966 3768-‐4171 Worse

Stockport 2175 3265 3119-‐3416 Worse

Tameside 910 2165 2018-‐2318 Better

Trafford 1426 2984 2821-‐3155 Worse

Wigan 2095 3629 3468-‐3795 Worse



MANCHESTER

Via Manchester Council’s website (http://www.manchester.gov.uk/) is a link (under heading People and communities) which

directs visitors to services for older people. This includes information on moving to a residential or nursing home, help with

repairs, maintenance or security, free swimming for over 60’s and valuing older people (VOP; information on a neighbourhood

level group bringing together people interested in improving services for older people). Other services within Manchester

include;

• Silver service

• Manchester Older People’s Forum

• Out in the city

• Manchester Older People’s Network

OLDHAM

Oldham Council’s website (http://www.oldham.gov.uk/) does not have a specified link for services for older people. However

under Social services and health is information on care homes, meals and nutrition and support to live at home. Other services

within Oldham include;

• Age UK Oldham

• Forum 4 Age

• Neighbour Care Network

ROCHDALE

Via Rochdale Council’s website (http://www.rochdale.gov.uk/) is a link (under A to Z of services) which directs to services for

older people. This includes information on moving to a residential or nursing home, getting out and about, legal and financial

issues, disabilities and living at home. Other services within Rochdale include;

• Age UK Rochdale

• Partnerships for Older People Project (POPPS)

SALFORD

Via Salford Council’s website (http://www.salford.gov.uk/) are links (under A to Z of services) which include information on older

people such as health and social care, housing and older people and travel. There is also a service directory for older people to

enable them to find the most appropriate service for them. Other services within Salford include;

• Age UK Salford

• Salford Forum for Older People

• Out in Salford



STOCKPORT

Stockport Council’s website (http://www.stockport.gov.uk/) does not have a specified link for services for older people.

However under different headings, e.g. housing, safeguarding adults, is information on services and provisions for older people.

Other services within Stockport include;

• Age UK Stockport

• All our Tomorrows Partnership

• People like Us

TAMESIDE

Via Tameside Council’s website (http://www.tameside.gov.uk/) is a link (under A to Z of services) which directs to services for

older people. This includes information on caring for the elderly, sports and leisure, hobbies and interests, stay safe and

socialising and networking. Other services within Tameside include;

• Age UK Tameside

• Community Action for Tameside Seniors (CATS)

• Tameside Senior Forum

TRAFFORD

Trafford Council’s website (http://www.trafford.gov.uk/) does not have a specified link for services for older people. However

there is information on accommodation for older people. Other services within Trafford include;

• Age UK Trafford

• 50+ Voice Network

• Older People Partnership board

WIGAN

Wigan Council’s website (http://www.wigan.gov.uk/) does not have a specified link for services for older people. However under

different headings, e.g. housing, safeguarding adults is information on services and provisions for older people. Other services

within Wigan include;

• Age UK Wigan

• Over 50s Forum

• Pensioners link



DATA FROM ACCIDENT AND EMERGENCY DEPARTMENTS (ED)

EDS IN GREATER MANCHESTER

Within Greater Manchester there are twelve accident and emergency departments (ED) which primarily serve Greater

Manchester residents. These are; Manchester Royal Infirmary (MRI); Royal Albert Edward Hospital (RAE); Salford Royal Hospital;

Stepping Hill Hospital; Tameside General Hospital; Royal Bolton Hospital; Trafford General Hospital1; Wythenshawe Hospital;

Fairfield General Hospital; North Manchester General Hospital; Royal Oldham Hospital and Rochdale Infirmary4.

TABLE OF INJURY GROUPS COLLECTED

Table 9 details which injury groups are collected by each ED. There are varying levels of data collected across trusts with some

collecting the College of Emergency Medicine (CEM) recommended injury groups only, which does not include falls. The EDs

which do collect falls and will be included in this report are Fairfield General Hospital, North Manchester General Hospital, Royal

Oldham Hospital, Rochdale Infirmary, Salford Royal, Stepping Hill Hospital, Tameside General Hospital, Royal Bolton Hospital and

Wythenshawe Hospital. Manchester Royal Infirmary, Royal Albert Edward Hospital and Trafford General Hospital do not collect

information on falls.

TABLE 9. Greater Manchester ED injury group data items

ED Pennine Acute Trust

MRI

RAE

Salford

Stepping Hill

Tameside

Royal Bolton

Trafford

Wythenshaw

e

Total

Out of all 12

EDs

Assault Y Y Y Y Y Y Y Y Y 9 12

Other injury Y Y Y Y Y Y Y Y Y 9 12

Road traffic collision Y Y Y Y Y Y Y Y Y 9 12

Sports injury Y* Y N Y Y Y Y Y Y 8 11

Deliberate self-‐harm Y Y Y Y N Y Y Y Y 7 10

Fall Y N N Y Y Y Y N Y 6 9

Burns & scalds Y N N Y Y N Y N Y 5 8

Bites & stings Y N N Y Y N Y N N 4 7

*Collected by Fairfield General and Rochdale Infirmary only

FALLS IN OLDER PEOPLE ACROSS GREATER MANCHESTER; AN ANALYSIS OF ED DATA

This section of the report examines the burden of older people sustaining injuries from falls in Greater Manchester using ED data

between April 2011 and March 2013. In order to support local work this report describes data split both at local authority level

and ED level to assist local partners in their work following the Public Health Outcome Framework (PHOF); in particular this

report can be used in work looking at the indicator ‘injuries due to falls in people aged 65 and over’.

4 Urgent Care Centre



DEMOGRAPHICS

Between April 2011 to March 2013, a total of 96,446 ED attendances for falls were recorded across Greater Manchester EDs. Of

these, 38,152 (40%) were made by people aged 65 and over (Table 10).

TABLE 10. 65 years and over fall attendances to Greater Manchester EDs (April 2011 – March 2013)

Month Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Total

2011/12 1590 1526 1531 1561 1504 1508 1652 1588 1653 1502 1395 1579 18589

2012/13 1478 1663 1526 1633 1546 1606 1635 1596 1804 1790 1559 1727 19563

Total 3068 3189 3057 3194 3050 3114 3287 3184 3457 3292 2954 3306 38152

Table 11 shows the breakdown of 65 and over fall attendances by ED attended. Royal Oldham Hospital saw the highest number

of attendances (5,684) followed by North Manchester General Hospital (5,285) and Wythenshawe Hospital (4,988). Rochdale

Infirmary saw the lowest number of fall attendances (1,750). However, Rochdale generally sees a lower number of attendances

than other sites, most likely due to its classification as an Urgent Care Centre (UCC) rather than ED.

TABLE 11. 65 years and over fall attendances by ED (April 2011 – March 2013)

ED Attendances

Fairfield General Hospital 4153

Royal Oldham Hospital 5684

North Manchester General Hospital 5285

Rochdale Infirmary 1750

The Royal Bolton Hospital 3843

Stepping Hill Hospital 4797

Wythenshawe Hospital 4988

Tameside General Hospital 3231

Salford Royal 4421

Total 38152

Across the 65 years and over fall attendances made to Greater Manchester EDs5 (38,152), 35,974 (94%) were made by Greater

Manchester residents. The highest out of region attendees came from Rossendale (457; 1%), and Macclesfield (381; 1%). Table

12 shows the breakdown of attendances by local authority and which ED they attended. Many attendees went to an ED in the

local authority where they lived; for example 2,889 of Bolton residents attended The Royal Bolton Hospital (98%) and 2,835 of

Tameside residents attended Tameside General Hospital (95%).6

5 Please note, as not all EDs collect falls this report does not represent a true picture of falls in Greater Manchester. For example the low number of fall attendances from people residing in Wigan local authority (338) is most likely due to the omission of data from Royal Albert Edward Infirmary. 6 The remainder of the ED section will look at Greater Manchester resident attendances only.



TABLE 12. 65 years and over fall attendances by ED and Local Authority (April 2011 – March 2013)7

Bolton

Bury

Manchester

Oldham

Rochdale

Salford

Stockport

Tameside

Trafford

Wigan

Total

Fairfield General Hospital 16 2454 13 14 1299 8 *** *** *** 0 3813

Royal Oldham Hospital *** 25 49 4195 1273 5 0 36 *** 0 5586

North Manchester General 0 1215 2707 121 821 348 *** 12 *** *** 5228

Rochdale Infirmary 0 *** *** 12 1582 *** 0 0 0 *** 1601

The Royal Bolton Hospital 2889 408 *** *** *** 187 *** 0 *** 260 3750

Stepping Hill Hospital 0 *** 27 *** 0 *** 4005 82 5 *** 4127

Wythenshawe Hospital 6 6 1992 6 *** 11 775 7 1798 *** 4606

Tameside General Hospital *** *** 23 32 *** *** 8 2835 *** *** 2909

Salford Royal 20 66 28 7 *** 4115 15 <10 24 72 4354

Total 2935 4179 4842 4390 4987 4680 4809 2979 1835 338 35974

Table 13 shows that the highest number of attendances came from the Lower Super Output Area (LSOA) Bury 013D (324),

followed by Rochdale 0174 (187) and Bury 025B (172).

TABLE 13. Top 10 LSOAs in Greater Manchester ED 65 year and over attendances (April 2011 – March 2013)

LSOA code LSOA name Number of attendances

E01005060 Bury 013D 324

E01005481 Rochdale 017F 187

E01005032 Bury 025B 172

E01005615 Salford 016F 164

E01005631 Salford 020A 143

E01005447 Oldham 003D 137

E01005165 Manchester 008D 125

E01004977 Bury 004B 124

E01005899 Stockport 012B 122

E01005592 Rochdale 009E 119

E01005225 Manchester 007C 117

7 Please note throughout this report all numbers less than five have been suppressed in line with patient confidentiality and if there is only one number less than five in a category then a second number will be suppressed at the next level in order to prevent back calculations from totals.



NUMBER OF FALLS IN OLDER PEOPLE BY LSOA WITH LA BOUNDARIES; ED DATA (APRIL 2011 TO MARCH 2013)

In the financial year 2011/12 there were 17,463 fall attendances made by Greater Manchester residents aged 65 and over to

Greater Manchester EDs. In 2012/13 this number had slightly increased to 18,511. There were more female (24,084; 67%) over

65 fall attendances than male (11,890; 33%) and this was consistent across each month over the two year period (Figure 1).

FIGURE 1. 65 years and over fall attendances by gender (April 2011 – March 2013)

0

200

400

600

800

1000

1200

1400

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

Num

ber o

f ac

enda

nces

Month (April 2011 to March 2013)

Male Female



Figure 2 shows the number of 65 years and over fall attendances from each age group. The highest proportion of injury

attendances was from the 85+ age group with 14,017 (39%); there were 13,557 attendances aged between 75 and 84 years

(38%) and 8,400 aged 65 to 74 years (23%).

FIGURE 2. 65 years and over fall attendances by age group (April 2011 – March 2013)

Figure 3 shows the ethnicity of fall injury attendances by ED. The vast majority (33,492; 93%) of attendees were White.

FIGURE 3. 65 years and over fall attendances by ethnicity and ED (April 2011 – March 2013)

0

200

400

600

800

1000

1200

1400

1600

1800

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

Num

ber o

f ac

enda

nces

Month (April 2011 to March 2013)

85+

75-‐84

65-‐74

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Perc

enta

ge o

f ac

enda

nces

ED

White

Pakistani

Not known

Mixed

Indian

Chinese

Black

Bangladeshi

Any other ethnic group

Any other Asian background



Table 14 shows the gender and age group of 65 years and over fall attendances split by ED. The distribution of age groups was

varied across all the EDs. Rochdale Infirmary saw a larger proportion of 65 to 74 year olds (558; 35%) whilst Stepping Hill saw the

highest proportion of over 85 year olds (1,857; 45%). All EDs saw more female than male attendances.

Table 15 shows the gender and age group of 65 year and over fall attendances split by local authority. The distribution of age

groups was varied across all the EDs. Manchester saw a larger proportion of 65 to 74 year olds (1,345; 28%) whilst Stockport saw

the highest proportion of over 85 year olds (2,093; 44%). All local authorities saw more female than male attendances.


TIIG

Greater M

anchester Themed Report: Falls in older people 2011/12 – 2012/13. M

ay 2014

TABLE 14. 65 years and over fall attendances by ED

, gender and age group (April 2011 – March 2013).

Age group 65-‐74

65-‐74 (%)

75-‐84 75-‐84 (%)

85+ 85+ (%)

Total

Gender

Female

Male

Female

Male

Female

Male

Female

Male

Fairfield General H

ospital 497

313 21

958 488

38 1149

408 41

2604 1209

Royal Oldham

Hospital

775 539

24 1308

685 36

1706 573

41 3789

1797

North M

anchester General H

ospital 796

552 26

1339 687

39 1323

531 35

3458 1770

Rochdale Infirmary

360 198

35 403

247 41

276 117

25 1039

562

The Royal Bolton Hospital

457 288

20 987

461 39

1185 372

42 2629

1121

Stepping Hill H

ospital 469

274 18

989 538

37 1371

486 45

2829 1298

Wythenshaw

e Hospital

659 419

23 1126

666 39

1259 477

38 3044

1562

Tameside G

eneral Hospital

432 315

26 632

424 36

737 369

38 1801

1108

Salford Royal 625

432 24

1012 607

37 1254

424 39

2891 1463

Total 5070

3330 23

8754 4803

38 10260

3757 39

24084 11890

TABLE 15. 65 years and over fall attendances by local authority, gender and age group (April 2011 – M

arch 2013).

Age group 65-‐74

65-‐74 (%

) 75-‐84

75-‐84 (%

) 85+

85+ (%)

Total

Gender

Female

Male

Female

Male

Female

Male

Female

Male

Bolton 358

217 20

769 380

39 926

285 41

2053 882

Bury 578

350 22

1081 497

38 1212

461 40

2871 1308

Manchester

790 555

28 1190

629 38

1206 472

35 3186

1656

Oldham

634

449 25

1012 555

36 1289

451 40

2935 1455

Rochdale 798

470 25

1249 697

39 1308

465 36

3355 1632

Salford 621

443 23

1122 654

38 1394

446 39

3137 1543

Stockport 565

333 19

1190 628

38 1524

569 44

3279 1530

Tameside

452 325

26 649

426 36

754 373

38 1855

1124

Trafford 221

159 21

411 291

38 554

199 41

1186 649

Wigan

53 29

24 81

46 38

93 36

38 227

111

Total 5070

3330 23

8754 4803

38 10260

3757 39

24084 11890



LOCATION

Figure 4 details the location of falls by Greater Manchester fall attendances. Almost six in ten (21,055; 59%) falls took place in

the home and 11% (3,802) took place in a public place.

FIGURE 4. 65 years and over fall attendances by location of fall (April 2011 – March 2013)

SOURCE OF REFERRAL

Figure 5 shows how patients were referred into the ED. The majority (19,461; 54%) self-‐referred.

FIGURE 5. 65 years and over fall attendances by source of referral (April 2011 – March 2013)

21055

11059

3802

47 11 0

5000

10000

15000

20000

25000

Home Other Public place Work Educa_onal establishment

Num

ber o

f aIen

dances

Fall locaJon

318 6

5853

50 671 484

7258

1149 22 651

19461

46 5 0

5000

10000

15000

20000

25000

Num

ber o

f aIen

dances

Source of referral



ARRIVAL MODE

Figure 6 shows how patients arrived at the ED. The majority (25,552; 71%) arrived by ambulance.

FIGURE 6. 65 years and over fall attendances by arrival mode (April 2011 – March 2013)

DISPOSAL METHOD

Figure 7 shows the outcome of patient attendances. Over two in five (14,677; 41%) were admitted and 33% (11,948) were

discharged. Only 30% (2,483) of 65 to 74 year olds were admitted into hospital following a fall; however 41% (5,525) and 48%

(6,669) of 75 to 84 year olds and over 85s respectively were admitted into hospital.

FIGURE 7. 65 years and over fall attendances by disposal method (April 2011 – March 2013)

25552

866 2150 12

4806

147 471 1970

Ambulance Foot Other Police Private transport

Public transport

Taxi Unknown 0

5000

10000

15000

20000

25000

30000

Arrival mode

Num

ber o

f aIen

dances

14677

11948

428

8921

Admibed

Discharged

Other

Referred / follow up



FALLS IN OLDER PEOPLE ACROSS GREATER MANCHESTER; AN ANALYSIS OF AMBULANCE DATA

This section of the report examines the burden of older people falling in Greater Manchester using North West Ambulance

Service (NWAS) call out data between April 2011 and March 2013. Between April 2011 and March 2013 there were 51,417

ambulance call outs for people aged 65 and over who had fallen. In the financial year 2011/12 there were 24,111 ambulance call

outs due to falls in older people in Greater Manchester. In 2012/13 this number had increased by around 13% to 27,306.

The majority of call outs were for females (33,135; 64%) with 18,273 (36%) for males and nine recorded as unknown. A large

proportion of attendances were aged 85 years and over (22,893; 45%), followed by 18,644 (36%) aged between 75 and 84 years

and 19% (9,880) aged between 65 and 74 years. The largest proportion of attendances came from females aged over 85 years

(Table 16). Please note, nine attendances did not have a gender recorded but have been recorded in the final total in Table 16.

TABLE 16. 65 years and over fall ambulance call outs by age group and gender (April 2011 – March 2013)

Female Male Total

65 to 74 5095 4785 9880

75 to 84 11528 7113 18644

85+ 16512 6375 22893

Total 33135 18273 51417

The majority of call outs took place in Manchester local authority (7,132; 14%), followed by Stockport (6,146; 12%) and Wigan

(6,074; 12%). Bury (4,096; 8%) and Oldham (4,084; 8%) saw the fewest ambulance call outs for older people falling (Table 17).

TABLE 17. 65 years and over fall ambulance call outs by local authority (April 2011 – March 2013)

Local authority Number of callouts

Manchester 7132

Stockport 6146

Wigan 6074

Trafford 5145

Bolton 5012

Tameside 4860

Salford 4640

Rochdale 4228

Bury 4096

Oldham 4084

Total 51417

The highest number of ambulance call outs (206) came from the LSOA Manchester 054E, followed by Rochdale 017F (201) and

Salford 016F (200). Table 18 shows the top ten LSOAs in Greater Manchester for ambulance call outs for older people falling.



TABLE 18. Top 10 LSOAs in Greater Manchester 65 years and over ambulance call outs (April 2011 – March 2013).

NUMBER OF FALLS IN OLDER PEOPLE BY LSOA WITH LA BOUNDARIES; NWAS DATA (APRIL 2011 TO MARCH 2013)

LSOA code LSOA name Number of callouts

E01033667 Manchester 054E 206

E01005481 Rochdale 017F 201

E01005615 Salford 016F 200

E01005899 Stockport 012B 188

E01005935 Tameside 006C 186

E01004821 Bolton 016A 182

E01005631 Salford 020A 168

E01005032 Bury 025B 167

E01005758 Stockport 014B 164

E01006167 Trafford 019D 155

E01004775 Bolton 014A 148



APPENDICES

APPENDIX 1 GREATER MANCHESTER RESIDENTS AGED 65 AND OVER WHO LIVE ALONE CRUDE RATES

Local authority Crude rate Lower CI Upper CI

Bolton 35982 35426 36545

Bury 35932 35269 36605

Manchester 36269 36727 37817

Oldham 36354 35719 36988

Rochdale 36518 35861 37184

Salford 36609 35971 37255

Stockport 36917 36402 37436

Tameside 35994 35377 36619

Trafford 37176 36561 37798

Wigan 35036 34541 35537

APPENDIX 2 GREATER MANCHESTER RESIDENTS AGED 65 AND OVER WITH DEMENTIA CRUDE RATES


Bolton 6590 6354 6834

Bury 6515 6235 6805

Manchester 7173 6936 7416

Oldham 6705 6434 6985

Rochdale 6798 6517 7089

Salford 6965 6688 7249

Stockport 7055 6831 7284

Tameside 6529 6268 6799

Trafford 7210 6941 7487

Wigan 5983 5780 6193

APPENDIX 3 GREATER MANCHESTER RESIDENTS AGED 65 AND OVER WITH MOBILITY PROBLEMS CRUDE RATES


Bolton 17755 17365 18151

Bury 17561 17098 18033

Manchester 18612 18229 19000

Oldham 17928 17483 18382

Rochdale 17984 17524 18453

Salford 18216 17767 18673

Stockport 18406 18043 18734

Tameside 17643 17212 18082

Trafford 18703 18268 19145

Wigan 16810 16468 17158

Jennifer Brizell, Mark Whitf ieldCentre for Public HealthFaculty of Educati on, Health and CommunityLiverpool John Moores UniversityHenry Cott on Campus15-21 Webster StreetLiverpoolL3 2ET

0151 231 [email protected]

www.cph.org.uk www.ti ig.info www.twitt er.com/ti ig_cph

ISBN: 978-1-908929-66-2 (print) ISBN: 978-1-908929-65-5 (web)