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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
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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
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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.
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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).
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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
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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
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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.
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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
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 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.
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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
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 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.
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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
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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
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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
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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
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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.
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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.
TIIG Greater Manchester Themed Report Page 15
TIIG Greater Manchester Themed Report: Falls in older people 2011/12 – 2012/13. May 2014
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
TIIG Greater Manchester Themed ReportPage 16
TIIG Greater Manchester Themed Report: Falls in older people 2011/12 – 2012/13. May 2014
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
TIIG Greater Manchester Themed Report Page 17
TIIG Greater Manchester Themed Report: Falls in older people 2011/12 – 2012/13. May 2014
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 Manchester Themed ReportPage 18
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
TIIG Greater Manchester Themed Report Page 19
TIIG Greater Manchester Themed Report: Falls in older people 2011/12 – 2012/13. May 2014
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
TIIG Greater Manchester Themed ReportPage 20
TIIG Greater Manchester Themed Report: Falls in older people 2011/12 – 2012/13. May 2014
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
TIIG Greater Manchester Themed Report Page 21
TIIG Greater Manchester Themed Report: Falls in older people 2011/12 – 2012/13. May 2014
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.
TIIG Greater Manchester Themed ReportPage 22
TIIG Greater Manchester Themed Report: Falls in older people 2011/12 – 2012/13. May 2014
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
TIIG Greater Manchester Themed Report Page 23
TIIG Greater Manchester Themed Report: Falls in older people 2011/12 – 2012/13. May 2014
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
Local authority Crude rate Lower CI Upper CI
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
Local authority Crude rate Lower CI Upper CI
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
TIIG Greater Manchester Themed ReportPage 24
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)