Falling costs: the case for investment

This report contributes to the Reducing Harm from Falls national programme of the Health Quality & Safety Commission. The aim is to present the evidence for investment in strategies to prevent falls and fall injuries, so that effective strategies which will reduce the costs of falls can be integrated into routine health care for older New Zealanders.

Key points and recommendations

• Injuries from falls are the most common and costliest injury event for older people. Investment in proven strategies to prevent falls and injuries is essential for maintaining independence and quality of life in the ≥5-year-old age group.
• Implementing specific falls prevention programmes saves health care costs within one year, and other proven falls prevention interventions provide good value for money, especially in the longer-term. The opportunities are largest in community living older people to reduce presentations to ED, hospital admissions and premature admissions to aged care facilities.
• Return on investment estimates reported for effective, carefully targeted falls prevention strategies range from 1.0 to 7.0. This means that for every $100,000 invested by a DHB, the investment will be cost neutral or there could be up to $700,000 available within one year to allocate to other effective and worthwhile budget items. The corresponding reduction in fall related hospital admissions for community dwelling older people ranges from 0.5 to 10.0 percent.
• Several different types of strategies reduce falls and should form part of integrated, timely care for older people. Falls prevention exercise programmes reduce falls by 30-40 percent in community dwelling older people. A home safety assessment and modification intervention, and individually targeted multifactorial interventions, prevent falls in those with specific risk factors. Vitamin D supplements reduce falls in older people with a risk factor for low vitamin D levels.
• Investment in an evidence based, national approach to reduce falls in older New Zealanders is feasible and will be welcomed by health care professionals, older people and their families.
• The following interventions would make the best investment for a comprehensive, nationwide, evidence based approach to reduce the rising costs of falls and fall injuries in older people:

1. Exercise programmes designed specifically to prevent falls:
   1. Otago Exercise Programme delivered at home to people aged ≥0 years (or ≥5 with a previous fall)
   2. Group exercise classes for people aged ≥5 years. Tai Chi classes for more active older people.
2. Vitamin D supplementation for all older people with a risk factor for a low serum vitamin D level (assume for housebound, requiring support services, resident in aged care facility, frail and dark skinned or obese).
3. Home safety assessment and modification intervention delivered by an experienced occupational therapist to older people at higher risk of falling, e.g. previous fallers recently discharged from hospital, those with severe visual impairment (eligible to register with the NZ Foundation of the Blind, e.g. visual acuity 6/24 or worse).
4. Multifactorial interventions based on the person’s risk factors for older people in the clinical setting, that is, receiving primary health care, presenting to ED with a fall, attending a falls clinic, admitted to hospital, or resident in an aged care facility.