Boufous, Soufiane

Carroll, Therese

Clemson, Lindy

Close, Jacqueline CT

Harvey, Lara

Li, Qiang

Lo, Serigne

Lord, Stephen R

Muecke, Sandy

Paul, Serene S

Priddis, Annabel

Sherrington, Catherine

Tiedemann, Anne

Public Health Research & Practice

English

Sydney eScholarship

1 SUPPLEMENTARY MATERIAL:  Trends in fall-related ambulance use and hospitalisation among older adults in NSW from 2006 to 2013: a retrospective, population-based study  Serene S Paul,a,b Lara Harvey,c Therese Carroll,d Qiang Li,e Soufiane Boufous,f Annabel Priddis,d Anne Tiedemann,a Lindy Clemson,b Stephen R Lord,c Sandy Muecke,g Jacqueline CT Close,c,h Serigne Lo,i Catherine Sherringtona  aMusculoskeletal Health Sydney, School of Public Health, Sydney Medical School, The University of Sydney, Sydney, Australia bFaculty of Health Sciences, The University of Sydney, Sydney, Australia cNeuroscience Research Australia, University of New South Wales, Sydney, Australia dPopulation Health, NSW Ministry of Health, Sydney, Australia eThe George Institute for Global Health, Sydney, Australia fTransport and Road Safety Research, University of New South Wales, Sydney, Australia gNSW Ambulance, Sydney, Australia hPrince of Wales Clinical School, University of New South Wales, Sydney, Australia iMelanoma Institute Australia, Sydney, Australia  Public Health Research and Practice 2017   2 Table S1. Characteristics of adults aged 65 years and over who used ambulance or hospital services for fall-related events in NSW during 2006–2013. Data are presented as N (%).  Characteristic NSW Ambulance data APDC data  N (%) N (%) Number 314,041 records 331,311 separations Sex †   Female 192,809 (61.5) 218,960 (66.1)  Male 120,810 (38.5) 112,351 (33.9) Age group    65-74 61,230 (19.5) 67,853 (20.5)   Female 33,111 (54.2)† 40,352 (59.5)   Male 28,036 (45.9)† 27,501 (40.5)  75-84 125,314 (39.9) 129,709 (39.2)   Female 74,514 (59.6)† 83,877 (64.7)   Male 50,624 (40.5)† 45,832 (35.3)    85 and over 127,497 (40.6) 133,749 (40.4)   Female 85,184 (66.9)† 94,731 (70.8)   Male 42,150 (33.1)† 39,018 (29.2) Socioeconomic status (SEIFA quintiles) ‡ §  1-2 50,191 (16.2) 46,190 (14.0)  3-4 87,190 (28.1) 78,949 (23.9)  5-6 62,528 (20.2) 59,542 (18.0)  7-8 47,130 (15.2) 56,900 (17.2)  9-10 62,829 (20.3) 88,596 (26.8) Remoteness index (ARIA+, 0-15)  ‡ §  Major cities (0 – 0.2) 209,166 (67.5) 229,374 (69.5)  Inner regional (>0.2 – 2.4) 76,623 (24.7) 66,739 (20.2)  Outer regional, remote and very remote (>2.4) 24,079 (7.8) 34,064 (10.3) †n=422 (0.1%) records with unknown sex were treated as missing data; these included 83 records in people aged 65-74 years, 176 records in people aged 75-84 years and 163 records in people aged ≥85 years. ‡Data were missing for n=4,173 (1.3%) records due to lack of geocoding in these records. §Data were missing for n=1,134 (0.3%) separations due to lack of geocoding in these separations. APDC: Admitted Patients Data Collection. ARIA+: 2011 accessibility/remoteness index of Australia which measures road distances from populated localities to the nearest service centres; low scores indicate high accessibility and low remoteness. SEIFA: 2011 socioeconomic indices of relative socioeconomic advantage and disadvantage for areas within Australia; low scores indicate a low proportion of advantage and a high proportion of disadvantage compared to other areas of Australia.     3 Table S2. Number of hospital separations for falls and fall-related injury in adults aged 65 and over, 2006–2013. Data are presented as N (%).  Number of hospitalisations per patient Number of fall-related separations (%) Number of fall injury-related separations (%) Number of individuals Number of separations Number of individuals Number of separations 1 138,322 (69.2) 138,322 (41.8) 125,183 (75.0) 125,183 (55.0) 2 39,099 (19.6) 78,198 (23.6) 29,489 (17.7) 58,978 (25.9) 3-5 18,424 (9.2) 63,031 (19.0) 11,708 (7.0) 39,433 (17.3) 6-9 2,117 (1.1) 15,125 (4.6) 561 (0.3) 3,722 (1.6) 10+ to <100 2,047 (1.0) 35,628 (10.8) 37 (0.0) 437 (0.2) 100+ 7 (0) 1,007 (0.3) 0 (0) 0 (0) Total 200,016 331,311 166,978 227,753    4 Table S3a. NSW Ambulance records of CAD determined ‘fall’-related injury for adults aged 65 years and over in NSW, by type of service provided, sex and decennial age groups, 2006–2013. Data are presented as N (row %).    All fall events Limb fractures^ Skin and soft tissue injuries Serious trauma†  Other  injury‡ Non-injurious falls Unspecified      Head injury only††    N 314,041 85,675 (27.3) 15,648 (5.0) 41,503 (13.2) 28,252 515 (0.2) 61,958 (19.7) 108,742 (34.6) Sex§             Female 192,809  60,282 (31.3) 9,384 (4.9) 25,015 (13.0) 17,255 312 (0.2) 34,805 (18.1) 63,011 (32.7)     Male  120,810  25,321 (21.0) 6,244 (5.2) 16,453 (13.6) 10,969 202 (0.2) 27,011 (22.4) 45,579 (37.7) Age group             65-74 years 61,230  17,287 (28.2) 2,875 (4.7) 8,684 (14.2) 5,425 131 (0.2) 11,884 (19.4) 20,369 (33.3)     75-84 years 125,314  33,580 (26.8) 6,461 (5.2) 15,761 (12.6) 10,636 228 (0.2) 26,281 (21.0) 43,003 (34.3)     85+ years 127,497  34,808 (27.3) 6,312 (5.0) 17,058 (13.4) 12,191 156 (0.1) 23,793 (18.7) 45,370 (35.6) Transported to hospital 231,077   79,924 (34.6) 13,323 (5.8) 39,118 (16.9) 26,155 452 (0.2) 44,157 (19.1) 54,103 (23.4) ^Limb fractures in NSW Ambulance data corresponds to the sum of hip fractures, other lower limb fractures and upper limb fractures in the APDC. †Includes pelvic, chest, head, spinal and penetrating injuries as well as serious trauma. ††Head injury is a subset of serious trauma. ‡Injuries consistent with ICD-10-AM codes S00-T95 and T99 which were not already classified. §Missing n=422 records. Injuries were extracted from the following NSW Ambulance clinical record protocols: Limb fractures: Limb injuries and fractures, limb realignment and difficult extraction; soft tissue injury: soft tissue injuries to the face and neck, epistaxis, wound care; serious injury: head injury, spinal injuries, chest injuries, penetrating trauma, pelvic injuries, pre-hospital management of serious trauma or deteriorating trauma patient; other injury: burns, eye injuries, airway obstruction, overdose or poisoning, radiation, venomous bites, near drowning; non-injuries: medical conditions, e.g. cardiac problems, respiratory problems, non-specific medical conditions such as vomiting and pain; unspecified: non-specific or missing a clinical record protocol.   5 Table S3b. Fall-related hospitalisations by adults aged 65 years and over in NSW, by injury type, single or multiple separations, sex and decennial age groups, 2006–2013. Data are presented as N (row %).  Characteristic Injurious fall separations         Non-injurious fall separations§  All injuries All fractures Hip fractures†^ Other lower limb fractures†^ Upper limb fractures†^ Other fractures† Traumatic brain injury Soft tissue injuries‡ Other injuries  N 227,753 129,437  44,471  (19.5) 16,703  (7.3) 33,685  (14.8) 34,578 (15.2) 10,105  (4.4) 20,506  (9.0) 67,705 (29.7) 103,558 Single admission 108,859   64,349  22,683 (20.8) 9,209  (8.5)  17,011 (15.6)  15,446 (14.2) 5,247  (4.8) 8,853  (8.1)  30,410 (27.9) 29,463 Multiple admissions  118,894   65,088  21,788 (18.3)   7,494  (6.3)  16,674 (14.0)  19,132 (16.1) 4,858  (4.1)  11,653 (9.8)  37,295 (31.4) 74,095 Sex           Female 156,098   95,799  32,445  (20.8) 12,604  (8.1) 27,391  (17.5) 23,359 (15.0)   5,261  (3.4) 13,542  (8.7) 41,496 (26.6) 62,862 Male   71,655   33,638  12,026  (16.8)   4,099  (5.7)   6,294  (8.8) 11,219 (15.7)   4,844  (6.8)   6,964  (9.7) 26,209 (36.6) 40,696 Age group           65-74 years   45,134   27,772    5,251  (11.6)   5,935 (13.1) 10,876  (24.1)   5,710 (12.7)   2,167  (4.8)   3,094  (6.9) 12,101 (26.8) 22,719 75-84 years   86,590   49,376  16,688  (19.3)   6,250  (7.2) 13,021  (15.0) 13,417 (15.5)   4,148  (4.8)   7,913  (9.1) 25,153 (29.0) 43,119 85+ years   96,029   52,289  22,532  (23.5)   4,518 (4.7)   9,788  (10.2) 15,451 (16.1)   3,790 (3.9)   9,499 (9.9) 30,451 (31.7) 37,720 §Including but not limited to neurological conditions, cardiac conditions, respiratory conditions, other medical conditions (e.g. vomiting, urinary tract infections). ^Hip fractures, other lower limb fractures and upper limb fractures are subsumed by the single category of ‘limb fractures’ in the NSW Ambulance data. †Subsets of all fractures. ‡Includes skin lacerations and contusions.  The following ICD-10-AM codes were used to identify hip fractures: S72.0-S72.2; other lower limb fractures: S72.3-S72.9, S82, S92, T02.3, T02.5, T12; upper limb fractures: S42, S52, S62, T02.2, T02.4, T10; other fractures: S02, S12, S22, S32, T02.0-T02.1, T02.6-T02.9, T08, T14.2; traumatic brain injury: S06; soft tissue injuries: S00, S10, S20, S30, S40, S50, S60, S70, S80, S90, T00, T09.0, T11.0, T13.0, T14.0; and other injuries (all injuries not previously classified): S01, S03-S05, S07-S09, S11, S13-S19, S21, S23-S29, S31, S33-S39, S41, S43-S49, S51, S53-59, S61, S63-69, S71, S73-S79, S81, S83-S89, S91, S93-S99, T01, T03-T07, T09.1-T09.9, T11.1-T11.9, T13.1-T13.9, T14.1, T14.3-T14.9, T15-T75, T79. 6 Table S4. Characteristics of individuals with single versus multiple admissions, by the individual’s first fall-related separation. Data are presented as N (%).  Characteristic Individuals with single admissions  Individuals with multiple admissions N 138,322 61,694 Sex   Females 86,636 (62.6) 42,012 (68.1) Males 51,686 (37.4) 19,682 (31.9) Age group   65-74 years 35,018 (25.3) 10,838 (17.6) Females 20,053 (57.3)   6,533 (60.3) Males 14,965 (42.7)   4,305 (39.7) 75-84 years 54,341 (39.3) 25,820 (41.9) Females 33,195 (61.1) 17,303 (67.0) Males 21,146 (38.9)   8,517 (33.0) 85 years and over 48,963 (35.4) 25,036 (40.6) Females 33,388 (68.2) 18,176 (72.6) Males 15,575 (31.8)   6,860 (27.4) Socioeconomic status (SEIFA quintiles)§   1-2  21,648 (15.7)   9,120 (14.9) 3-4 36,417 (26.4) 15,012 (24.5) 5-6 24,139 (17.5) 10,747 (17.5) 7-8 23,806 (17.3) 10,758 (17.5) 9-10 31,855 (23.1) 15,705 (25.6)  Remoteness index (ARIA+, 0-15)§   Major cities (0 – 0.2) 89,987 (65.3) 41,846 (68.2) Inner regional (>0.2 – 2.4) 31,172 (22.6) 12,676 (20.7) Outer regional, remote and very remote (>2.4) 16,706 (12.1)   6,820 (11.1) Resident of an aged care facility 22,348 (16.2)   8,909 (14.4) Injuries   No injuries 29,463 (21.3) 12,826 (20.8) Fractures 64,349 (46.5) 28,324 (45.9) Traumatic brain injury   5,247 (3.8)   1,773 (2.9) Soft tissue injury   8,853 (6.4)   4,453 (7.2) Other injuries 30,410 (22.0) 14,318 (23.2) §Data were missing for n=809 (0.3%) individuals due to lack of geocoding for these individuals on their first hospital separation; 457 were in individuals with single admissions and 352 were in individuals with multiple admissions.  7 Table S5. All fall separations and injurious fall separations, for residents of aged care facilities versus community-dwellers. Data presented as N (%).   All fall separations (N=331,311) Injurious fall separations (N=227,753)  Residents of aged care facilities^ (N=59,419) Community dwelling (N=271,892) Residents of aged care facilities^ (N=50,806) Community dwelling (N=176,947) Single separations 22,348 (37.6) 115,974 (42.7) 19,536 (38.5)   89,323 (50.5) Multiple separations 37,071 (62.4) 155,918 (57.3) 31,270 (61.5)   87,624 (49.5) Sex        Female 43,885 (73.9) 175,075 (64.4) 37,993 (74.8) 118,105 (66.8)    Male 15,534 (26.1)   96,817 (35.6) 12,813 (25.2)   58,842 (33.3) Age group        65-74 years   3,142 (5.3)   64,711 (23.8)   2,513 (5.0)   42,621 (24.1)    75-84 years 17,076 (28.7) 112,633 (41.4) 14,494 (28.5)   72,096 (40.7)    85+ years 39,201 (66.0)   94,548 (34.8) 33,799 (66.5)   62,230 (35.2) Type of injury§        Fractures 27,404 (46.1) 102,033 (37.5)      Non-fracture injuries 23,402 (39.4)   74,914 (27.6)      No injuries   8,613 (14.5)   94,945 (34.9)   ^Residents of aged care facilities were estimated from place of occurrence codes (Y92.14) or source of referral (6 – Nursing Home). However, place of occurrence was unspecified in 19.2% separations, while 84.4% of falls occurring in nursing homes had source of referral listed as the Emergency Department.  Injury was identified using ICD-10-AM codes S00-T95 and T99 and grouped as fractures or non-fracture injuries.    8 Table S6. Types of falls in older adults which required hospitalisation, by decennial age groups and sex, NSW, 2006–2013. Numbers reported are for hospital separations for a fall-related event by the entire cohort (top row), with the number of separations by females reported in the bottom row for each category.    FALL-RELATED SEPARATIONS  FALL-INJURY-RELATED SEPARATIONS  Fall circumstance All 65-74 years 75-84 years 85+ years All 65-74 years 75-84 years 85+ years  (N=331,311) (N=67,853) (N=129,709) (N=133,749) (N=227,753) (N=45,134) (N=86,590) (N=96,029) Fell due to trips, slips and stumbles 172,901 33,694 68,360 70,847 128,789 24,564 49,823 54,402  Females  117,397 21,390 45,206 50,801 90,871 16,163 34,332 40,376 Fell onto lower level 3,036 1,247 1,152 637 2,310 924 893 493  Females 1,575 562 615 398 1,200 375 504 321 Fell due to collisions with people or objects 2,900 599 1,131 1,170 2,211 434 855 922  Females 1,789 329 695 765 1,410 249 553 608          Fell while supported by another person 139 27 50 62 93 18 37 38  Females 108 19 37 52 75 12 31 32 Fell from bed 15,484 2,042 5,898 7,544 9,594 990 3,357 5,247  Females 9,565 991 3,371 5,203 6,554 539 2,142 3,873 Fell out of chair, wheelchair, furniture 11,431 2,338 4,372 4,721 8,364 1,637 3,126 3,601  Females 7,246 1,292 2,705 3,249 5,555 949 2,005 2,601 Fell getting on/off the toilet or shower 3,812 654 1,412 1,746 2,422 334 852 1,236  Females 2,751 406 985 1,360 1,853 219 631 1,003 Fell on stairs, ramps or escalators 19,518 6,026 8,531 4,961 15,387 4,628 6,704 4,055  Females 13,127 4,063 5,785 3,279 10,163 2,975 4,494 2,694            9  FALL-RELATED SEPARATIONS  FALL-INJURY-RELATED SEPARATIONS  Fall circumstance All 65-74 years 75-84 years 85+ years All 65-74 years 75-84 years 85+ years  (N=331,311) (N=67,853) (N=129,709) (N=133,749) (N=227,753) (N=45,134) (N=86,590) (N=96,029) Fell from ladders, scaffolding, buildings, trees or playground equipment 6,385 3,661 2,021 703 4,804 2,765 1,553 486  Females 1,681 796 661 224 1,182 566 441 175 Fell from cliff or diving / jumping into water 326  200 102  24  195  115  57  23   Females 156  93  52  11  65  40  14  11  Fell on ice and snow 96  71  25  0  31  23  8  0   Females 42  21  21  0  18  14  4  0  Unspecified 95,283 17,294 36,655 41,334 53,553 8,702 19,325 25,526  Females 63,523 10,390 23,744 29,389 37,152 5,222 12,786 19,144   10 Figure S1a. Annual crude rates of fall-related ambulance usage in NSW’s older adults, by sex and decennial age groups, 2006 - 2013.        02000400060008000100001200014000160002006 2007 2008 2009 2010 2011 2012 2013Crude rates of fall-related ambulance use in NSW adults aged 65+ (per 100,000 population)Yearwomen 65-74 years women 75-84 years women over 85 yearsmen 65-74 years men 75-84 years men over 85 years11 Figure S1b. Annual crude rates of fall-related hospitalisations for NSW’s older adults, by sex and decennial age groups, 2006 - 2013.       Figure S1c. Annual crude rates of injurious fall-related hospitalisations for NSW’s older adults, by sex and decennial age groups, 2006 - 2013.   02000400060008000100001200014000160002006 2007 2008 2009 2010 2011 2012 2013Crude rates of fall-related hospitalisations in NSW adults aged 65+ (per 100,000 population)Yearwomen 65-74 years women 75-84 years women over 85 yearsmen 65-74 years men 75-84 years men over 85 years02000400060008000100001200014000160002006 2007 2008 2009 2010 2011 2012 2013Crude rates of fall-realted injury hospitalisations in NSW adults aged 65+ (per 100,000 population)Yearwomen 65-74 years women 75-84 years women over 85 yearsmen 65-74 years men 75-84 years men over 85 years

SUPPLEMENTARY MATERIAL - Trends in fall-related ambulance use and hospitalisation among older adults in NSW from 2006 to 2013: a retrospective, population-based study

https://ses.library.usyd.edu.au/bitstream/2123/16249/4/supplementary%20material_%20updated.pdf

SUPPLEMENTARY MATERIAL - Trends in fall-related ambulance use and hospitalisation among older adults in NSW from 2006 to 2013: a retrospective, population-based study

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