Objective: To estimate the burden of hospitalised fall-related injury in community-dwelling older people in Victoria. Methods: We analysed fall-related, person-identifying hospital discharge data and patient-level hospital treatment costs for community-dwelling older people aged 65+ years from Victoria between 1 July 2005 and 30 June 2008, inclusive. Key outcomes of interest were length of stay (LOS)/episode, cumulative LOS (CLOS)/patient and inpatient costs. Results: The burden of hospitalised fall-related injury in community-dwelling older people aged 65+ years in Victoria was 284,781 hospital bed days in 2005-06, rising to 310,031 hospital bed days in 2007-08. Seventy-one per cent of episodes were multiday. One in 15 acute care episodes was a high LOS outlier and 14% of patients had â‰¥1 episode classified as high LOS outlier. The median CLOS/patient was nine days (interquartile range 2-27). The annual costs of inpatient care, in June 2009 prices, for fall-related injury in community-dwelling people aged 65+ years in Victoria rose from $213 million in 2005-06 to $237 million in 2007-08. The burden of hospitalised fall-related injury in community-dwelling older women, people aged 85+ years and those with comorbidity was considerable. Conclusions: The burden of hospitalised fall-related injury in community-dwelling older people aged 65+ years in Victoria is significantly more than previously projected. Importantly, this study identifies that women, patients with comorbidity and those aged 85+ years account for a considerable proportion of this burden. Implications: A corresponding increase in falls prevention effort is required to ensure that the burden is properly addressed.
Objective: To model the population level impact of tai-chi on future rates of falls and fall-related injury in older people as a tool for policy development. Design: An epidemiological and economic model for estimating population-level effectiveness of tai-chi. Setting: Australia, 2009. Patients or subjects: Australian community-dwelling population aged 70+ years, ambulatory and without debilitating conditions or profound visual defects. Intervention: Group-based tai-chi, for 1 h twice weekly for 26 weeks, assuming no sustained effect beyond the intervention period. Main outcome measure: Total falls and fall-related hospitalisation prevented in 2009. Results: Population-wide tai-chi delivery would prevent an estimated 5440 falls and 109 fall-related hospitalisations, resulting in a 0.18% reduction in the fall related hospital admission rate for community-dwelling older people. The gross costs per fall and per fall-related hospital admission prevented were $ A4414 ((sic)3013) and $A220 712 ((sic)150 684), respectively. A total investment of $A24.01 million ((sic)16.39 million), equivalent to 4.2% of the cost of fall-related episodes of hospital care in 2003/4, would be required to provide tai-chi for 31 998 people and achieve this effect. Conclusions: Substantial investment in, and high population uptake of, tai-chi would be required to have a large effect on falls and fall-related hospitalisation rates. Although not accounted for in this study, investment in tai-chi is likely to be associated with additional significant health benefits beyond falls prevention. This approach could be applied to other interventions to assist selection of the most cost effective falls-prevention portfolio for Australia and other countries.