Fall-related sub-acute and non-acute care and hospitalised rehabilitation episodes of care: what is the injury burden?
Authors: Mitchell Rebecca J. , Close Jacqui , Cameron Ian D. , Lord Stephen 
Published: May 2013

Background
Falls are the leading cause of injury in older people. Rehabilitation services can assist individuals to improve mobility and function after sustaining a fall-related injury. However, the true effect of fall-related injury resulting in hospitalisation is often underestimated because of failure to consider sub-acute and non-acute care provided following the acute hospitalisation episode.

Aim
This study aims to describe the sub-acute and non-acute health service use of individuals hospitalised in New South Wales (NSW), Australia for a fall-related injury during 2000–01 to 2008–09, to examine the burden of fall-related inpatient rehabilitation hospital admissions from 1998–99 to 2010–11 and to estimate future demand for fall-related inpatient rehabilitation admissions in NSW to 2020.

Method
Retrospective review of sub-acute and non-acute records linked to hospital admission records during 2001–02 to 2008–09 in NSW. Analysis of temporal trends from 1998–99 to 2010–11 and projections to 2020 for rehabilitation-related (ICD-10-AM: Z47, Z48, Z50, Z75.1) inpatient hospital admissions.

Results
There were 4317 individuals with a fall-related injury admitted to hospital and subsequently admitted for sub-acute and non-acute care; 84% of these were aged 65+ years; 70.4% were female and 27.2% had femur fractures. For the rehabilitation-related admissions, total mean functional independence measure (FIM) scores improved significantly (from 78.4 to 94.6; P < 0.0001) between admission and discharge. Fall-related inpatient rehabilitation episodes increased by 9.1% each year between 1998 and 2011 for individuals aged 65 years and older and are projected to rise to 50 000 admissions annually by 2020.

Conclusion
This is the first study to provide an epidemiological profile of individuals using sub-acute and non-acute care in NSW using linked data. Improvements in data validity and reliability would enhance the quality of the sub-acute and non-acute care data and its ability to be used to inform resource use in this sector. The examination of temporal trends using only the inpatient hospital admissions provides a guide for resource implications for inpatient rehabilitation services.

What is known about this topic?
Fall-related injuries that result in inpatient hospital admissions are increasing in Australia. However, the extent of the effect of fall-related injuries in the sub-acute and non-acute sector remains unknown, due to data limitations.

What does this paper add?
Provides the first epidemiological profile of individuals who fall and go on to use sub-acute and non-acute care in NSW using linked data. It highlights where improvements in data quality in the sub-acute and non-acute care data could be made to improve their usefulness to inform resource use in this sector.

What are the implications for clinicians?
Fall injury prevention and healthy ageing strategies for older individuals remain a priority for clinicians. The current and projected future resource implications for inpatient rehabilitation and follow-up services provide an indication for clinicians of future demand in this area as the population ages. However, data quality needs to improve to provide clinicians with strongly relevant guidance to inform clinical practice.