October 2017; Vol. 27(4):e27341701
https://doi.org/10.17061/phrp27341701
www.phrp.com.au
Research
Trends in fallrelated ambulance use and
hospitalisation among older adults in NSW, 2006–
2013: a retrospective population-based study
Serene S Paula,b,j, Lara Harveyc, Therese Carrolld, Qiang Lie,
Soufiane Boufousf, Annabel Priddisd, Anne Tiedemanna, Lindy Clemsonb,
Stephen R Lordc, Sandy Mueckeg, Jacqueline CT Closec,h, Serigne Loi
and Catherine Sherringtona
e
a
The George Institute for Global Health, Sydney, NSW, Australia
Transport and Road Safety Research, UNSW Sydney, Australia
g
NSW Ambulance, Sydney, Australia
h
Prince of Wales Clinical School, UNSW Sydney, Australia
i
Melanoma Institute Australia, Sydney, NSW
j
Corresponding author: serene.paul@sydney.edu.au
Musculoskeletal Health Sydney, School of Public Health,
Sydney Medical School, University of Sydney, NSW, Australia
b
Faculty of Health Sciences, University of Sydney,
NSW, Australia
c
Neuroscience Research Australia, UNSW Sydney
d
Centre for Population Health, NSW Ministry of Health,
Sydney, Australia
f
Article history
Abstract
Publication date: October 2017
Citation: Paul SS, Harvey L, Carroll T, Li
Q, Boufous S, Priddis A, et al. Trends
in fallrelated ambulance use and
hospitalisation among older adults
in NSW, 2006–2013: a retrospective
populationbased study. Public Health
Res Pract. 2017;27(4):e27341701
https://doi.org/10.17061/phrp27341701
Objective and importance of study: To describe characteristics and temporal
trends of fallrelated ambulance service use and hospital admission in older
adults in New South Wales (NSW), Australia. Such information will facilitate a
more targeted approach to planning and delivery of health services to prevent
falls and their adverse sequelae in different groups of older adults.
Key points
Results: There were 314 041 occasions of fall-related ambulance use
by older adults and 331 311 fall-related hospitalisations, of which 69%
(n = 227 753) were for injurious falls. Fractures accounted for 57% of injurious
hospitalisations. Slips and trips were the most common mechanism of falls
requiring hospitalisation (52%). Residents of aged care facilities had a greater
proportion of fall injury hospitalisations compared with people living in the
community (85% and 65%, respectively).
• Fallrelated ambulance service use has
increased over time
• Fall prevention interventions should
include safety and avoidance strategies
• Fall management strategies should
continue to be targeted at those aged
older than 85 in an effort to reduce their
fallrelated health service use
• There is a need for specific fall
injury prevention strategies in
aged care facilities
Study type: Retrospective populationbased descriptive study.
Methods: Fallrelated ambulance use and hospital admissions for all falls and
injurious falls in NSW residents aged ≥65 years between 2006 and 2013 were
obtained from two discrete sources of routinely collected data. Rates of use
are presented descriptively.
Conclusions: Rates of fallrelated ambulance use and hospitalisation were
similar and continued to increase over time. Increased effort is needed to
prevent falls and associated injury among older people in NSW, particularly
among people living in aged care facilities. Ongoing monitoring of rates and
the characteristics of people who fall are needed to determine the longterm
impact of fall prevention interventions.
1
Public Health Research & Practice October 2017; Vol. 27(4):e27341701 • https://doi.org/10.17061/phrp27341701
Fall-related health service use in older adults in NSW
Introduction
Ambulance records
Each year, one-third of people aged ≥65 years fall,
particularly older females.1 Fall prevention strategies
aim to address this problem, but have yet to affect the
continued increase in fallrelated health service use
among older adults.2
Older people who have had a fall comprise a
substantial proportion of users of paramedic and hospital
services. Falls in older adults constitute 5% of emergency
ambulance responses in Australia3, and 66–76% of
older people who have had a fall require transport to
hospital.3 Of all falls in older adults, 10–15% result in
fracture4,5, a further 15–20% result in other serious injuries
requiring medical attention4,6 and approximately 5%
result in injury warranting hospital admission.6 Despite
the small proportion of falls resulting in hospitalisation,
the costs associated with these admissions account for
more than 80% of the cost of treatment for fall-related
injuries.6 Because the proportion of older adults in the
population is increasing, it is unsurprising that fallrelated
hospitalisations are increasing in New South Wales
(NSW), Australia.7
The studies cited above provide a clear understanding
that falls in older adults remain problematic, and that
people who fall use substantial healthcare resources.8
However, there has not previously been a systematic
investigation about patterns of fallrelated ambulance use
over time, and few studies of fallrelated hospitalisations
have identified the characteristics of individuals with
multiple admissions. Understanding recent patterns of
serious falls that require health service use (such as
multiple admissions to hospital or paramedic attendance)
in older adults at a population level, along with these
individuals’ characteristics, will facilitate a more targeted
approach to planning and delivery of health services
to prevent falls and their adverse sequelae in different
groups of older adults.
For the NSW population aged ≥65 years, this study
aims to: 1) describe fall-related ambulance service use,
and fall-related and fall injury–related hospital admission;
2) explore patterns of service use by age, sex and injury
type; and 3) describe rates of service use over time, by
age groups and sex.
Ambulance use data were obtained from routinely
collected NSW Ambulance Computer Aided Dispatch
(CAD), Patient Health Care Record (PHCR) and electronic
Medical Record (eMR) databases. NSW Ambulance is the
sole provider of emergency outofhospital care in NSW.
CAD data gathered during the emergency call includes
information about the problem and the patient’s location.
PHCR and eMR datasets contain patientrelated clinical
information recorded by attending paramedics. Use of
eMR was introduced in a staged approach from 2011.
Both systems remain in use, because not all paramedics
have access to the eMR system at all times. NSW
Ambulance routinely links CAD and clinical records for
each patient.
Following a patient assessment, not all patients
are transported to an emergency department (ED) by
paramedics. Referral pathways have been established
since 2011 so that, at the time of the patient encounter,
paramedics can recommend subsequent review by
communitybased healthcare providers. Additionally,
since 2008, NSW Ambulance has implemented an
extended care paramedic role, where experienced
paramedics receive additional education to treat patients
with lowacuity conditions at the scene.
In the NSW Ambulance data collections, eligible
records were those where a ‘falls’ problem was recorded
in the CAD database for patients aged ≥65 years,
as documented in their clinical record. The master
incident number was used to deduplicate records so
that a single ambulance dispatch was used in analyses.
Transport disposition was used to exclude ineligible
records (‘operational standby’, ‘PHCR incident cancel
en route’, ‘PHCR not required’, ‘unable to locate patient’,
‘assist/treat/load’), and to identify records transported
(‘transported’) or not transported (all other dispositions
including ‘deceased on examination’) to hospital.
For CAD ‘falls’ records, information about associated
injuries was obtained from the corresponding clinical
record completed by paramedics. NSW Ambulance
paramedics classify and document care using clinical
protocols (trauma, cardiac/cardiovascular, drug/
toxicology, environment/envenomation, medical/
surgical, and specialty care such as obstetrics or mental
health). Patients with ‘limb injuries and fractures’ and
‘limb realignment and difficult extraction’ were grouped
as limb fractures; ‘soft tissue injuries to the face and
neck’, ‘epistaxis’ and ‘wound care’ were grouped as
soft tissue injury; ‘head injury’, ‘spinal injuries’, ‘chest
injuries’, ‘penetrating trauma’, ‘pelvic injuries’ and ‘pre
hospital management of serious trauma or deteriorating
trauma patient’ were grouped as serious injury; with the
remaining injuries grouped as other injuries. Protocols
describing medical conditions were grouped as noninjuries; and protocols without specific clinical diagnoses
were grouped as unspecified. Because an individual may
have requested more than one ambulance over the study
Methods
Two data sources, NSW Ambulance data and the
NSW Admitted Patient Data Collection (APDC), were
used to identify people aged 65 years and older who:
1) requested an ambulance for a fall-related incident; or
2) were admitted to a hospital in NSW between 1 January
2006 and 31 December 2013. Interstate residents were
excluded from both datasets.
Ethics approval for this study was granted by the
NSW Population and Health Services Research Ethics
Committee. This study conforms to STROBE guidelines.
2
Public Health Research & Practice October 2017; Vol. 27(4):e27341701 • https://doi.org/10.17061/phrp27341701
Fall-related health service use in older adults in NSW
were calculated as: 1) directly age standardised to the
estimated resident Australian population at 30 June
200111; and 2) crude rates based on the NSW population
aged ≥65 years, using annual estimates from the ABS for
each year of the study.11 SAS Enterprise Guide v5.1 (SAS
Institute Inc, Cary NC) was used for analysis.
period, ambulance use results are presented as ‘records’
rather than ‘patients’.
Hospitalisations
The APDC records all public and private hospitalisations
that occur in NSW. These episodes of care end with
discharge, transfer to another facility, death, or when the
service category changes (e.g. a change from acute to
subacute care within the same facility), so an individual
may have multiple episodes of care recorded in the
APDC for a single hospital admission. Using probabilistic
matching of individuals’ names, date of birth and address
with ChoiceMaker software, the NSW Centre for Health
Record Linkage internally linked the APDC to itself to
identify all episodes of care that constituted the overall
hospital stay for each patient and to determine the
number of individual patients admitted to hospital.
Data about patient diagnoses were coded using
the International Classification of Diseases and Related
Health Problems, 10th revision, Australian Modification
(ICD-10-AM).9 Fallrelated hospitalisations were
determined using external cause codes W00-W19.
Injurious falls were subsequently identified using primary
diagnosis codes S00-T75 and T79, and described
in categories similar to those described in the NSW
Ambulance data, except that upper limb, lower limb
and hip fractures are singularly described in NSW
Ambulance data as ‘limb fractures’. Records with a place
of occurrence ‘Y92.14’ or source of referral ‘6 – Nursing
Homes’ were used to estimate the number of residents
of aged care facilities who were hospitalised because
of a fall. To avoid overestimating the number of hospital
admissions per fall, we excluded episodes of care
coded as statistical transfers (i.e. changes in the service
category or transfers between different units within the
same hospital); and transfers and/or discharges to a
different hospital, residential aged care facility or ED, or to
ambulatory care.
Results
In NSW from 2006 to 2013, there were 314 041 records
of fallrelated ambulance use by older adults and
331 311 fall-related hospitalisations (supplementary
Table S1 http://hdl.handle.net/2123/16249), of which
69% (227 753 admissions) were for injurious falls. These
admissions comprised 200 016 individuals, and 84% of
these individuals (166 978) were admitted to hospital for
injury associated with the fall (Table S2 http://hdl.handle.
net/2123/16249).
People who used ambulance services and were
admitted to hospital for falls were similar in terms of
age, sex, socioeconomic status and remoteness index
(Table S1 http://hdl.handle.net/2123/16249). Fallrelated
health service use was highest among females and
lowest among adults aged 65–74 years.
Of all falls attended by paramedics, 74% were
transported to hospital (Table S3a http://hdl.handle.
net/2123/16249) and 46% were associated with an injury.
The largest proportion of associated injuries was limb
fractures (30%). Serious trauma accounted for 15% of
injuries. Most people with injury were transported to
hospital (85–94%), particularly for fractures or serious
injury (93–94%). Injuries appeared to be evenly spread
across all ages. The reason for falling was not specified in
35% of ambulance records.
Females of all ages had higher rates of hospitalisation
for injurious falls (Figure S1c http://hdl.handle.
net/2123/16249), particularly for upper and lower
limb fractures, including hip fractures (Table S3b
http://hdl.handle.net/2123/16249). Noninjurious falls
involving medical issues (e.g. nausea, urinary tract
infection or a neurological condition) accounted for
31% of fall-related hospitalisations. Overall, adults
aged 65–74 years had fewer fall-injury admissions, but
more admissions for upper and lower limb fractures
excluding hip fractures. People aged ≥85 years had more
admissions for hip fractures, soft tissue and nonspecified
injuries.
Most adults had a single fallrelated hospitalisation
(69%), 20% were admitted twice and 1% had
frequent (≥10) fall-related hospitalisations (Table S2
http://hdl.handle.net/2123/16249). A greater proportion
of females, across all age groups, had multiple fall
related hospital admissions (Table S4 http://hdl.handle.
net/2123/16249). Fewer adults aged 65–74 years,
and more people aged ≥85 years during their first fall
separation, had multiple fallrelated admissions. At the
first fall separation, there were no obvious differences
Statistical analyses
The characteristics of older people who used ambulance
services or were admitted to hospital because of a fall
(including residents of aged care facilities) and the
circumstances of the fallrelated incident (including
fallrelated injuries) were summarised using descriptive
statistics. Geographical remoteness was estimated
for each location (Statistical Local Area 2011 [SLA2011]) using rounded scores of the 2011 Accessibility/
Remoteness Index of Australia10; low scores indicate
low remoteness. Socioeconomic status was obtained
by mapping the Australian Bureau of Statistics (ABS)
2011 socio-economic indices of relative socio-economic
advantage and disadvantage (cat. no. 2033.0.55) to
SLA-201111; low scores indicate a low proportion of
advantage and a high proportion of disadvantage.
Rates (per 100 000 people) of fall-related ambulance
use and hospitalisations for all falls and injurious falls
3
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Fall-related health service use in older adults in NSW
for ambulance, 4167 for hospitalisation and 2791 for
injurious hospitalisations. These rates increased over
time (Table 1). Crude rates of fallrelated health service
use were greater in females and with increasing age
(Table 1; Figures S1a–c http://hdl.handle.net/2123/16249).
in injuries sustained or residential aged care status
between people with single or multiple admissions. Most
fall admissions by residents of aged care facilities were
in females and in people aged ≥85 years (Table S5
http://hdl.handle.net/2123/16249). Residents of aged
care facilities had more injurious falls admissions (86%
compared with 65% in people living in the community),
particularly fractures (46% versus 38%, respectively).
The cause of the fall was not specified in 29%
of fallrelated hospitalisations overall, and was not
specified by 43% of people aged ≥85 years (Table S6
http://hdl.handle.net/2123/16249). Where the cause of the
fall could be identified, most occurred because of slips
and trips (52%). Falling off ladders and buildings (2% of
falls) occurred mostly in males (67–78%), particularly in
those aged 65–74 years.
Agestandardised rates of fallrelated health
service use in 2013 per 100 000 people were 3814
Discussion
Fallrelated health service use (i.e. ambulance use and
hospitalisations) among older adults in NSW increased
between 2006 and 2013. These rates were higher than
reports from earlier years8 but similar to figures from
recent years.7 Fallrelated health service use was highest
among females and people aged ≥85 years.1,3,7,8 The
latter likely reflects the increasing frailty and accumulation
of fall risk factors with increasing age that contribute to
Table 1. Age-standardised and crude rates (per 100 000 people) of fall-related ambulance use, fall-related and fall
injury–related hospital separations in NSW, by sex and age groups, 2006–2013
Category
NSW Ambulance
dispatches
Fallrelated hospital
admissions
Fall injury–related
hospital admissions
Age-standardised
Year
rate (all)
Crude rate
All
Females
Males
65–74 years
75–84 years
85+ years
2006
3 220
3 359
3 759
2 837
1 260
4 114
10 114
2007
3 452
3 627
4 091
3 041
1 336
4 397
10 961
2008
3 610
3 804
4 265
3 228
1 423
4 581
11 394
2009
3 740
3 946
4 417
3 366
1 458
4 674
12 120
2010
3 768
3 987
4 507
3 357
1 422
4 706
12 444
2011
3 964
4 198
4 717
3 574
1 533
4 841
13 264
2012
3 895
4 102
4 647
3 457
1 483
4 806
12 994
2013
3 814
4 009
4 556
3 370
1 461
4 667
12 803
2006
3 498
3 654
4 496
2 612
1 358
4 341
11 454
2007
3 553
3 739
4 572
2 716
1 396
4 363
11 702
2008
3 567
3 760
4 648
2 677
1 435
4 453
11 345
2009
3 799
4 010
4 870
2 973
1 507
4 677
12 399
2010
4 044
4 273
5 160
3 214
1 635
4 958
13 111
2011
4 260
4 499
5 499
3 316
1 766
5 175
13 752
2012
4 180
4 396
5 305
3 329
1 708
5 072
13 633
2013
4 167
4 371
5 149
3 466
1 744
5 015
13 515
2006
2 544
2 660
3 360
1 794
982
3 062
8 660
2007
2 542
2 681
3 374
1 830
981
3 031
8 751
2008
2 561
2 709
3 455
1 800
1 005
3 081
8 638
2009
2 608
2 761
3 506
1 863
1 035
3 102
8 860
2010
2 723
2 888
3 634
1 997
1 070
3 268
9 214
2011
2 776
2 948
3 691
2 070
1 094
3 282
9 533
2012
2 782
2 939
3 692
2 057
1 098
3 292
9 532
2013
2 791
2 941
3 634
2 135
1 115
3 302
9 498
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Fall-related health service use in older adults in NSW
during their first admission. This may be because of
the higher fall risk for some groups, such as those with
neurological conditions.22 Future research is warranted to
determine which older people who have had a fall have a
high likelihood of readmission, the conditions associated
with multiple admissions and the average time between
readmissions. Demonstrated age and sex differences in
the types of injuries and circumstances of falls suggest
that it may be beneficial to classify people who have
had a fall according to specific risk profiles. This may
assist in the targeted delivery of content-specific fall
prevention and health promotion interventions5,23, and limit
future hospitalisations.
This study has several limitations and strengths. The
methodology did not permit patients’ entire healthcare
journeys to be examined because APDC data were not
linked to NSW Ambulance records or ED data. Linkage
would be beneficial in understanding the proportion of
falls admissions that arrived by ambulance; the proportion
of people who were not initially transported to an ED
by ambulance but were subsequently admitted, or who
arrived by any mode of transport but were discharged
from the ED; and the characteristics of older people who
have had a fall who use ambulance and ED services
multiple times a year. Linkage with death records
would also provide more comprehensive information.
Nevertheless, it is likely that both datasets represented a
similar population of older adults in NSW.
Coding differences between NSW Ambulance and
the APDC made it difficult to compare the patterns of
injury sustained by older people who had a fall. A small
underestimation of fallrelated health service use in
NSW may have occurred because older adults living
near state borders may have been attended by other
ambulance services or been hospitalised interstate;
there was a lack of ED data; and only 72% of actual
falls records are captured by the CAD system.13,14 Using
the CAD database to identify a population of interest is
problematic because information collected at the time of
the emergency call may not accurately reflect the true
nature of the patient’s problems. The caller may be a third
party and, at times of anxiety, information provided to call
takers may be imprecise. Routinely collected information
is not primarily collected for research purposes, as noted
in missing data across various outcomes and lack of
detail in coding of some variables (e.g. a large proportion
of unspecified fall circumstances in hospitalised patients).
Greater variability in APDC coding of external cause
codes to identify falls compared with greater accuracy
of coding of primary diagnosis codes to identify injury24
may have magnified the differences in rates between
admissions for all falls compared with injurious falls.
Key strengths of this paper are the reported patterns
of fall-related ambulance use over time and identification
of individual patients within the APDC dataset, which
enable quantification of older people who have had a fall
and who had multiple hospital admissions. Our results
suggest that public health policy needs to target separate
increased fall incidence12, and highlights the importance
of targeting fall prevention interventions in this group.
Rates of fallrelated ambulance use were slightly lower
than fallrelated hospital admissions. The sexrelated
difference in rates of fallrelated ambulance use was
also smaller than for hospital admissions, and lower than
previous reports of ambulance use by older females who
had a fall.3 Most (74%) fall events in older adults attended
by paramedics resulted in the person being transported
to hospital13,14, although transportation rates were higher
in instances where a fall led to an injury (85–94%). It
may be that some people who sustained minor or no
fallrelated injury required ‘lift only’ assistance15 or were
managed in the community.16 As paramedicinitiated
communitybased referral pathways expand in NSW, it is
anticipated that transportation rates to EDs will decline,
particularly for noninjurious falls. It was not possible to
accurately ascertain the reasons for nontransportation to
an ED in our data. Some of those initially not transported
to hospital may have refused transport at that time.16
Those not initially transported may have later presented to
an ED by alternative modes of transport (such as private
car) or requested a subsequent paramedic attendance.16
Not all patients with fractures or serious injury were
transported to hospital (6–7%, including those who died
at the scene of the fall).
For most fall circumstances, females and the older
age groups accounted for the largest proportions within
each category (e.g. falls due to trips and slips, or falls in
the toilet/shower). The notable difference was in injuries
from falling off ladders or scaffolding, or from diving,
which were more prevalent in males aged 65–74 years.17
It appears that men continue to take risks as they age:
‘younger old’ males account for the majority of trauma
and hospital admissions following falls from ladders.17 Fall
prevention and health promotion interventions need to
account for increased risk taking by older men to promote
both safe use and avoidance messages.
Twothirds of fallrelated hospitalisations were for
fallrelated injuries3,7, although less than 50% of falls
in the ambulance data were recorded as injurious.
Injuries documented in ambulance clinical records
are provisional, paramedicdetermined diagnoses.
The exact nature of injuries and determination of injury
severity require confirmation by radiologic imaging or
other assessments in hospital. Residents of aged care
facilities also had a high proportion of injurious fall
hospitalisations, although, unlike other studies, we did
not find that males in residential aged care facilities had
a higher incidence of falls and fall injuries.18,19 However,
we were unable to accurately determine the number of
aged care facility residents in our dataset because ED
and Australian Government residential aged care data
were not included.20 Females had higher instances of
fracture than males8, particularly upper limb fractures
(81% and 74%, respectively, for all fractures).21 People
with multiple hospital separations had a higher proportion
of noninjurious falls, although this was not apparent
5
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Fall-related health service use in older adults in NSW
for the study design, and drafting, reviewing and editing
the manuscript.
fall prevention messages and programs for males and
females. The finding that most falls in older adults occur
because of slips and trips supports the importance
of communitybased health services delivering fall
prevention programs. Delivering appropriate fall
prevention programs to special populations (such as
people with neurological conditions) may help reduce
hospital readmissions for falls.22 There is also a need for
programs and strategies to prevent fall injury, particularly
for residents of aged care facilities.
References
1. Lord SR, Sherrington C, Menz HB, Close JCT. Falls in
older people. 2nd ed. New York: Cambridge University
Press; 2007.
2. NSW Ministry of Health. Snapshot November
2014: preventing falls and harm from falls. Sydney:
NSW Ministry of Health; 2014 [cited 2017 Aug 30].
Available from: fallsnetwork.neura.edu.au/wp-content/
uploads/2014/12/NSWH6992_Snapshot_FallsPrevention_
final.pdf
Conclusion
Rates of fallrelated health service use continued to
increase, despite the various health promotion and
fall prevention strategies that were implemented in
NSW during the study period.2,25 Increased efforts and
innovative strategies to prevent falls and associated injury
among older people in NSW are needed, particularly
safety and avoidance strategies targeted at males. Future
linkage studies may provide a better understanding of the
characteristics and overall healthcare usage of people
who fall, and can assist in evaluating the effectiveness of
fall prevention interventions.
3. Simpson PM, Bendall JC, Patterson J, Tiedemann A,
Middleton PM, Close JC. Epidemiology of ambulance
responses to older people who have fallen in New South
Wales, Australia. Australas J Ageing. 2013;32(3):171–6.
4. Berry SD, Miller R. Falls: epidemiology, pathophysiology,
and relationship to fracture. Curr Osteoporos Rep.
2008;6(4):149–54.
5. Kelsey JL, Procter-Gray E, Hannan MT, Li W.
Heterogeneity of falls among older adults: implications
for public health prevention. Am J Public Health.
2012;102(11):2149–56.
Acknowledgements
6. Watson WL, Clapperton AJ, Mitchell RJ. The cost of fallrelated injuries among older people in NSW, 2006–07.
NSW Public Health Bull. 2011;22(3–4):55–9.
This work is supported by the National Health and
Medical Research Council (NHMRC) Partnerships for
Better Health grant (ID: 1016876). The authors thank
NSW Health for its inkind support and contribution to
the NHMRC Partnership Projects grant Widespread
implementation of interventions to prevent falls in older
people. Salary funding for SRL, LH, AT, LC and CS is
provided by NHMRC fellowships.
7. Harvey LA, Close JCT. Trends in fall-related
hospitalisations, persons aged 65 years and older, NSW,
1998–99 to 2011–12. Sydney: Neuroscience Research
Australia; 2013 [cited 2017 Aug 10]. Available from:
fallsnetwork.neura.edu.au/wp-content/uploads/2011/03/
Trends-in-fall-related-hospitalisations-in-NSW-1998-99to-2011-12.pdf
8. Dowling AM, Finch CF. Baseline indicators for measuring
progress in preventing falls injury in older people.
Aust N Z J Public Health. 2009;33(5):413–7.
Competing interests
None declared
9. National Centre for Classification in Health. International
statistical classification of diseases and related health
problems, 10th revision, Australian modification. Sydney:
University of Sydney; 2013.
Author contributions
SP was responsible for the study design, analysis of
data, and drafting and editing of the manuscript. LH was
responsible for drafting and editing, and contributing
to data analysis. TC was responsible for acquiring the
data, and reviewing and editing. QL was responsible
for overseeing the data analysis, and reviewing and
editing. SB was responsible for reviewing and editing,
and contributing to the study design and data analysis.
AP was responsible for acquiring the data, reviewing
and editing, and contributing to the study design. AT,
LC, SRL and JC were responsible for the study design,
and reviewing and editing. SM was responsible for
acquiring the data, and reviewing and editing. SL was
responsible for the study design, reviewing and editing,
and contributing to data analysis. CS was responsible
10. University of Adelaide. Adelaide: Hugo Centre for
Migration and Population Research; 2016. ARIA+ 2011;
[cited 2015 Aug 30]. Available from: www.spatialonline.
com.au/ARIA_2011/default.aspx
11. Australian Bureau of Statistics. Canberra: ABS, 2017.
Statistics; 2015 [cited 2015 Feb 20]. Available from:
www.abs.gov.au/AUSSTATS
12. Vu T, Finch CF, Day L. Patterns of comorbidity in
communitydwelling older people hospitalised for
fall-related injury: a cluster analysis. BMC Geriatr.
2011;11:45.
6
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Fall-related health service use in older adults in NSW
13. Simpson P, Bendall J, Patterson J, Tiedemann A,
Middleton P, Close J. The ‘CATCH’ study: a preliminary
analysis describing the epidemiology of 500
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