Tunstall’s Adrian Scaife analyses fires and falls fatalities and asks what we can learn.


(Source: ONS Deaths Registered in England and Wales. Underlying causes of death due to External Causes, Table 5.19, 2003-2012.)

The two graphs above show the trends in numbers of people dying due to fires and falls in England and Wales. The differences are striking both in terms of the numbers of people affected and the direction of the trends.

I believe the Fire Service success is down to using two strategies. Firstly, they are focused on reducing the probability of a fire occurring, typically this involves home assessment visits and reducing risk. Secondly, the now almost universal use of smoke detectors ensures that the consequences of any fire is minimised.

In contrast Falls Services appear to be almost completely reliant on a single strategy of probability reduction. The National Audit of Falls and Bone Health1 published by the Royal College of Physicians (RCP) in 2011 found:

  • In the organisational audit 94% of providers of falls service reported they have mechanisms for providing alarms, call systems or other assistive technology. However, in the clinical audit only 21% of hip fracture patients and 8% of non-hip fragility fracture patients were referred for any form of telecare, excluding patients where this was not appropriate or who had refused.
  • Only 32% of non-hip fracture patients (upper arm, wrist or pelvis) but 67% of hip fracture patients had an assessment to find out whether they were at risk of more falls and fractures.

The RCP report recommendations included:

We recommend that local services consider introducing a scheme for all fallers to be offered a free care alarm for a trial period on discharge from hospital. This scheme is already available in some localities.

People often say to me ‘but alarms, fall detectors and other telecare solutions don’t stop people falling’. To which I politely point out that smoke detectors don’t stop fires!

So what can these falls solutions really offer? In broad terms they minimise the consequences of falling.

A no physical injury fall with a long lie on the floor may give rise to the complications of dehydration, pressure sores and perhaps hypothermia and at least require an ambulance callout and a trip to A&E and at worst a hospital admission. Anecdotally, every hour lying on the floor after a fall results in an additional day in hospital.

With a telecare alarm call generated the same fall but now with a very short lie may only require assessment and assistance to rise.

From the individual’s perspective telecare can boost confidence, it can support avoiding a ‘spiral of decline’ that  reduces quality of life and enables people to remain living at home independently for as long as possible.

So will telecare be suitable for everyone at risk of falling? Certainly not, but it could help many of the 2,500,000 people aged 65 and over who likely to fall in the next 12 months2.

For more information, please see our Falls Management Guide


1. Falling standards, broken promises. Report of the national audit of falls and bone health in older people 2010, Royal College of Physicians.

2. People aged 65 and over in England predicted have a fall in 2014. Projecting Older People Population Information System.

@AdrianScaife Adrian Scaife, Health and Social Care Programme Manager, Tunstall Healthcare.