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Impact of the COVID-19 pandemic on hospital episodes for falls and fractures associated with new-onset disability and frailty in England: a national cohort study

Thomas, Seth; Littleboy, Kathryn; Foubert, Josephine; Nafilyan, Vahe; Bannister, Neil; Routen, Ash; Morriss, Richard; Khunti, Kamlesh; Armstrong, Natalie; Gray, Laura J; Gordon, Adam L

Impact of the COVID-19 pandemic on hospital episodes for falls and fractures associated with new-onset disability and frailty in England: a national cohort study Thumbnail


Seth Thomas

Kathryn Littleboy

Josephine Foubert

Vahe Nafilyan

Neil Bannister

Ash Routen

Professor of Psychiatry and Community Mental Health

Kamlesh Khunti

Natalie Armstrong

Laura J Gray

Professor of The Care of Older People


Background: Older people with frailty are at risk of harm from immobility or isolation, yet data about how COVID-19 lockdowns affected them are limited. Falls and fractures are easily measurable adverse outcomes correlated with frailty. We investigated whether English hospital admission rates for falls and fractures varied from the expected trajectory during the COVID-19 pandemic, and how these varied by frailty status. Methods: NHS England Hospital Episode Statistics Admitted Patient Care data were analysed for observed versus predicted outcome rates for 24 January 2020 to 31 December 2021. An auto-regressive integrated moving average time-series model was trained using falls and fracture incidence data from 2013 to 2018 and validated using data from 2019. Models included national and age-, sex- and region-stratified forecasts. Outcome measures were hospital admissions for falls, fractures, and falls and fractures combined. Frailty was defined using the Hospital Frailty Risk Score. Results: 144,148,915 pre-pandemic hospital admissions were compared with 42,267,318 admissions after pandemic onset. For the whole population, falls and fracture rates were below predicted for the first period of national lockdown, followed by a rapid return to rates close to predicted. Thereafter, rates followed expected trends. For people living with frailty, however, falls and fractures increased above expected rates during periods of national lockdown and remained elevated throughout the study period. Effects of frailty were independent of age. Conclusions: People living with frailty experienced increased fall and fracture rates above expected during and following periods of national lockdown. These remained persistently elevated throughout the study period.

Journal Article Type Article
Acceptance Date Feb 26, 2024
Online Publication Date Apr 6, 2024
Publication Date 2024-04
Deposit Date Feb 28, 2024
Publicly Available Date Apr 7, 2025
Journal Age and Ageing
Print ISSN 0002-0729
Electronic ISSN 1468-2834
Publisher Oxford University Press
Peer Reviewed Peer Reviewed
Volume 53
Issue 4
Article Number afae071
Keywords Fractures, Bone - diagnosis - epidemiology, Pandemics, fractures, frailty, Frail Elderly, Communicable Disease Control, COVID-19, older people, Aged, Humans, Frailty - diagnosis - epidemiology, COVID-19 - epidemiology, falls, Hospitals, Cohort Studies
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