Ask middle-aged women workers to share health information that's relevant to a potential falls risk

Falls responsible for one hospital admission for injury in five

The researchers compared fall and other injuries; ‘falls from height’ and ‘same-level falls’; age and sex; presence of co-existing long-term conditions; time and place of injury; work and injury types; body parts involved; injury severity; and length of hospital stay. Some 45,539 people were admitted to hospital for work-related injuries during the study period, of which 42,176 admissions were included in the final analysis 

The average annual rate of hospital admission for a work-related injury was 2.54 in every 1,000 employees, but men outnumbered women: 3.91 vs 0.98/1,000 employees. About one in five of these admissions (8,669; 21 per cent) were associated with a fall, around half of which (52 per cent) were falls from a height, while 37 per cent were same-level/low falls.

Falls from ladder/scaffolds (21 per cent), stairs/steps (9 per cent), building/structure (8.5 per cent) and different level falls (13.5 per cent) made up those from height. Other specified and unspecified falls represented 1.5 per cent and 10.5 per cent, respectively. Over half of the fall injuries were fractures.

The average annual rate of hospital admission associated with a workplace fall was 0.52 in every 1,000 employees: 0.68 for men and 0.34 for women. Most work-related falls occurred in 25-64-year-olds, with men accounting for more than two thirds (69 per cent) of all such falls. Women aged 45 and older, however, accounted for 1 in 5 (21 per cent) of these falls and more than 5 per cent of other workplace injuries. 

While the rates for height falls were higher in men than in women: 0.44 vs 0.08 per 1,000 workers, especially among those aged 45 and older, same-level falls were higher in women: 0.21 vs 0.18, particularly after the age of 50. 

‘It is possible that this higher rate of high falls among men is explained by the greater rates of men, particularly young men, relative to women, working in sectors in which working at height is relatively common, for example, construction, telecommunications, and mechanical engineering,’ Dr Wah and colleagues suggest.

Same-level fall rates increase with age

Same-level fall rates were relatively low in the youngest age groups, but rose sharply with increasing age, and were highest among the oldest female employees. One faller in five (21 per cent) had at least one co-existing health condition recorded during their hospital stay – 30 per cent of those with fall-related injuries and 19 per cent of those with other work-related injuries. Co-existing health problems were more common among those who had experienced a same-level fall than among those who had fallen from height, particularly circulatory, respiratory, and musculoskeletal conditions.

Falls, especially those from height, were more common among those working in construction, while other work-related injuries were more common among those working in agriculture, forestry, fishing and manufacturing. 

Fall injuries were more likely to be serious, compared with other work-related injuries; this was particularly evident for falls from height. Prolonged admissions were also more common for falls than for other types of injury. Nearly a third of hospital days due to work-related injuries were attributable to falls.

Employers either need to consider a generalised approach to fall reduction among their entire workforce … or perhaps a targeted 'screening' approach in which workers are offered opportunities to share health information relevant to fall risk [Win Wah et al]

Limitations

As the findings relate to just one state in Australia they might not be more widely applicable, and the coding indicating where the fall occurred included a high proportion of ‘unspecified’ entries, the researchers acknowledge.

But Dr Wah and colleagues state: ‘Our findings add to a growing body of evidence suggesting that older working-aged women are at increased risk of same-level falls and fall-related injuries, particularly in the presence of comorbidity (whereas we observed a different risk profile for high falls, which were associated with males and which did not have a pronounced association with the number of comorbidities).’

Recommendations

The authors add: ‘For employers of middle-aged female workers, employers either need to consider a generalised approach to fall reduction among their entire workforce … or perhaps a targeted "screening" approach in which workers are offered opportunities to share health information relevant to fall risk (including history of falls).’

And they conclude: ‘Fall injuries, particularly same-level falls, are likely to increase in workplaces with current demographic changes, and employers, regulators, and policy makers could usefully consider raising the profile of workplace falls and developing effective prevention strategies.’

Fact file

The prevalence and relative severity of workplace falls mean that better preventive strategies are needed to tackle the sex specific risk factors outlined in their article, Dr Wah and colleagues suggest.

In 2016, an estimated 1.53 million deaths and 76.1 million years of lived disability were caused by workplace injuries, note the researchers. Falls accounted for more than a quarter of these figures.

The Australian workforce is ageing: people aged from 50-64 made up 11 per cent of employees in the mid-1990s, rising to 21 per cent in 2023. And ageing in general is associated with a heightened risk of falls, say the researchers.

To read the full version of the article – titled Epidemiology of work-related fall injuries resulting in hospitalisation: individual and work risk factors and severity doi 10.1136/oemed-2023-109079  – click