What Is A Long Lie Fall? Causes, Impact, and Prevention

What is a long lie?

A ‘long lie’ is a term for when a person has fallen and spends a long time on the floor, waiting for assistance. It is generally agreed that if a person waits on the floor for more than 1 hour after falling, their fall is classed as a ‘long lie’.

What causes a long lie after a fall?

A number of factors can contribute to long lies occurring in the elderly, with a major cause currently being the pressure on the ambulance service and the subsequent long response times.

In the UK, people who have fallen, but not sustained any injuries, are usually triaged by the ambulance service as “category four” patients. This is the lowest priority category for ambulance services in the UK; therefore, patients who have fallen will typically wait hours for help to arrive.

The rise in pressure on the NHS and ambulance services since COVID has only worsened the response times to low-priority calls; in July 2022, the average response time to a Category 4 call was just over 4 hours¹.

Another scenario that would often result in a long lie occurring, is when elderly people fall when they are at home on their own, with no access to a phone line or telecare device to call for help, resulting in them spending a long time on the floor waiting for assistance. 

What is the impact of long lies?

Even if a fallen person hasn’t sustained any injury as a direct result of falling, they could develop an injury whilst lying on the floor for a long time.

Some of the serious complications associated with long lies include:

• Pressure sores
• Dehydration
• Hypothermia
• Pneumonia
• Acute kidney failure

According to paramedic, James Gough, who previously hosted a webinar for Felgains on the topic of falls, patients who suffer long lies “will start to come to harm”, and there is “massive amounts of research that show the longer someone stays on the floor, the worse their outcomes are going to be.”

A study following older people living in Cambridge found that lying on the floor for a prolonged period after a fall was associated with repeated falls, fall-induced injuries, and subsequent admissions to hospital and long-term care².

In fact, a fifth of elderly people who are admitted to hospital after they have had a non-injury fall will have been left on the floor for more than an hour. And of those, half will die within six months from related complications (Velas et al, 1997).

How do long lies affect the NHS?

From an NHS perspective, long lies can have a huge impact on system-wide pressure and can affect multiple partners. 

As mentioned above, patients that experience a long lie are much more likely to require admission to hospital and specialised treatment, resulting in an increase in bed day and bed occupancy numbers in hospitals, both of which result in increased pressure in hospitals, as well as the financial impact. 

For ambulance services, increased pressures in hospitals result in slower handover times at emergency departments, further impacting their ability to rapidly respond to high-priority calls. 

How can long lies be prevented?

To prevent a long lie from occurring after someone has fallen, a rapid and effective response is required.

For elderly people living at home, this may mean having lifting equipment in place to enable them to lift the faller off the floor themselves, rather than waiting for an ambulance. Or it could be investing in telecare devices such as pendants that are worn around the wrist or neck, to alert a telecare company when a fall has occurred, enabling a faster response than a typical ambulance response.

From a regional NHS perspective, long lies and their effects can be reduced by enabling and equipping more people to respond to falls; be that care homes, CFRs, rapid response teams, domiciliary care organisations, or even GPs.

Clicking the links below will take you to some examples of where NHS organisations have successfully upskilled these groups to respond to falls:

• Care Homes
• Urgent Community Response teams
• Community First Responders (CFRs)
• Domiciliary Care organisations 

For other ways NHS organisations can reduce the impact of falls and long lies in the community, take a look at our article which outlines 3 different solutions to the current crisis. 

Citations

[1] https://www.nuffieldtrust.org.uk/embed?contenttype=charts&id=1964

[2] Fleming, J. and Brayne, C., 2008. Inability to get up after falling, subsequent time on floor, and summoning help: prospective cohort study in people over 90. BMJ, 337(nov17 1), pp.a2227-a2227.

Related articles

How Much Do Falls Cost The NHS?

How To Use HelpFall To Assess A Fallen Person For Injury

What Are The Consequences Of Falls In The Elderly?

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