Circumstances and consequences of falls in independent community-dwelling older adults

Age and Ageing,  July, 1997  by William P. Berg,  Helaine M. Alessio,  Eugenia M. Mills,  Chen Tong

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Abstract

Background: knowledge of the circumstances and consequences of falls in older adults is important for understanding the aetiology of falls as well as for effective clinical assessment and design of fall prevention strategies. Such data, however, are relatively scarce, especially in community-dwelling ciders. Method: accidental falls (including their circumstances and consequences) occurring in 96 male and female participants between 60 and 88 years of age were monitored prospectively for 1 year. After the monitoring period, participants were divided into three groups based on fall status: non-fallers (n = 46), one-time fallers (n = 27) and recurrent fallers (n = 23). Frequency distributions were created for selected circumstances and consequences of falls and the prevalence of these consequences were examined. Results: 50 participants (52%) fell during the 1 year period, amassing 91 falls. Trips and slips were the most prevalent causes of falls, accounting for 59% of falls. Falls most often occurred during the afternoon and while subjects walked on level or uneven surfaces. Fallers most commonly attributed falls to hurrying too much. Fractures resulted from five of the 91 falls and eight other falls resulted in soft tissue injuries that required treatment by a physician. There were no differences between one-time and recurrent fallers in the circumstances and consequences of falls. However, several notable differences were found between men (n = 20) and women (n = 30) who fell. Falls by men most often resulted from slips whereas falls by women most often resulted from trips. Moreover, women and men differed in the time of the year in which falls occurred, with men falling most often during winter and women during summer. Conclusions: the results of this study provide insight into the circumstances and consequences of falls among independent community-dwelling older adults and suggest some possible ways of preventing falls. Preventive services, however, should not solely target recurrent fallers, nor should the type of services necessarily differ for one-time and recurrent fallers.

Introduction

Falls are a threat to the health and well-being of older adults. Unintentional injury, which most often results from falls, is the sixth leading cause of death in people age 65 and older[1]. Other consequences of falls include non-fatal injury[2-31, fear[4] and loss of function and independence[5]. Although the identification of underlying risk factors for falls has received considerable attention, relatively little research has addressed what fallers are actually doing at the time of a fall, especially among older adults living independently in the community. This information is crucial for understanding the aetiology of falls as well as for effective clinical assessment and design of preventive strategies.

Data about how the circumstances of falls differ for recurrent fallers (people who fall two or more times in a given year) and one-time fallers (people who fall once in a given year) are particularly scarce. This is important because it has been recommended that recurrent fallers be targeted for diagnostic and preventive efforts[6-7]. Although some reports have suggested that recurrent fallers are more likely to suffer fall-related injuries than one-time fallers[7] and that recurrent fallers may be more likely to have underlying neurological and musculo-skeletal problems which predispose them to falling[31, the evidence upon which the prevailing distinction between one-time fallers and recurrent fallers is based is lacking. Exclusive targeting of recurrent fallers for diagnostic and preventive efforts could be problematic if it results in the inappropriate exclusion of individuals who fall less frequently.

The purpose of this study was to investigate the circumstances and consequences of falls in community-dwelling older adults and to compare recurrent and one-time fallers as well as men and women.

Materials and methods

Ninety-six male and female volunteers between the ages of 60 and 88 years participated in this study. Participants were residents of Oxford, OH, USA (population 9000) and the surrounding area and were recruited by posting announcements at various locations in the community, advertising in local newspapers and contacting former faculty and staff of Miami University by letter. To qualify for participation, volunteers had to be at least 60 years of age, live independently in the community and be able to walk unaided. The mean age of participants was 71.9 years (SD = 6.6). All participants who began the study completed the study. Characteristics of the participants are resented in Tables 1 and 2.

Table 1. Participant characteristics: age, height and weight

                 Mean value ([+ or -] SD)

                      Women (n = 58)          Men (n = 38)

Age (years)[sup.a]   71.5 [+ or -] 6.9     72.5 [+ or -] 6.1
Height (cm)         162.0 [+ or -] 6.8    175.6 [+ or -] 6.2
Weight (kg)          65.7 [+ or -] 12.0    80.5 [+ or -] 12.8