A longitudinal study of falls in an elderly population: I. Incidence and morbidity. An epidemiological study of falls in older community-dwelling women: the Randwick falls and fractures study. Falls in the healthy elderly: predisposing causes. Risk factors for falls in a community-based prospective study of people 70 years and older. Incidence and consequences of falls among elderly people living in the community. Circumstances and consequences of falls in community-dwelling older women. Does mortality of the aged increase with the number of falls? Results from a nine-year follow-up study Risk factors for falls among elderly persons living in the community. Community-dwelling older people with an injurious fall are likely to sustain new injurious falls within 5 years - a prospective long-term follow-up study Circumstances and consequences of falls in independent community-dwelling older adults. Factors associated with falling in elderly hospital patients. A two-year longitudinal study of falls in 482 community-dwelling elderly adults. Risk factors for injurious falls: a prospective study. Circumstances of falls and falls-related injuries in a cohort of older patients following hospital discharge Falls in patients with vestibular deficits. Falls as a complication of diabetes mellitus in older people. Falls and fall-related injuries in older dialysis patients.
Falls among the elderly , although associated with substantial morbidity and mortality , have not been previously the subject of a longitudinal study . This five-year prospect i ve study of an active ambulatory institutionalized population over 65 years of age , revealed an annual fall rate of 668 incidents per 1000 , with a rising frequency in successive age groups after age 75 . Forty-five per cent of all subjects suffered at least one fall during the study period . Women had a higher fall rate in all age groups and the severity of their injuries appeared to increase with age . Injuries severe enough to be brought ordinarily to the immediate attention of a physician occurred in 17.5 % of falls . Among subjects who ultimately died after suffering many falls , there appeared in some to be a ' clustering ' of falls prior to death Seven hundred and four women aged between 65 and 99 years ( mean age 74.6 years ) , who were r and omly selected from the community , took part in a study to determine whether health and lifestyle factors were associated with falls . In the 12 months before the survey , 66.1 per cent of the subjects experienced no falls , 19.7 per cent fell once and 14.2 per cent fell on two or more occasions . The proportion of women who fell outside the home decreased with age , with a corresponding increase in the proportion who fell inside the home on a level surface . The most common causes of falls reported were trips , slips and loss of balance . Some ( 27 per cent ) suffered injuries as a result of a fall , and the proportion suffering injuries increased with age . Those who rated their health and balance as impaired , those with a limitation in activities of daily living , those receiving community services , those taking psychoactive drugs , and those taking four or more drugs had significantly more falls . On the other h and , those taking part in planned exercise and those active for seven or more hours per week had fewer falls . Smoking and alcohol consumption were not significantly associated with falls . Stepwise logistic regression analysis revealed poor vision , inactivity and subjective fall risk as variables that were independently and significantly associated with falling . These findings highlight possible intervention strategies for reducing falls risk in older people One hundred healthy men and women aged 65 - 85 took part in a prospect i ve study . They were clinical ly examined and underwent laboratory tests of gait , balance and reaction time at the start of an observation year . All falls occurring in that year were analysed in detail . Three-quarters of them were trips or slips ; however , ten personal factors were identified which , if present , increased the likelihood of a fall occurring . These were : disturbance of gait following a rest period accompanied by a lighting change ( in persons aged 70 and over ) ; an absent or abnormal plantar reflex ; failure to wear prescribed spectacles ; the presence of anxiety/depression , of a foot problem , or of two or more self-perceived limitations on mobility ; a history of former wearing of high heels ; a sustained drop in pulse pressure 5 min after cessation of a rest period ; restricted neck movements ; and the presence of an inverse Romberg ratio . The number of circumstantial and personal factors contributing to the falls varied between thr We investigated factors associated with falls in a community-based prospect i ve study of 761 subjects 70 years and older . The group experienced 507 falls during the year of monitoring . On entry to the study a number of variables had been assessed in each subject . Variables associated with an increased risk of falling differed in men and women . In men , decreased levels of physical activity , stroke , arthritis of the knees , impairment of gait , and increased body sway were associated with an increased risk of falls . In women , the total number of drugs , psychotropic drugs and drugs liable to cause postural hypotension , st and ing systolic blood pressure of less than 110 mmHg , and evidence of muscle weakness were also associated with an increased risk of falling . Most falls in elderly people are associated with multiple risk factors , many of which are potentially remediable . The possible implication s of this in diagnosis and prevention are discussed BACKGROUND AND OBJECTIVES To evaluate the incidence of falls according to socio-demographic and health factors , and to determine their physical , psychological and social consequences . SUBJETS AND METHOD : Population -based prospect i ve study , which included a representative cohort of 448 elderly community-dwellers , aged 65 or more living in the city of Mataró ( Spain ) . We made a baseline evaluation , which was repeated after a one-year follow up , consisting of a st and ardized question naire on socio-demographic characteristics , physical activity , tests of physical and cognitive function , history of falls during the previous year , the Falls Efficacy Scale , and associated chronic conditions .  Follow-up interviews at intervals of one month over 12 months , consisting of a st and ardized question naire aim ed at detecting and describing any fall occurred during the previous month . RESULTS 25.1 % ( 95 % CI , 18.8 - 31.4 ) of males and 37.0 % ( 95 % CI , 31.2 - 42.8 ) of females fell . Multiple falls were observed in 3.8 % of men and 10.9 % of women . 203  falls  were reported , providing a crude incidence rate of 30.9 falls per 100 men-years ( 95 % CI , 23.3 - 41.0 ) and 56.5 falls per 100 women-years ( 95 % CI , 46.5 - 68.8 ) . A positive association with falls was found with age , reduced physical and cognitive function , associated chronic conditions and previous falls . 71.1 % of falls had physical consequences , with 7.7 % of fractures , and 21.7 % needed medical aid . 64.4 % of fallers feared of falling again . CONCLUSIONS Our study shows a pattern of high incidence of falls among the elderly living in the Spanish non-institutionalized community . Our data confirm that adverse consequences derived from the falls are frequent and often severe , which makes falls one of the major problems of elderly people AIMS To describe the circumstances and consequences of falls reported by community-dwelling older women . METHODS This prospect i ve study collected data for approximately 2 years for women aged > or=70 years at risk for falling who were enrolled in the Fall Evaluation and Prevention Program . RESULTS Participants ( 263 ) completed a median of 24 months of follow-up . A total of 143 participants reported 341 falls ; 70 reported 1 fall , and 73 reported 2 or more . A majority of falls ( 62 % ) occurred in/around the home , primarily during the daytime , and in living rooms or kitchens/dining rooms . Falls frequently occurred while walking , carrying objects , or reaching/leaning . Many falls did not result in injury ( 53 % ) ; however , 31 % result ed in minor injuries , 10 % in moderate injuries , and 6 % in major injuries . Soft tissue injuries were common , and 5 % of falls result ed in fractures . Nine falls result ed in hospitalization . CONCLUSIONS The high rate of injurious falls seen here and the detailed information on activity at the time of the fall emphasize the need to increase awareness of behaviors and the environment to reduce fall risk . Previous studies have identified risk factors for falls , some of which can not be modified , such as age or gender . In contrast , this study describes the activity at the time of the fall : many falls occur in the home environment , some with modifiable circumstances The objective of the study was to examine the predictive effect of prospect ively registered falls on survival within a r and omly selected group of elderly women . A longitudinal study , with 9 years follows up after 1 year prospect i ve fall registration was design ed . Persons age 75 or more living in the community . A total of 300 Norwegian women ; mean age was 80.8 participated in the study . Base-line registration s of health , functioning and medication were made .  Falls  which occurred during a 1-year period after baseline were registered as well as the date of death within a 9-year period after the end of the fall registration period . Half of the women reported one or more falls ( 1–11 ) . Eighty-six women ( 28.7 % ) experienced only one fall and 65 ( 21.7 % ) had at least two . During the 9-year follow-up period , 41.7 % died . Cox regression analyzes demonstrated that frequent falling , old age and a self-reported worsening of health were significantly associated with mortality during the follow-up period . Their relative risks of death when experiencing at least two falls was 1.6 ( 95 % CI 1.1–2.4 ) , P = 0.04 , when compared with no falls . Older fallers appear to have markedly increased mortality . Since falls are common among elderly people , this is a relevant fact for public health policy . Increasing age , poor self-rated health and high frequency of falls predict independently mortality in our 9 years follow up study . Because women represent the largest proportion of the elderly and falls are amendable , fall preventive may have the potential for significant impact on increasing year of life To study risk factors for falling , we conducted a one-year prospect i ve investigation , using a sample of 336 persons at least 75 years of age who were living in the community . All subjects underwent detailed clinical evaluation , including st and ardized measures of mental status , strength , reflexes , balance , and gait ; in addition , we inspected their homes for environmental hazards . Falls and their circumstances were identified during bimonthly telephone calls . During one year of follow-up , 108 subjects ( 32 percent ) fell at least once ; 24 percent of those who fell had serious injuries and 6 percent had fractures . Predisposing factors for falls were identified in linear-logistic models . The adjusted odds ratio for  sedative use was 28.3 ; for cognitive impairment , 5.0 ; for disability of the lower extremities , 3.8 ; for palmomental reflex , 3.0 ; for abnormalities of balance and gait , 1.9 ; and for foot problems , 1.8 ; the lower bounds of the 95 percent confidence intervals were 1 or more for all variables . The risk of falling increased linearly with the number of risk factors , from 8 percent with none to 78 percent with four or more risk factors ( P less than 0.0001 ) . About 10 percent of the falls occurred during acute illness , 5 percent during hazardous activity , and 44 percent in the presence of environmental hazards . We conclude that falls among older persons living in the community are common and that a simple clinical assessment can identify the elderly persons who are at the greatest risk of falling Background Fall-related injuries in older people are a leading cause of morbidity and mortality . Self-reported fall events in the last year is often used to estimate fall risk in older people . However , it remains to be investigated if the fall frequency and the consequences of the falls have an impact on the risk for subsequent injurious falls in the long term . The objective of this study was to investigate if a history of one single non-injurious fall , at least two non-injurious falls , or at least one injurious fall within 12 months increases the risk of sustaining future injurious falls . Methods Community-dwelling individuals 75–93 years of age ( n = 230 ) were initially followed prospect ively with monthly calendars reporting falls over a period of 12 months . The participants were classified into four groups based on the number and type of falls ( 0 , 1 , ≥2 non-injurious falls , and ≥1 injurious fall severe enough to cause a visit to a hospital emergency department ) . The participants were then followed for several years ( mean time 5.0 years ±1.1 ) regarding injurious falls requiring a visit to the emergency department . The And ersen – Gill method of Cox regression for multiple events was used to estimate the risk of injurious falls . Results During the long-term follow-up period , thirty per cent of the participants suffered from at least one injurious fall . Those with a self-reported history of at least one injurious fall during the initial 12 months follow-up period showed a significantly higher risk for sustaining subsequent injurious falls in the long term ( hazard ratio 2.78 ; 95 % CI , 1.40–5.50 ) compared to those with no falls . No other group showed an increased risk . Conclusions In community-dwelling people over 75 years of age , a history of at least one self-reported injurious fall severe enough to cause a visit to the emergency department within a period of 12 months implies an increased risk of sustaining future injurious falls . Our results support the recommendations to offer a multifactorial fall-risk assessment coupled with adequate interventions to community-dwelling people over 75 years who present to the ED due to an injurious fall BACKGROUND knowledge of the circumstances and consequences of falls in older adults is important for underst and ing 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 elders . METHOD accidental falls ( including their circumstances and consequences ) occurring in 96 male and female participants between 60 and 88 years of age were monitored prospect ively 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 result ed from five of the 91 falls and eight other falls result ed 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 result ed from slips whereas falls by women most often result ed 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 Forty-four patients aged 65 years and over who fell whilst in an acute hospital and 44 patients who did not fall during their hospital stay underwent structured medical examinations to identify factors associated with falling . The control subjects were matched for age ( + /- 3 years ) , sex , patient type , and primary diagnosis . The examination was based on established assessment s of posture , balance and gait , the musculoskeletal system , vision , cardiovascular status , and neurological function . Bivariate analyses revealed seven assessment measures that were significantly associated with falls : cognitive impairment , particularly impaired orientation ; evidence of previous cerebrovascular accident ; incoordination as measured clinical ly ; inability to perform the ' Get-up- and -go ' test , especially an inability to turn around after a 5-metre walk , and the use of psycho-active medications . Of these variables , impaired orientation , psycho-active drug use , evidence of stroke , and impaired performance in the ' Get-up- and -go ' test were included in a stepwise logistic regression which correctly classified 80 % of the patients into faller and non-faller groups . Falling was also related to the number of these identified risk factors . These findings suggest that a simple screening protocol , taking about 5 min to complete , can assist in the identification of patients at risk of falls whilst in hospital BACKGROUND Falls are a common occurrence in elderly persons , including relatively healthy , community-dwelling men and women . A significant percentage of falls result in soft-tissue injuries . Although some risk factors for falls have been identified , more research is needed on risk factors for injurious falls . In addition , there is little information from prospect i ve studies on the long-term consequences of falls other than injury . METHODS Risk factors and consequences of falls were analyzed in a 24-month prospect i ve study of 482 elderly ( mean age 74 + /- 6.7 years ) men and women living independently.in the community .  Falls and injurious falls were ascertained by telephone and by a bimonthly postcard follow-up . Predictor variables were obtained from a baseline assessment and follow-up question naire . Outcomes were defined as rates of falls and injurious falls , circumstances surrounding the fall , and the long-term correlates of falls . RESULTS Sixty-one percent of the participants ( 53.7 % of men and 65.7 % of women ) reported one or more falls during the 2-year follow-up . The crude rates of injurious falls were 11.17 per 1000 person-months in women and 7.23 per 1000 person-months in men . Age , history of fracture , low physical health , and low or high mobility level were risk factors for injurious falls in both sexes . The inability to balance unsupported on one leg was associated with injurious falls in women ( rate ratio [ RR ] = 3.0 ; 95 % confidence interval 1.9 - 4.7 ) . Self-reported cognitive , physical health , and mobility impairments were greater in female fallers compared to the nonfallers . CONCLUSIONS Falls and injurious falls without fracture are frequent events for healthy elderly people and may be associated with morbid changes in cognitive status , physical health , and mobility We conducted a prospect i ve study of the consequences of  falls  in 325 elderly community-dwelling persons , all of whom had fallen in the previous year . We contacted subjects every week for one year to ascertain falls and to determine the circumstances and consequences of falls . Only 6 % of 539 falls result ed in a major injury ( fracture , dislocation , or laceration requiring suture ) , but over half ( 55 % ) result ed in minor soft tissue injury . One in ten falls left the faller unable to get up for at least 5 minutes , and one in four falls caused subjects to limit their activities . The risk of injury per fall was about the same regardless of the number of falls a person had during follow-up . The risk of major injury was increased ( age- and sex-adjusted odds ratio : 5.9 , 95 % confidence interval : 2.3 - 14.9 ) in falls associated with loss of consciousness compared to nonsyncopal falls . In multivariate analyses of nonsyncopal falls , the risk of major injury per fall was higher in persons having a previous fall with fracture ( 6.7 ; 2.1 - 21.5 ) , a slower Trail Making B time ( 1.9 ; 1.1 - 3.2 ) , and in Whites ( 18.4 ; 7.5 - 44.6 ) . The risk that a nonsyncopal fall would result in minor injury ( versus no injury ) was increased in persons with a slower h and reaction time ( 1.8 ; 1.0 - 3.2 ) decreased grip strength ( 1.5 ; 1.0 - 2.3 ) , in Whites ( 2.0 ; 1.0 - 3.7 ) , in falls while using stairs and steps ( 2.2 ; 1.0 - 5.0 ) , and turning around or reaching ( 3.5 ; 1.7 - 7.3 ) . Our findings suggest that neuromuscular and cognitive impairment , as well as the circumstances of falls , affect the risk of injury when a fall occurs Background Older people are at increased risk of falls after hospital discharge . This study aim ed to describe the circumstances of falls in the six months after hospital discharge and to identify factors associated with the time and location of these falls . Methods Participants in this r and omized controlled study comprised fallers ( n = 138 ) who were part of a prospect i ve observational cohort ( n = 343 ) nested within a r and omized controlled trial ( n = 1206 ) . The study tested patient education on falls prevention in hospital compared with usual care in older patients who were discharged from hospital and followed for six months after hospital discharge . The outcome measures were number of falls , falls-related injuries , and the circumstances of the falls , measured by use of a diary and a monthly telephone call to each participant . Results Participants ( mean age 80.3 ± 8.7 years ) reported 276 falls , of which 150 ( 54.3 % ) were injurious . Of the 255 falls for which there were data available about circumstances , 190 ( 74.5 % ) occurred indoors and 65 ( 25.5 % ) occurred in the external home environment or wider community . The most frequent time reported for falls was the morning ( between 6 am and 10 am ) when 79 ( 28.6 % ) falls , including 49 ( 32.7 % ) injurious falls , occurred . The most frequently reported location for falls ( n = 80 , 29.0 % ) , including injurious falls ( n = 42 , 28.0 % ) , was the bedroom . Factors associated with falling in the bedroom included requiring assistance with activities of daily living ( adjusted odds ratio 2.97 , 95 % confidence interval ( CI ) 1.57–5.60 , P = 0.001 ) and falling in hospital prior to discharge ( adjusted odds ratio 2.32 , 95 % CI 1.21–4.45 , P = 0.01 ) . Fallers requiring assistance with activities of daily living were significantly less likely to fall outside ( adjusted odds ratio 0.28 , 95 % CI 0.12–0.69 , P = 0.005 ) . Conclusion Older patients who have been recently discharged from hospital and receive assistance with activities of daily living are at high risk of injurious falls indoors , most often in the bedroom . These data suggest that targeted interventions may be needed to reduce falls in this population OBJECTIVE To determine to what extent patients with vestibular hypofunction experience falls . STUDY DESIGN Prospect i ve clinical study . SETTING Outpatient tertiary care facility in a university . PATIENTS Patients with unilateral ( n = 70 ) and bilateral ( n = 45 ) vestibular hypofunction , confirmed on vestibular function testing , aged 24 to 89 years . INTERVENTION None . MAIN OUTCOME MEASURE Incidence of falls . RESULTS There was a significant difference in the incidence of falls reported since the onset of the vestibular deficit by patients with unilateral ( UVL ) and bilateral ( BVL ) vestibular hypofunction . The incidence of falls for BVL was significantly greater than that for UVL . The incidence of falls for UVL was not different from that expected in a community-based population when age was considered . The incidence of falls for BVL was significantly greater than that reported for the general population aged 65 through 74 years ( 51.1 % for BVL , 25 % for community-dwelling individuals ) but was significantly less than expected for persons aged > or = 75 years ( 18.2 % for BVL , 49 % for community-dwelling individuals ) . The lower incidence of falls in patients with BVL aged > or = 75 years may be related to the use of assistive devices and to a decrease in risky behavior . All patients with serious injury were from the UVL group , and all were > 65 years old . The incidence of fall-related injuries requiring medical attention among patients with UVL was similar to that in community-dwelling individuals . CONCLUSIONS Falls are an important consequence of bilateral vestibular hypofunction , and patients should be counseled about the increased risk of falling . Assistive devices should be considered , especially for persons aged > 65 years with BVL OBJECTIVES The aims of this study were to determine the incidence of falls in a group of elderly patients with diabetes and to assess for the prevalence of risk factors for falls in this population . DESIGN This is a population -based study with question naire-based interviews . SETTING The setting for this study was the London District General Hospital outpatient department . PARTICIPANTS Seventy-seven patients with diabetes , aged over 65 years , r and omly selected whilst attending for general diabetic annual review . Patients with dementia , blindness , and immobility and those who were unable to give informed consent were excluded from this study . MEASUREMENTS The incidence of falls in the last 12 months was used . Information was collected on the incidence of hypoglycaemic episodes , the presence of other medical conditions , visual impairment , and peripheral neuropathy , the use of medications and walking aids , and HbA1C and blood pressure control . RESULTS The incidence of falls was 39 % . Falls occurred more frequently in female patients and patients of increasing age . Falls occurred more frequently in patients with poor diabetic control [ risk ratio (RR)=7.83 ( 2.948 - 20.799 ) , chi2 value=6.422 ] ; patients requiring assistance with mobility : for those mobile with a stick [ RR=1.839 ( 1.048 - 3.227 ) , chi2=4.619 ] ; and those who had previously suffered a stroke [ RR=1.929 ( 1.143 - 3.257 ) , chi2=4.615 ] . CONCLUSION We provide evidence that poorly controlled diabetes and conditions associated with complications of diabetes are associated with an increased risk of falling in older people . We recommend early recognition of the multiple causes of falls in the older diabetic patient and prompt referral of this group of patients to a specialist falls clinic Dialysis patients are increasingly older and more disabled . In community-dwelling seniors without kidney disease , falls commonly predict hospitalization , the onset of frailty , and the need for institutional care . Effective fall prevention strategies are available . On the basis of retrospective data , it was hypothesized that the fall rates of older ( > or = 65 yr ) chronic outpatient hemodialysis ( HD ) patients would be higher than published rates for community-dwelling seniors ( 0.6 to 0.8 falls/patient-year ) . It also was hypothesized that risk factors for falls in dialysis out patients would include polypharmacy , dialysis-related hypotension , cognitive impairment , and decreased functional status . Using a prospect i ve cohort study design , HD patients who were > or = 65 yr of age at a large academic dialysis unit were recruited . All study participants underwent baseline screening for fall risk factors . Patients were followed prospect ively for a minimum of 1 yr . Falls were identified through biweekly patient interviews in the HD unit . A total of 162 patients ( mean age 74.7 yr ) were recruited ; 57 % were male . A total of 305 falls occurred in 76 ( 47 % ) patients over 190.5 person-years of follow-up ( fall-incidence 1.60 falls/person-year ) . Injuries occurred in 19 % of falls ; 41 patients had multiple falls . Associated risk factors included age , comorbidity , mean predialysis systolic BP , and a history of falls . In the HD population , the fall risk is higher than in the general community , and fall-related morbidity is high . Better identification of HD patients who are at risk for falls and targeted fall intervention strategies are required
ORs were generally higher for recurrent fallers than for all fallers .
This meta- analysis provides comprehensive evidence -based assessment of risk factors for falls in older people , confirming their multifactorial etiology .
Some nonspecific indicators of high baseline risk were also strong predictors of the risk of falling
BACKGROUND Falls are the main cause of accidental death in persons aged 65 years or older .