Falls in old people at home: Intrinsic versusenvironmental factors in causation

doi:10.1016/S0033-3506(83)80008-0

Public Health

Volume 97, Issue 2, March 1983, Pages 115-120

https://doi.org/10.1016/S0033-3506(83)80008-0 Get rights and content

Abstract

In this study of 339 attendances by elderly patients at an Accident and Emergency (A & E) Department following a home accident fall, attempts were made to evaluate the relative importance of environmental and intrinsic causes for the fall. This was found to vary systematically with age, trips and slips being more important in the age group 65–74 years, while intrinsic causes in the form of illness and disability assumed much greater importance over the age of 75 years.

A mortality follow-up over a period of 1 year effected by a simple record-linkageshowed that the group of elderly fallers studied had a considerable excess mortality that could not be attributed to the injuries sustained in the fall. It is suggested that old people often fall because they are sick, and because of this such patients who attend an A & E Department should be considered as forming an “at-risk” group likely to benefit from investigation of their general health and medication.

References (7)

SheldonJ.H.
On the natural history of falls in old age
British Medical Journal
(1960)
OverstallP.W. et al.
Falls in the elderly related to postural imbalance
British Medical Journal
(1977)
BrocklehurstJ.C. et al.
Facture of the femur in old age: a two-centre study of associated clinical factors and the cause of the fall
Age and Ageing
(1978)

There are more references available in the full text version of this article.

Cited by (49)

The contribution of counter-rotation movements during fall recovery: A validation study
2018, Journal of Biomechanics
Citation Excerpt :
Many falls are due to external causes, such as a push, pull, trip, or slip. For example, 44–75% of all falls in older adults (Morfitt, 1983; Yasumura et al., 1996) and 34% of falls in individuals with chronic stroke (Schmid et al., 2013) are due to extrinsic causes. In laboratory studies, older adults (Crenshaw and Grabiner, 2014; Mcllroy et al., 1999) and individuals with chronic stroke (Geurts et al., 2005) have demonstrated an impaired ability to recover from external postural disturbances.
Three mechanisms of maintaining standing stability include M₁ – moving the COP within the base of support, M₂ – segment counter-rotation, and M₃ – applying an external force. To date, the contributions of these mechanisms have not been quantified for the response to an external postural disturbance. The purpose of this study was to evaluate the construct validity of measures that quantify the M₂ contribution to anteroposterior fall recovery. We evaluated the whole-body rotation contribution, as well as a measure specific to arm motion (M_ARMS). With segment counter-rotation as the main focus of this study, we examined standing feet-in-place responses to treadmill-induced falls. The treatment validity of our measures was assessed by comparing unconstrained responses to those with constrained arm motion. The convergent validity of our measures was assessed by correlating peak shoulder flexion and extension velocities with counter-rotation contributions. Eleven unimpaired participants responded to anteroposterior belt accelerations from a treadmill, and the M₂ and M_ARMS contributions were quantified from three-dimensional segment motion. The treatment validity of these measures was partially supported. Constraining the arms reduced M₂ for anterior, but not posterior falls. Conversely, M_ARMS was reduced for posterior, but not anterior falls. Convergent validity was supported for M_ARMS (r = 0.64–0.78), but not M₂ (r = −0.40 to −0.15). These results support the use of M_ARMS over M₂ when interested in the role of arm motion. Given that arm constraints did not change the contribution of M_ARMS during a forward fall, unimpaired participants may not necessarily rely on arm motion as part of their recovery strategy in this context.
The circumstances, orientations, and impact locations of falls in community-dwelling older women
2017, Archives of Gerontology and Geriatrics
Citation Excerpt :
The percentage of falls induced by a trip (33%) was amongst the highest reported in the literature (3–40%), and the proportion induced by a slip (22%) exceeded previous reports (3–17%) (Aoyagi et al., 1998; Berg et al., 1997; Lord, Ward, Williams, & Anstey, 1993; Luukinen et al., 1994; Robinovitch et al., 2013). These results are alarming, as 21–42% and 19–28% of injurious falls are due to a trip or slip, respectively (Morfitt, 1983; Yasumura et al., 1996). Unlike previous studies that associated intrinsic factors with 56% of falls in women (Aoyagi et al., 1998), we found only 6% of falls in our cohort were attributed to intrinsic factors of dizziness, loss of consciousness, alcohol/medication, a sudden decline in health, or injury before the fall.
We sought to characterize the circumstances, orientations, and impact locations of falls in community-dwelling, ambulatory, older women.
For this longitudinal, observational study, 125 community-dwelling women age ≥ 65 years were recruited. Over 12-months of follow-up, fall details were recorded using twice-monthly questionnaires.
More than half (59%) of participants fell, with 30% of participants falling more than once (fall rate = 1.3 falls per person-year). Slips (22%) and trips (33%) accounted for the majority of falls. Approximately 44% of falls were forward in direction, while backward falls accounted for 41% of falls. About a third of all falls were reported to have lateral (sideways) motion. Subjects reported taking a protective step in response to 82% of forward falls and 37% of backward falls. Of falls reporting lateral motion, a protective step was attempted in 70% of accounts. Common impact locations included the hip/pelvis (47% of falls) and the hand/wrist (27%). Backwards falls were most commonly reported with slips and when changing direction, and increased the risk of hip/pelvis impact (OR = 12.6; 95% CI: 4.7–33.8). Forward falls were most commonly reported with trips and while hurrying, and increased the risk of impact to the hand/wrist (OR = 2.6; 95% CI: 1.2–5.9).
Falls in older ambulatory women occur more frequently than previously reported, with the fall circumstance and direction dictating impact to common fracture locations. Stepping was a common protective recovery strategy and that may serve as an appropriate focus of interventions to reduce falls in this high risk population.
A self-assessment tool was reliable in identifying hazards in the homes of elders
2005, Journal of Clinical Epidemiology
Citation Excerpt :
However, even among the general population of elderly, home environment modification appears to increase the effectiveness of multifactorial interventions for reducing falls-risk [16], and is recommended as part of a comprehensive falls prevention strategy [6]. Frequently, studies of the association between environmental factors and the risk of falling among the elderly have relied on patients' self-reports, information in medical records [17–19], or rating systems with undocumented reliability or validity [20,21]. Although rating systems have been developed and validated, these systems are most often based on home assessments conducted by trained observers, a costly and time-consuming process [7,8,14,22,23].
Falls are a leading cause of fatal and nonfatal injuries, particularly among the elderly. A reliable instrument for self-assessment of home falls hazards would facilitate screening for falls risk. This study examined the reliability of self-assessment of home falls hazards by elderly women.
Participants were 52 elderly women, aged 67 to 97. All evaluations were performed in the participants' homes. Home falls hazards were evaluated independently by study participants and by trained observers.
Kappa statistics indicated good to excellent agreement for most of the environmental factors. However, observers were significantly more likely than the study participants to report certain tripping hazards, particularly objects in walkways.
This home checklist is an important step towards a reliable self-report instrument for measuring home falls hazards. Self-assessment appears to be a reliable method for assessing many putative hazards of falling in the home. However, our findings raise questions regarding the reliable assessment of tripping hazards.
Long-term survival after falls among the elderly in institutional care
2004, Archives of Gerontology and Geriatrics
Falls of the elderly are a major problem in institutional care. However, more comprehensive studies concerning the long-time survival of fallen institutionalised elderly are lacking. We investigated the 5-year survival of institutionalised elderly fallers and controls. Data of the patients aged over 60 years, who fell during the 1-year period (n=218) in four institutions were collected prospectively. The controls consisted of patients of the same age who did not fall within the same period (n=632). The survival of both groups was analysed by gender in the total data, and in the short-term (ST) and long-term (LT) patients separately. In addition, the survival of fallers was investigated according to the number of falls per patient. After follow-up, 164 (75%) fallers and 369 (58%) controls were dead. The female controls survived best and the survival of the male fallers was the poorest. The death rate was higher than expected among female fallers and lower than expected among female controls. The survival of the patients who fell twice during the 1-year period was clearly poorer than of those who fell once or three or more times. No difference in the survival rates was found between the injured and non-injured fallers. Falls in institutional care predict poor survival. The first and especially the second fall should be prevented.
The epidemiology of falls and syncope
2002, Clinics in Geriatric Medicine
Falls and fall prevention in the nursing home
1996, Clinics in Geriatric Medicine
The mean incidence of falls in nursing homes is 1.5 falls per bed per year (range 0.2-3.6). The most common precipitating causes include gait and balance disorders, weakness, dizziness, environmental hazards, confusion, visual impairment, and postural hypotension.The most important underlying risk factors for falls and injuries include some of these same items as well as others: leg weakness, gait and balance instability, poor vision, cognitive andfunctional impairment, and sedating and psychoactive medications. A focused history and physical examination after a fall can usually determine the immediate underlying cause(s) of the fall and contributory risk factors. Many strategies for fall prevention have been tried with mixed success. The most successful take into account the multifactorial causes of falls, and include interventions to improve strength and functional status, reduce environmental hazards, and allow staff to identify and monitor high-risk residents.Regular evaluations in the nursing home can help identify patients at high risk who can then be targeted for specific treatment and prevention strategies. Strategies that reduce mobility through use of restraints have been shown to be more harmful than beneficial and should be avoided. A number of promising fall prevention strategies, involving both specific quality assurance programs and technologic devices, are being evaluated currrently.

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Falls in old people at home: Intrinsic versusenvironmental factors in causation

Abstract

On the natural history of falls in old age

British Medical Journal

Falls in the elderly related to postural imbalance

British Medical Journal

Facture of the femur in old age: a two-centre study of associated clinical factors and the cause of the fall

Age and Ageing