Epidemiology of falls among community-dwelling elderly people

The purpose of the present study was to report the prevalence and circumstances of falls among community-dwelling elderly people in order to contribute to prevention of falls in the community. The subjects were 2,774 elderly people who participated in health examinations conducted by Tokoname-shi, Aichi Prefecture in 2002. The variables investigated in the present study were demography and history of falls in the past one-year. Circumstances of falls, e.g. time, location, activities associated with falls, cause of falls and degree of injury due to falls were asked when the subjects experienced a fall. The prevalence of falls among 2,774 subjects was 13.7%. It was significantly higher among women (17.2%) than men (8.3%, chi 2 = 48.1, p < 0.001). Prevalence increased as subjects get older. Circumstances of falls were assessed in 655 subjects. The distribution of time, location, activity associated with falls, cause and injury due to falls corresponded with previous fall studies among community dwelling elderly people. The incidence of falls was extremely high during the daytime and outdoors. Falls occurred most frequently while walking. The majority of falls were due to extrinsic factors. About 10% of all falls caused fracture.     

Hypotensive responses to common daily activities in institutionalized elderly. A potential risk for recurrent falls

Transient hypotension may be one of many factors contributing to the high prevalence of falls among elderly people. To determine the frequency and magnitude of hypotensive responses to common daily activities, and their potential relationship to falls in the elderly, we examined blood pressure (BP) and heart rate during a standardized series of activities in 38 institutionalized recurrent fallers (age, 87 +/- 6 years), 20 institutionalized nonfallers (age, 85 +/- 5 years), and 10 healthy young control subjects (age, 24 +/- 3 years). The coefficient of variation for systolic BP during all activities was higher in elderly subjects (fallers, 14% +/- 5%; nonfallers, 12% +/- 3%) than in young control subjects (8% +/- 1%). In contrast, the coefficient of variation for heart rate during all activities was higher in young subjects than in the elderly subjects. Elderly subjects had marked BP reduction following meals and nitroglycerin, which was significantly greater in fallers than in nonfallers, independent of the cause of the fall. Thus, institutionalized elderly have marked BP variability and hypotensive responses to meals and nitroglycerin. A decline in BP during common preload-reducing stresses may predispose some elderly people to falls.     

Falls among community‐dwelling elderly people of Hokkaido,Japan

Background: Although the circumstances surrounding falls among community‐dwelling elderly people have been described by numerous studies, there are few that have reported falls in the northern regions of Japan, such as Hokkaido, that experience a severe winter with heavy snow. As a preliminary study, we surveyed the circumstances of falls among community‐dwelling elderly people in Hokkaido with a self‐administered questionnaire. Methods: Residents living in private homes throughout Hokkaido were randomly contacted by telephone and those aged over 65 years were recruited for this study. In all, 1000 subjects participated in the survey. A questionnaire was used to obtain the histories of falls, including the number of falls, the season and place of occurrence, and the cause of the falls in the year prior to the survey. Results: Of the 1000 subjects, 849 (436 men and 413 women; mean age, 73.0 years) completed the questionnaire. Among the 849 subjects, 277 (32.6%) fell at least once during the year of the survey. Of these 277 subjects, 155 subjects (56.0%) experienced two or more falls in the year. Approximately 60% of the falls occurred during the winter. The most common location where falls occurred was on roads or sidewalks, and slipping was the most prevalent cause. Conclusion: Our findings revealed several aspects regarding the circumstances surrounding falls among community‐dwelling elderly people in Hokkaido.     

Atrial fibrillation, anticoagulation, fall risk, and outcomes in elderly patients

Atrial fibrillation (AF) affects 2.5 million patients in the United States. The incidence of this condition increases with age, such that approximately 5% of people > 65 years of age have AF. Because of the lack of organized atrial contraction and thrombus formation in the left atrium, patients with AF are at increased risk of stroke. The estimated risk of stroke among all AF patients is 5% per year. Among patients without mitral stenosis, there is a graded relationship of stroke risk with the number of CHADS? risk factors. Warfarin is the recommended treatment for embolic stroke prophylaxis in AF in intermediate- to high-risk patients. However, elderly patients who are deemed to be at risk of falls are often not started on warfarin therapy secondary to a perceived higher risk of bleeding complications. These risks have been evaluated, but conclusive data regarding the risk-benefit trade-off are elusive. This review summarizes available data on the use of warfarin in elderly patients with AF, focusing on the risk of bleeding, and will specifically address the utility of falls risk assessment in the decision to initiate warfarin therapy for AF.     

Systematic review of fall-related factors among the house-dwelling elderly in Japan

BACKGROUND: Fall-related factors and individual characteristics of the elderly who have had fall are necessary to develop practical fall prevention programs, and life support management. However, no nation-wide meta-analysis of the fall-related factors of elderly has been performed in Japan. OBJECTIVES: To conduct a meta-analysis concerning fall-related factors among the house-dwelling elderly in Japan. DATA SOURCES: Japana Centra Revuo Medicina, version 3 (systematic literature search system for Japanese literature), and Pub Med (a service of the National Library of Medicine) from January 1994 to December 2003. METHODS: Study search terms included the following: retrograde case-control, prospective cohort, and retrospective cohort study with falls. Search terms included older adults (60 years and over), falls and humans. Thirty-two fall-related factors were meta-analyzed. RESULTS: Among 32 fall-related factors, only nine factors were statistically proven to be related to falls. These factors were female gender, age over 70 years old, fall experience, past history of cerebrovascular disease, grip strength, knee extensor strength, one foot standing time with eyes open, one foot standing time with eyes closed, and skinfold thickness (female). Eleven factors: presence of a spouse, past medical history of hypertension, complaints of dizziness, numbness of the extremities, 10 meter maximum walking velocity, tendency to stumble, use of supportive equipment, standing postural sway. sitting trunk flexion, skinfold thickness (male), and body mass index, were not statistically proven to be related to falls. CONCLUSIONS: More studies are necessary to determine the efficacy of fall-related factors among the Japanese elderly.     

Circumstances of injurious falls leading to medical care among elderly people living in a rural community

The objective of the present study is to describe the circumstances of injurious falls leading to medical care among the elderly living in a rural community, which have never been reported comprehensively. From 1992 to 1993, an interview survey on falls was carried out every 3 months. Of the 1349 subjects aged 65 or more of Nakazato village in Japan, 1317 persons responded to the survey by a door-by-door interview. Two-hundred-and-fifty-six elderly people experienced a fall at least once during the 1-year period. One-hundred-and-twenty-four falls were recorded by 94 men and 215 falls were experienced by 162 women. In men, 16 (31.31/1000 person-year) injurious falls leading to medical care were documented. In women, 58 (75.74/1000 person-year) falls were found to be injurious. The difference in the rate of injurious falls between the sexes was statistically significant (P < 0.01). In each sex, there was no increased rate of injurious falls with advancing age. Most of the injurious falls occurred in the daytime. As for the location of injurious falls, outdoor falls were more frequent than indoor falls in the case of men. Half of the injurious falls in women occurred indoors. Extrinsic factors largely contributed to the occurrence of injurious falls compared with intrinsic ones. Women tended to be injured in the buttocks and hip in a greater proportion than men. This study reveals the circumstances of injurious falls leading to medical care and provides useful information on preventing injurious falls among the elderly living in the community.     

Falls incidence, risk factors, and consequences in Chinese older people: a systematic review

Falls incidence in Chinese older people has been reported to be approximately half that of Caucasian populations. It is possible that the falls risk factor profile may differ significantly between Caucasian and Chinese populations, and a better understanding of this reported difference in incidence and associated risk factors may influence potential approaches to future intervention. A systematic literature review was conducted using the EMBase, Medline, Chinese Electronic Periodical Services, and WanFangdata databases to collate and evaluate the studies that have addressed the incidence and risk factors for falls in Chinese older people. Twenty-one studies conducted in China, Hong Kong, Macao, Singapore, and Taiwan met the inclusion criteria. Fall rates ranged between 14.7% and 34% per annum (median 18%). In the four prospective studies, injuries were reported by 60% to 75% of those reporting falls, with fractures constituting 6% to 8% of all injuries. One hundred thirty-two variables were identified as fall risk factors, with commonly reported factors being female sex, older age, use of multiple medications, gait instability, fear of falling, and decline in activities of daily living. The findings reveal a consistently lower incidence of self-reported falls in Chinese older people than in Caucasian older people, although the types and prevalence of risk factors were not dissimilar from those found in studies of Caucasian older people. A greater understanding of the health, behavioral, and lifestyle factors that influence fall rates in Chinese populations is required for elucidating fall prevention strategies in Chinese and non-Chinese older people.     

Falls and injurious falls late in home-dwelling life

Of the Finnish persons aged 85 years or older, living at home, 555 (67% of this age class) were monitored for two years to describe the circumstances and the frequency of falls and injury-causing falls. The incidence rates of falls, major soft tissue injuries and fractures were 1039 (95% confidence interval = CI: 974-1093), 74 (58-92) and 89 (72-108), respectively. The incidence of falls was higher among women 1127 (1055-1199) than among men 755 (651-870), but only among those younger than 90 years. The probability of getting injured in a fall was higher in the morning (p = 0.010) and in the evening (p = 0.007) as compared to the daytime. More injury-causing falls than other falls were non-defined as regards ongoing activity at the time of fall (p < 0.001) and type of falling (p < 0.001). Ongoing activity and type of falling did not discriminate injury-causing falls from other falls after exclusion of the non-defined falls. We conclude that incidence of falls among the home-dwelling elderly increases up to the oldest ages, especially among the men. Time of day affects the occurrence of injuries in falls. Ongoing activity and type of falling play a minor role in falls causing injuries among the most elderly.     

莱州市农村老年人跌倒危险因素的调查研究

目的：分析农村老年人跌倒的情况和危险因素，为开展老年跌倒的预防提供依据。方法：采用整群抽样方法，对莱州市西由镇60岁及以上的1003位农民，发生在2001年3月前12个月的跌倒情况进行调查，结果：跌倒发生率为22．6％，男性15．9％，女性28．4％，女性，年龄大，前1年跌倒史，独居，2种以上慢性病，2种以上不良症状，自我健康评价差，与前1年对比健康评价差，步态不稳是跌倒的危险因素。社会交往少是跌倒的保护因素，结论：由多种原因造成农村老年人跌倒，预防老年人跌倒也亦采取多种措施。     

Prevalence, characteristics and factors associated with falls among the elderly living at home.

Attempts to determine the underlying causes of falls have come to conflicting conclusions, partly because subject groups studied have not been representative of all elderly people. Two hundred and three randomly selected people of 75 years and over, living at home, were visited and questioned about falls experienced in the previous 12 months, and about factors that might be related to falling. Eighty-six subjects (42.4%) had suffered one or more falls during this time, and of fallers, 49 (59.3%) were injured, 9 of them seriously. Women were slightly more likely to have had falls and were more likely to have suffered injury, but no increase in frequency of falls with age was demonstrated. Only a minority of fallers (43.0%) sought medical attention following their fall. Falls outside the home accounted for 39.5% of falls and these were more likely to be due to simple trips or slips. Analysis of the factors related to falls showed a considerable overlap between fallers and non-fallers. Fallers had significantly greater dependency and cognitive impairment, more physical symptoms, and higher scores for anxiety and depression, but there was no association with postural hypotension, neurological abnormalities, or measurements relating to nutritional state. The factors found to be significant on discriminant analysis were combined to determine a "fall risk score". This type of easily calculated score might be of use to medical and paramedical personnel for assessing the risk of falling among the elderly living at home.     

Assessment of acute myocardial infarction in Japan by the Japanese Coronary Intervention Study (JCIS) Group.

BACKGROUND: Until now, large-scale nationwide surveys of acute myocardial infarction (AMI), such as those performed in Europe and America, have not been performed in Japan. Therefore, in 2000 the Japanese Coronary Intervention Study (JCIS) group conducted a nationwide survey on the incidence of AMI in Japan. METHODS AND RESULTS: Questionnaires were collected from 8,268 facilities throughout Japan. The total annual number of patients with AMI was 66,459 (52.4 patients/10(5) population), and the AMI incidence rate in Japan was approximately 25% of that in the United States. Most facilities with AMI patients treated less than 50 AMI patients annually, and that number was 45.0% of total AMI patients. The incidence of AMI patients was highest in Kochi, Kumamoto, and Wakayama prefectures, and lowest in Yamanashi, Saitama and Shiga prefectures. The ratio of the highest incidence to the lowest incidence was 2.0. A significant correlation was observed between the mean age of the prefectural population, as a coronary risk factor, and the incidence of AMI. CONCLUSIONS: The incidence of AMI in Japan is approximately 25% that in the United States and it varies considerably among the prefectures, one of the causes being the difference in the mean age. This provides important information for assessing the guidelines for Japanese patients with AMI.     

Fall Risk Index predicts functional decline regardless of fall experiences among community‐dwelling elderly

Aim: The 21‐item Fall Risk Index (FRI‐21) has been used to detect elderly persons at risk for falls. The aim of this longitudinal study was to evaluate the FRI‐21 as a predictor of decline in basic activities of daily living (BADL) among Japanese community‐dwelling elderly persons independent of fall risk. Methods: The study population consisted of 518 elderly participants aged 65 years and older who were BADL independent at baseline in Tosa, Japan. We examined risk factors for BADL decline from 2008 to 2009 by multiple logistic regression analysis on the FRI‐21 and other functional status measures in all participants. We carried out the same analysis in selected participants who had no experience of falls to remove the effect of falls. Results: A total of 45 of 518 participants showed decline in BADL within 1 year. Multivariate logistic regression analysis showed that age (odds ratio [OR] 1.13, 95% confidence interval [CI] 1.05–1.20), FRI‐21 ≥ 10 (OR 3.81, 95% CI 1.49–9.27), intellectual activity dependence (OR 3.25, 95% CI 1.42–7.44) and history of osteoarthropathy (OR 3.17, 95% CI 1.40–7.21) were significant independent risk factors for BADL decline within 1 year. FRI‐21 ≥ 10 and intellectual activity dependence (≤3) remained significant predictors, even in selected non‐fallers. Conclusion: FRI‐21 ≥ 10 and intellectual activity dependence were significant predictive factors of BADL decline, regardless of fall experience, after adjustment for confounding variables. The FRI‐21 is a brief, useful tool not only for predicting falls, but also future decline in functional ability in community‐dwelling elderly persons. Geriatr Gerontol Int 2012; ??: ??–?? .     

Tuberculosis in Japan at present and in near future

The high incidence of tuberculosis in the elderly people and no decrease in the incidence rate of the young people are two main features of current tuberculosis problem in Japan. To examine the near future prediction of the incidence rate and the rate of clinical breakdown by age group, the incidence rates of the newly registered tuberculosis cases of the cohorts born before 1918, in 1919-28, 1929-38, 1939-48, 1949-58 and 1959-68 were studied every ten years. The curves of incidence rate in each cohort were extrapolated to the future to obtain the incidence rates in 2008 and 2018. The numbers of predicted new cases in 2008 and 2018 were estimated to be some 31,000 and 23,000, respectively. The percentage of the cases above 60 y.o. was estimated to be 59%, 59% respectively. As the number of new cases in 1998 was 41,000, 55% of which was above 60 y.o., it will steadily decrease from now on, but the elderly people more than 60 y.o. will continue to occupy high percentage of the new cases. The incidence rate of the new cases will also decrease from 32.4 (per 100,000 populations) in 1998 to 24.5 in 2008 and 19.4 in 2018, and Japan in 2018 will still be a middle prevalence country in the world as now. The rate of clinical breakdown is obtained from dividing the incidence rate by the prevalence of tuberculosis infection. The latter is theoretically calculated from the annual risk of tuberculosis infection assuming that it doesn't depend on age. In Japan the annual risk of infection was supposed to be constant and about 4% till 1947. Since then it declined by some 10% annually till around 1977. Thereafter the annual speed of its decline was estimated to have slowed down. But we cannot know the true annual risk of tuberculosis infection, as BCG vaccination hinders the interpretation of the result of tuberculin skin testing in Japan. We postulated it declined 5% annually (Model A) or it was constant to be 0.17% since 1977 (Model B). Using these models of annual risk of tuberculosis infection, the prevalence of tuberculosis infection by age group was calculated in every calendar year. The incidence rate of each age group was assumed to be equal to that of median age in each age group. For example, the incidence rate of the cohort born in 1919-28 was assumed to be equal to that of the cohort born in 1923. In this way, the annual rates of clinical breakdown of the cohorts born in 1923, 1933, 1943, 1953, 1963 and 1973 were calculated. The rates of clinical breakdown for the cohorts born in 1923, 1933 and 1943 were similar with each other and were approximately 100 per 100,000 in both models. The rate of clinical breakdown at 25 years old for the cohort born in 1953 was 0.64 times smaller than that for the cohort born in 1943. It might due to the improvement of nutritional state and the effectiveness for adult tuberculosis of compulsory BCG vaccination which has been done after World War II in Japan. But for the cohort born after World War II, the later the cohort was born, the larger its rate of clinical breakdown was in both models. And, for example, the rate of clinical breakdown at age 25 years old for the cohort born in 1973 was 2.4 times (in Model A) or 1.7 times (in Model B) larger than that for the cohorts born in 1953. This may imply that there has been some factor(s) which facilitates tuberculous disease after tuberculous infection in young people in modern Japan. One explanation for this is the possibility that immune ability to tuberculosis might be weakened in young generations by some factor(s) such as environmental pollution.     

Vitamin D supplementation and the prevention of fractures and falls: results of a randomised trial in elderly people in residential accommodation

OBJECTIVES: To determine whether vitamin D supplementation reduces the risk of fracture or falls in elderly people in care home accommodation. DESIGN: A randomised controlled trial of cluster design. SETTING AND SUBJECTS: 223 Residential units (mainly identical 30-bedded units), within 118 homes for elderly people throughout Britain, with 3,717 participating residents (76% women, average age 85 years). The units provided mainly or entirely residential care (35% of residents), nursing care (42%) or care for elderly mentally infirm (EMI) residents (23%). METHODS: Participants were randomly allocated by residential unit (cluster design) to a treated group offered ergocalciferol 2.5 mg every 3 months (equivalent to a daily dose of 1,100 IU), or to a control group. Fractures were reported by staff and confirmed in hospital, and routinely collected data on reported falls were obtained. RESULTS: After median follow-up of 10 months (interquartile range 7-14 months), 64 (3.6%) of 1,762 vitamin D-treated residents and 51 (2.6%) of 1,955 controls had one or more non-vertebral fractures, and 24 (1.3%) and 20 (1.0%), respectively, had a hip fracture. The proportion reporting at least one fall was 44% in vitamin D-treated and 43% in control residents. The differences between the vitamin D and control groups were not statistically significant. The incidence of all non-vertebral fractures in the care homes (3.2% per year) and of hip fractures (1.1% per year) was low, similar to rates in elderly people in sheltered accommodation, and the pre-treatment serum 25-hydroxy vitamin D concentration was high [median 47 nmol/l, measured in a 1% (n = 18) sample]. CONCLUSIONS: We found no evidence that vitamin D prevents fractures or falls in elderly people in care home accommodation.     

澳门居家老年人跌倒的危险因素分析

目的 分析澳门居家老年人跌倒的危险因素. 方法 以问卷调查的方式成功访谈了2039名60岁及以上的老年人;利用多因素Binary Logistic Regression识别出老年人跌倒的危险因素.结果 在受访的2039名老年人中,3个月内曾发生跌倒者73人(3.6%);多因素回归分析结果 显示高龄,患有痛风、两耳均听不到、家居地面凹凸不平的老年人跌倒的发生率比较高. 结论 老年人服务机构应教育群众特别关心照顾高龄及失聪的老年人,另外去除家居环境的危险因素有利于预防老年人跌倒的发生.     

Falls in the institutionalized elderly in Japan

Falls can be considered a vital factor in impeding successful aging in the elderly. The purpose of the study is to know rates of falls per year among the elderly, to observe the situations when falls occurred, and to clarify the association of falls with physical deterioration. The survey was carried out in 1406 residents aged 65 and over of the Tokyo Metropolitan Home for the Elderly in 1982. The rate of subjects who fell more than once during a one-year period was 14.5%. Females had a higher rate than males. Sixty per cent of all the falls occurred indoors. As for the cause of the falls, extrinsic factors were accounted three times as much as intrinsic factors. Among injuries sustained by the falls, fracture was more frequent in females than in males. Length of time of standing on one leg was shorter for fallers than for non-fallers in both sexes. However, the differences were not significant when age was controlled. Fall is attributed not only to physical factors but also to environmental factors. Therefore, it should be encouraged to design an environment with devices.     

Prevalence,outcome and risk for falling in 155 ambulatory patients with rheumatic disease

Aim: Older people are at greater risk of falls and fall‐related adverse outcomes. Risk for falls is multifactorial, and relative importance of risk factors (RF) may vary according to the population studied. Although several population studies identify musculoskeletal factors as one of many RFs, there have been few studies of falls in populations with rheumatic disease. In this study we aim to assess the incidence of falls, prevalence of falls RFs and outcomes of falls in an ambulatory population with rheumatic disease. Methods: Using a retrospective cohort study design, consecutive patients attending rheumatology outpatient clinics completed a self‐administered falls questionnaire that investigated falls within the previous 12 months, risk for falling and fear of falling. Results: One hundred and fifty‐five patients, with a mean age of 59.7 years (SD 15.0) completed the survey. Seventy‐six patients (49%) reported one or more falls in the previous 12 months. Fifty‐eight (76.3%) reported an adverse outcome which included fracture in 12 (15.8%) and hospital attendance or admission in 20 (26.7%). Fear of falling was also common, being reported in 81 (52.3%) patients. Moderately or severe fear of falling was reported in 26 (16.8%) among the whole group and in 10% of the 78 patients who had not yet experienced a fall. Conclusions: The findings of this study highlight the high incidence of falls and fear of falling in patients with rheumatic disease and identify groups likely to be at higher risk. These patients should be considered for falls prevention programs that have been shown to reduce falls risk and improve self‐efficacy.     

上海市卢湾区55岁及以上人群跌倒流行病学调查分析

目的了解上海市卢湾区55岁及以上人群跌倒伤害流行特征。方法采用问卷调查方式,对4706名上海卢湾区55岁及以上常住居民进行了跌倒伤害横断面流行病学调查。结果上海市卢湾区55岁及以上人群跌倒发生率为4．02％;男女跌倒发生有所不同,女性发生跌倒高于男性（5．53％vs2．31％,χ^2=29．29,P=0：000）,随着年龄的增长,跌倒发生的风险也呈增加趋势（χ^2=28．03,P=0．000）,文化程度越低,跌倒的发生率越高（趋势r=9．22,P=0．002）,离婚（r=9．42,P=0．002）和丧偶（χ^2=26．10,P=0．000）的跌倒发生率比已婚的高。跌倒多数发生在家中（37．57％）,跌倒后造成不同程度的损伤,其中以骨折最常见（43．92％）。结论年龄、文化程度及婚姻状况都是影响55岁以上人群跌倒发生的主要因素。女性较男性更易发生跌倒。同时,居家是发生跌倒的主要地点,骨折是主要损伤结局。     

Medications and multiple falls in elderly people: the St Louis OASIS study.

The purpose of this study was to identify associations between the use of commonly taken medications and groups of medications and the risk of falls in elderly people living in the community. A stratified random sample of 1358 persons aged 65 years and over was selected from the 15,000 members of an educational organization for functionally independent, community-dwelling elderly people in St Louis, Missouri. Twenty-seven per cent of subjects reported at least one fall in the past year and 8% reported two or more falls. After adjusting for potential confounders (including age, sex, relevant medical conditions, health status, cognitive impairment, use of alcohol, depression and use of other medications), the following medications were found to be important risk factors for multiple falls: diazepam [odds ratio (OR): 3.7, 95% confidence interval (CI): 1.5-9.3], diltiazem (OR: 1.8, 95% CI: 0.8-4.1), diuretics (OR: 1.8, 95% CI: 1.2-2.8) and laxatives (OR: 2.1, 95% CI: 1.0-4.5). We conclude that caution is needed before prescribing diuretics and psychotropics, especially diazepam, for elderly people. The safety of diltiazem in this age group should be assessed further.     

A two-year longitudinal study of falls in 482 community-dwelling elderly adults

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 prospective studies on the long-term consequences of falls other than injury. METHODS: Risk factors and consequences of falls were analyzed in a 24-month prospective 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 questionnaire. 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.