Falls in nonagenarians living in their own homes: The NonaSantfeliu study

Objectives: To evaluate the prevalence of falls and their circumstances in non-institutionalized people older than 89 years and living in an urban community.Design: Cross-sectional cohort study.Setting: Community-based study.Participants: 137 nonagenarians living at home.Measurements: We evaluated socio-demographic data, capacity to perform basic activities according to the Barthel Index (BI) and instrumental activities on the Lawton-Brody Index (LI), cognition with the Spanish version of the Mini-Mental State Examination (MEC), near visual acuity by the Snellen test, and auditory acuity with the whisper test.Results: Ninety-nine women (72%) and 38 men with an average age of 93.07 years (0.7) were included. 48.1% of them had suffered a fall during the last year, and in 20% of cases this had happened on more than one occasion. In 5.7% of cases, falls led to fractures. Factors associated with falls were a lower LI and a greater number of prescribed drugs. In the multivariate analysis the only factor related to falls was the number of drugs taken (p>0.001, odds ratio 0.785, 95% confidence interval 0.676–0.912).Conclusions: Measures to prevent falls among nonagenarians should be intensified due to their high frequency. In this age group the increase in the percentage of falls is mainly related to the higher number of drugs taken.     

Age,Sex, and Dose Effects of Nonbenzodiazepine Hypnotics on Hip Fracture in Nursing Home Residents

Objective

The Food and Drug Administration recommends a reduced dose of nonbenzodiazepine hypnotics in women, yet little is known about the age-, sex-, and dose-specific effects of these drugs on risk of hip fracture, especially among nursing home (NH) residents. We estimated the age-, sex-, and dose-specific effects of nonbenzodiazepine hypnotics on the rate of hip fracture among NH residents.

Risk of Hospitalized Falls and Hip Fractures in 22,103 Older Adults Receiving Mental Health Care vs 161,603 Controls: A Large Cohort Study

ObjectivesTo investigate the risk of hospitalized fall or hip fracture among older adults using mental health services.DesignRetrospective cohort study.Setting and ParticipantsResidents of a South London catchment aged >60 years receiving specialist mental health care between 2008 and 2016.MeasuresFalls and/or a hip fracture leading to hospitalization were ascertained from linked national records. Incidence rates and incidence rate ratios (IRRs) were age- and gender-standardized to the catchment population. Multivariable survival analyses were applied investigating falls and/or hip fractures as outcomes.ResultsIn 22,103 older adults, incidence rates were 60.1 per 1000 person-years for hospitalized falls and 13.7 per 1000 person-years for hip fractures, representing standardized IRRs of 2.17 [95% confidence interval (CI) 2.07-2.28] and 4.18 (3.79-4.60), respectively. The IRR for falls was high in those with substance-use disorder [IRR = 6.72 (5.35-8.33)], bipolar disorder [IRR = 3.62 (2.50-5.05)], depression [IRR = 2.28 (2.00-2.59)], and stress-related disorders [IRR = 2.57 (2.10-3.11)]. Hip fractures were increased in all populations (IRR > 2.5), with greatest risk in substance use disorders [IRR = 12.64 (7.22-20.52)], dementia [IRR = 4.38 (3.82-5.00)], and delirium [IRR = 4.03 (3.00-5.29)]. Comparing mental disorder subgroups with each other, after the adjustment for 25 potential confounders, patients with dementia and substance use had a significantly increased risk of falls, and patients with dementia also had an increased risk of hip fractures.Conclusion and ImplicationsOlder people using mental health services have more than double the incidence of falls and 4 times the incidence of hip fractures compared to the general population. Although incidences differ between diagnostic subgroups, all groups have a higher incidence than the general population. Targeted interventions to prevent falls and hip fractures among older adult mental health service users are urgently needed.     

Falls and hip fracture in Hong Kong Chinese

The risk factors for hip fracture were studied in four hundred patients and eight hundred community and hospital controls. Falling was found to be important as a direct cause of fracture. A history of falls was a significant risk factor for hip fracture in men and women younger than 70, but was less important in older men and women. Medical conditions and treatments did not occur more frequently in hip fracture patients with a history of falls than in patients without, and the patients with a history of falls was not less ambulant than patients without. Regular weight-bearing exercise programmes are recommended as a practical preventive measure for falls and hip fractures.     

Fear of Falling in Patients With Hip Fractures: Prevalence and Related Psychological Factors

ObjectiveTo determine the prevalence of fear of falling (FoF) in patients after a hip fracture, to investigate the relation with time after fracture, and to assess associations between FoF and other psychological factors.DesignCross-sectional study performed between September 2010 and March 2011 in elderly patients after a hip fracture.SettingTen postacute geriatric rehabilitation wards in Dutch nursing homes.ParticipantsA total of 100 patients aged ≥65 years with a hip fracture admitted to a geriatric rehabilitation ward.MeasurementsFoF and related concepts such as falls-related self-efficacy, depression, and anxiety were measured by means of self-assessment instruments.ResultsOf all patients, 36% had a little FoF and 27% had quite a bit or very much FoF. Scores on the Falls Efficacy Scale-International were 30.6 in the first 4 weeks after hip fracture, 35.6 in the second 4 weeks, and 29.4 in the period ≥8 weeks after fracture. In these 3 periods, the prevalence rates of FoF were 62%, 68%, and 59%, respectively. Significant correlations were found between FoF and anxiety (P < .001), and self-efficacy (P < .001).ConclusionIn these patients with a hip fracture, FoF is common and is correlated with anxiety and falls-related self-efficacy. During rehabilitation, FoF is greatest in the second 4 weeks after hip fracture. More studies are needed to explore the determinants of FoF and develop interventions to reduce FoF and improve outcome after rehabilitation.     

Mild anemia and the risk of falls in older adults from nursing homes and the community

OBJECTIVES: The objectives of this study were to determine if a relationship exists between a history of falls and anemia in older adults and to compare the findings by place of residence. DESIGN: The authors conducted a retrospective and observational study. PARTICIPANTS: One hundred forty-five adults (60-97 years of age) from nursing homes and the community hospitalized for hip fracture over a 2-year period were included in this study. MEASUREMENTS: Laboratory values (hemoglobin [Hb], hematocrit [Hct]), medical history, and demographics were measured. RESULTS: Falls occurred similarly in both nursing home patients and community patients (19% vs. 17%, P=0.785). Nursing home and community patients also had similar Hb (P=0.0899), Hct (P=0.1929), and rates of anemia (P=0.187). Nursing home residents were older (P=0.0188) and had lower serum albumin levels (P=0.0007) than community patients. When the two groups were combined, falls were more common in anemic individuals (30% vs. 13%; P=0.028). Furthermore, those with a history of falls were older (P=0.0447), had lower Hb (P=0.0257) and Hct levels (P=0.0310). After controlling for age, gender, place of residence, and arthritis in a logistic regression model, anemia predicted a threefold increased risk of falls (P=0.041), and a 45% decreased risk of falls was predicted for every 1.0-g/dL increase in Hb (P=0.005). Falls risk increased 7% per year of age (P=0.040), whereas musculoskeletal disease increased the falls risk 3.2-fold, both increases being independent of Hb levels or anemia. Finally, falls were not associated with gender or other comorbidity, nor did these variables alter the falls risk attributed to low Hb or anemia. CONCLUSIONS: These findings suggest a new and potentially important link between anemia and the risk of falls in patients sustaining hip fractures from both nursing homes and the community. Further studies will help determine if this risk is modified or eliminated with treatment of anemia and if the relationship applies to larger samples of older adults in different settings.     

Effectiveness of Hip Protectors to Reduce Risk for Hip Fracture from Falls in Long-Term Care

ObjectiveTo generate evidence of the effectiveness of hip protectors to minimize risk of hip fracture at the time of falling among residents of long-term care (LTC) by contrasting rates of hip fractures between falls with and without hip protectors.DesignA 12-month, retrospective cohort study. We retrospectively reviewed fall incident reports recorded during the 12 months prior to baseline in participating homes.Setting and participantsA population-based sample comprising all residents from 14 LTC homes owned and operated by a single regional health authority, who experienced at least 1 recorded fall during the 12-month study.ResultsAt baseline, the pooled mean (standard deviation) age of residents in participating homes was 82.7 (11.3) years and 68% were female. Hip protectors were worn in 2108 of 3520 (60%) recorded falls. Propensity to wear hip protectors was associated with male sex, cognitive impairment, wandering behavior, cardiac dysrhythmia, use of a cane or walker, use of anti-anxiety medication, and presence of urinary and bowel incontinence. The incidence of hip fracture was 0.33 per 100 falls in falls with hip protectors compared with 0.92 per 100 falls in falls without hip protectors, representing an unadjusted relative risk (RR) of hip fracture of 0.36 (95% confidence interval 0.14–0.90, P = .029) between protected and unprotected falls. After adjusting for propensity to wear hip protectors, the RR of hip fracture was 0.38 (95% confidence interval 0.14–0.99, P = .048) during protected vs unprotected falls.Conclusions and implicationsHip protectors were worn in 60% of falls, and the risk of hip fracture was reduced by nearly 3-fold by wearing a hip protector at the time of falling. Given that most clinical trials have failed to attain a similar level of adherence, our findings support the need for future research on the benefits of dissemination and implementation strategies to maximize adherence with hip protectors in LTC.     

Falling in Parkinson disease: more often due to postural instability than to environmental factors

OBJECTIVE: To document the circumstances surrounding falls in patients with Parkinson's disease. DESIGN: Prospective. METHOD: Parkinson patients with a check-up appointment in the period 1 May 1998-31 May 1999 at the Neurology Outpatient's Department of Leiden University Hospital, used standardized forms to record the circumstances surrounding all incidents of falling during the subsequent 6 months. For control purposes, a partner or acquaintance with comparable living conditions was asked to do the same. The researchers judged whether falls were related to physical impairment (personal, intrinsic factors) or environmental factors (extrinsic factors). RESULTS: 59 patients with Parkinson's disease (21 women (36%); mean age: 60.8 years; mean Hoehn and Yahr score: 2.3) and 55 controls (37 women (67%); mean age: 59.6 years) were studied. Patients reported 205 falls and controls 10 falls. Recurrent (> or = 2) falls occurred in 15 patients (25%) and two controls (4%) (relative risk (RR): 9.0: 95% confidence interval (95% CI): 2.0-41.7). Recurrent falls were more common among persons using benzodiazepines (RR: 5.0: 95% CI: 1.6-15.5). Reliable information was obtained for 160 falls in patients. Most falls (79%) had an intrinsic cause, like turning around, standing up, bending and stumbling. Abrupt movements were a particularly frequent cause of falls. Simultaneous performance of multiple tasks contributed to almost 50% of falls in patients. CONCLUSION: Falls are common among Parkinson patients. Most falls are related to intrinsic factors. Prevention of these intrinsic falls requires treatment of the underlying postural instability. Use of benzodiazepines must be avoided whenever possible. Interventions aimed at extrinsic factors, such as reduction of domestic hazards, are possibly less effective.     

衰弱综合征对社区老年糖尿病患者跌倒影响的队列研究

目的 探讨衰弱综合征与社区老年糖尿病患者跌倒之间的关系。方法 在都江堰市平义社区建立≥ 65岁老年人队列,分别于2014年1月和2017年1月进行问卷调查,包括自报糖尿病、跌倒、衰弱状态、认知功能和营养状况等。采用多因素logistic回归方法分析基线衰弱水平与随后3年内跌倒发生风险之间的关系。结果 653名老年人接受了第一次调查,473人完成第二次调查。糖尿病的患病率为13.3%,糖尿病合并衰弱综合征老年人的跌倒发生率为62.5%。衰弱综合征是非糖尿病老年人（OR=3.87,95%CI：1.45~10.28）发生跌倒的独立危险因素,且对糖尿病老年人（OR=6.68,95%CI：1.14~38.99）的影响更强。结论 衰弱综合征是老年糖尿病患者未来发生跌倒的强烈预测因子,需要早期发现和干预。     

Medication as a risk factor for falls resulting in severe fractures in the elderly

Falls leading to fractures among the elderly are a major public problem. A case-control study was conducted on the use of certain drugs as a risk factor for hospitalization due to fractures after falls among individuals aged 60 years or over in the city of Rio de Janeiro, Brazil. One hundred sixty-nine cases and 315 in-patient controls were matched by age, sex, and hospital. Odds ratios (OR) adjusted for potential confounders were calculated using conditional logistic regression. Increased risk of such accidents was found for calcium channel antagonists (OR = 1.96, 1.16-3.30) and benzodiazepines (OR = 2.09, 1.08-4.05), and decreased risk was associated with diuretics (OR = 0.40, 0.20-0.80). Antacids, digitalis, and laxatives were associated with reduced risk of fractures after falls that reached borderline statistical significance (0.05 < p < 0.10). The findings highlight the need to weigh risks and benefits of medication in the elderly. It is also important to advise such individuals and their families on how to avoid falls when such medication proves necessary.     

Long-term benzodiazepine use by elderly people living in the community

Objective : To investigate the prevalence of long‐term benzodiazepine use in an elderly community sample, and factors associated with such use. Method : Data came from the Sydney Older Persons Study, a longitudinal study of people aged 75 or over. There were 337 subjects who were interviewed in 1991–93, and subsequently followed up after three and 4.5 years. At the first interview, subjects were assessed for socio‐demographic characteristics, physical and mental health, and use of health services. At the first and subsequent interviews, subjects were asked about use of medications, including benzodiazepines. Results : There were 16.6% who were using benzodiazepines at the time of all three interviews, while a further 19.6% were using them at one or two interviews. In a multivariate ordered logit regression model, long‐term benzodiazepine use was associated with treatment for nervous conditions, restless sleep, being female, being divorced and greater contact with medical services. Conclusions : The prevalence of benzodiazepine use in the elderly is high and much of this use is long term. The high prevalence of benzodiazepine use stands in contrast to the findings from national surveys that the elderly living in the community tend to have better mental health than younger age groups. Implications : Efforts are needed to reduce the number of elderly people becoming long‐term users. The use of benzodiazepines in this age group is of particular concern, because they may be a risk factor for falls and for cognitive impairment in the elderly.     

Risk Factors Correlated with Post-operative Mortality for Hip Fracture Surgery in the Elderly: A Population-based Approach

Objectives: To estimate the effect of waiting time for surgery and volume of surgical activity on mortality in patients with hip fracture and to compare risk-adjusted outcomes between hospitals providing surgery for such patients. Design: Retrospective cohort study. Setting: Friuli Venezia Giulia, Italy. Participants: A total of 6,629 elderly people who underwent surgery for hip fracture between 1st January 1996 and 31th December 2000. Main outcome measures: In-hospital, 6-month and 1-year mortality rate Results: In-hospital mortality rate was 5.4%. At six months, the mortality rate was 20.0%, and at 1 year 25.3%. Age, male sex, and comorbidity were significant predictors of mortality. Logistic regression analysis indicated that, after controlling for main patients risk factors and taking into account the hospital level variability, there was no significant association between increase in mortality rate and more than 1 day of waiting time for surgery (OR 0.90; 95% CI 0.58–1.40 for in-hospital mortality). One hospital had a significantly higher mortality rate than the others; high hospital volume for hip fracture surgery was associated with worse outcomes (OR 1.57; 95% CI 1.38–1.78 for in-hospital mortality). Mortality after hip fracture decreased significantly from 1996 to 2000 (OR 0.85; 95% CI 0.80–0.90). Conclusions: Longer waiting time for surgery was not associated with mortality after adjusting for patient risk factors, and taking into account hospital level variability. Hospital level variability was statistically significant, and was partially explained by the total volume of hospital surgical activity. The decrease in mortality between 1996 and 2000 was confirmed by multivariate models.     

And mortality in older Chinese adults: Results from the Beijing longitudinal study of aging

Objectives

Falls are well known to be associated with adverse health outcomes, especially when complicated by fracture. Falls are more common in people who are frail and readily related to several items in the frailty phenotype. Less is known about the relationship between falls and frailty defined as deficit accumulation. Our objective was to investigate the relationship between falls, fractures, and frailty based on deficit accumulation.

Design

Representative cohort study, with 8 year follow-up.

Setting

The Beijing Longitudinal Study of Aging (BLSA).

Participants

3,257 Chinese people aged 55+ years at baseline.

Measurements

A frailty index (FI) was constructed using 33 health deficits, but excluding falls and fractures. The rates of falls, fractures and death as a function of age and the FI were analyzed. Multivariable models evaluated the relationships between frailty and the risk of recurrent falls, fractures, and mortality adjusting for age, sex, and education. Self or informant reported fall and fracture data were verified against participants?? health records.

Results

Of 3,257 participants at baseline (1992), 360 people (11.1%) reported a history of falls, and 238 (7.3%) reported fractures. By eight years, 1,155 people had died (35.3%). The FI was associated with an increased risk of recurrent falls (OR=1.54; 95% confidence interval (CI)=1.34?C1.76), fractures (OR=1.07; 95% CI=0.94?C1.22), and death (OR=1.50, 95% CI=1.41?C1.60). The FI showed a significant effect on mortality in a multivariate Cox regression model (Hazard Rate=1.29, 95% CI=1.25?C1.33). When adjusted for the FI, neither falls nor fractures were associated with mortality.

Conclusion

Falls and fractures were common in older Chinese adults, and associated with frailty. Only frailty was independently associated with death.     

Older fallers attended to by an ambulance but not transported to hospital: a vulnerable population at high risk of future falls

Objective : This prospective cohort study describes older non‐transported fallers seen by the Ambulance Service of New South Wales (ASNSW), quantifies the level of risk and identifies predictors of future falls and ambulance use. Methods : Participants were 262 people aged 70 years or older with a fall‐related ASNSW attendance who were not transported to an emergency department. They completed a questionnaire about health, medical and physical factors previously associated with falling. Falls were monitored for six months after ambulance attendance with monthly fall calendars. Results : Participants had a high prevalence of chronic medical conditions, functional limitations and past falls. During follow‐up, 145 participants (58%) experienced 488 falls. Significant predictors of falls during follow‐up were three or more falls in the past year, being unable to walk more than 10 minutes without resting, and requiring assistance for personal‐care activities of daily living (ADLs). Sixty‐two participants (25%) required repeat, fall‐related ambulance attendance during the study. Predictors of repeat ambulance use were: 3+ falls in past year, requiring assistance for personal‐care ADLs and having disabling pain in past month. Conclusions : Older, non‐transported fallers seen by the ASNSW are a vulnerable population with high rates of chronic health conditions. Implications : Onward referral for preventive interventions may reduce future falls and ambulance service calls.     

Fatal work‐related falls in the United States, 2003‐2014

Background

Falls are the second leading cause of work‐related fatalities among US workers. We describe fatal work‐related falls from 2003 to 2014, including demographic, work, and injury event characteristics, and changes in rates over time.

Methods

We identified fatal falls from the Bureau of Labor Statistics (BLS), Census of Fatal Occupational Injuries and estimated rates using the BLS Current Population Survey.

Results

From 2003 to 2014, there were 8880 fatal work‐related falls, at an annual rate of 5.5 per million FTE. Rates increased with age. Occupations with the highest rates included construction/extraction (42.2 per million FTE) and installation/maintenance/repair (12.5 per million FTE). Falls to a lower level represented the majority (n = 7521, 85%) compared to falls on the same level (n = 1128, 13%).

Conclusions

Falls are a persistent source of work‐related fatalities. Fall prevention should continue to focus on regulation adherence, Prevention through Design, improving fall protection, training, fostering partnerships, and increasing communication.

     

Chronic obstructive pulmonary disease and mortality following hip fracture: a population-based cohort study

Introduction: Mortality rates after hip fracture have not declined in 20 years. We assessed the impact of chronic obstructive pulmonary disease (COPD) on mortality after hip fracture, and compared mortality in this cohort to persons without hip fracture in a population-based prospective cohort study. Methods: Using Danish health care registries, we identified persons ≥40 years old with first-time hospitalization for hip fracture between 1/1/1998 and 1/31/2003. Hospitalization for COPD was assessed from hospital discharge registries. Using Cox regression, we computed relative risks (RR) and 95% confidence intervals (CI) for mortality endpoints among persons with COPD compared to persons without COPD. Mortality following hip fracture was also compared to age and gender matched controls without hip fracture. Results: We identified 11, 985 persons with first-time hospitalization for hip fracture; 771 (6.4%) had a diagnosis of COPD. Average follow up was 22 months. Compared to persons without COPD, mortality following hip fracture in persons with COPD was RR = 1.58 (95% CI 1.30–1.90) at 30 days, RR = 1.52 (95% CI 1.30–1.77) at 90–days, RR = 1.58 (95% CI 1.40–1.78) at 1 year, and RR = 1.71 (95% CI 1.55–1.88) overall. The 1-year mortality in persons with hip fracture and COPD was approximately 3–5 times greater than in controls without hip fracture. Conclusions: In this cohort, persons with COPD have a 60–70% higher risk of death following hip fracture than those without COPD. In addition, hip fracture and COPD increased 1-year mortality 3–5 times that of persons without hip fracture. Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

Epidemiology of bone fractures occurring during hospitalization

OBJECTIVE: To investigate the incidence and epidemiology of nosocomial bone fractures. DESIGN: Observational, case series. SETTING: Tertiary care center. PATIENTS: All patients sustaining a fracture during hospitalization during the 18-month study period from July 1989 through December 1990. RESULTS: Twenty nosocomial fractures were identified. Twelve of these resulted from falls (3.5 fractures from falls/100,000 patient days). Fracture rates were higher on the neurology service than on other services. Patients who fell and sustained a fracture were significantly older than patients who fell but did not sustain a fracture (74 versus 58 years, respectively, p < .05). Falls occurring on weekends and holidays were approximately three times more likely to result in fracture than falls occurring on other days (p = .06). CONCLUSIONS: Nosocomial fractures were infrequent events but were more common in the elderly and in persons with significant neuropsychological impairment. Persons who sustained fractures during hospitalization were similar to those who fell and fractured bones in a community setting.     

Educational intervention to reduce falls and fear of falling in patients after fragility fracture: results of a controlled pilot study

OBJECTIVES: Falls and fear of falling are a major health problem. We sought to determine the effectiveness of an educational intervention in reducing fear of falling and preventing recurrent falls in community-dwelling patients after a fragility fracture. METHODS: One hundred two community-dwelling patients aged 50 years or older who fell and sustained a wrist fracture and were treated at Emergency Departments in Edmonton, Alberta, Canada (2001-2002) were allocated to either standardized educational leaflets and post-discharge telephone counseling regarding fall prevention strategies ("intervention") or attention-controls ("controls"). Main outcomes were fear of falling and recurrent falls 3 months after fracture. RESULTS: Mean age was 67 years and most patients were female (80%). The majority of falls (76%) leading to fracture occurred outdoors. Three months post-fracture, almost half of patients (48%) reported increased fear of falling and 11 of 102 (11%) reported falling again. The intervention did not reduce the fear of falling (43% had increased fear vs. 53% of controls, adjusted P value=0.55) or decrease recurrent falls (17% fell vs. 5% of controls, adjusted P value=0.059) within 3 months of fracture. CONCLUSIONS: An educational intervention undertaken in the Emergency Department was no more effective than usual care in reducing fear of falling or recurrent falls in community-dwelling patients. Future strategies must address a number of dimensions beyond simple education.