Patients with recurrent falls attending Accident & Emergency benefit from multifactorial intervention--a randomised controlled trial

OBJECTIVES: To determine the effectiveness of multifactorial intervention to prevent falls in cognitively intact older persons with recurrent falls. DESIGN: Randomised controlled trial of multifactorial (medical, physiotherapy and occupational therapy) post-fall assessment and intervention compared with conventional care. SETTING: Accident & Emergency departments in a university teaching hospital and associated district general hospital. SUBJECTS: 313 cognitively intact men and women aged over 65 years presenting to Accident & Emergency with a fall or fall-related injury and at least one additional fall in the preceding year; 159 randomised to assessment and intervention and 154 to conventional care. Outcome measures: primary outcome was the number of falls and fallers in 1 year after recruitment. Secondary outcomes included injury rates, fall-related hospital admissions, mortality and fear of falling. RESULTS: There were 36% fewer falls in the intervention group (relative risk 0.64, 95% confidence interval 0.46-0.90). The proportion of subjects continuing to fall (65% (94/144) compared with 68% (102/149) relative risk 0.95, 95% confidence interval 0.81-1.12), and the number of fall-related attendances and hospital admissions was not different between groups. Duration of hospital admission was reduced (mean difference admission duration 3.6 days, 95% confidence interval 0.1-7.6) and falls efficacy was better in the intervention group (mean difference in Activities Specific Balance Confidence Score of 7.5, 95% confidence interval 0.72-14.2). CONCLUSION: Multifactorial intervention is effective at reducing the fall burden in cognitively intact older persons with recurrent falls attending Accident & Emergency, but does not reduce the proportion of subjects still falling.     

Inpatient falls and injuries in older patients treated for femoral neck fracture

A prospective inpatient study was performed at the Orthopedic and Geriatric Departments at the Ume? University Hospital, Sweden, to study inpatient falls, fall-related injuries, and risk factors for falls following femoral neck fracture surgery. Ninety-seven patients with femoral neck fracture aged 70 years or older were included, background characteristics, falls, injuries, and other postoperative complications were assessed and registered during the hospitalization. There were 60 postoperative falls among 26/97 patients (27%). The postoperative fall event rate was 16.3/1000 Days (95% CI 12.2-20.4). Thirty two percent of the falls resulted in injuries, 25% minor, and 7% serious ones. In multiple regression analyses, delirium after Day 7, HRR 4.62 (95% CI 1.24-16.37), male sex 3.92 (1.58-9.73), and sleeping disturbances 3.49 (1.24-9.86), were associated with inpatient falls. Forty-five percent of the patients were delirious the day they fell. Intervention programs, including prevention and treatment of delirium and sleeping disturbances, as well as better supervision of male patients, could be possible fall prevention strategies. Improvement of the quality of care and rehabilitation, with the focus on fall prevention based on these results, should be implemented in postoperative care of older people.     

Fall injuries among the elderly. Community-based surveillance

Falls are a leading cause of fatal and nonfatal injuries among the elderly in the United States. Despite the importance of fall injuries, epidemiological studies of falls among the elderly have identified neither their causes nor the methods to prevent them. Therefore, we established a community-based surveillance system in Miami Beach, Florida, as part of a study to assess falls among the elderly. A total of 1,827 fall injury events occurred in this community between July 1985 and June 1986. More than 85% (1,567) of the persons who fell and received care were seen in an emergency room. The remaining cases were identified from one of the three other sources used: fire rescue reports, inpatient medical records, or medical examiner reports. Most falls (97%) were coded as accidental (E880-E888). More than 100 people sought medical assistance for a fall each month. The time of the injury was known for 68% (1,244) of the people who fell. Seventy-four percent of these falls (921) occurred during daylight hours. Fifty-four percent of the falls (986) occurred in and around the home, and 38% of these had a particular area of the home recorded: 42% occurred in the bedroom, 34% in the bathroom, 9% in the kitchen, 5% on the stairs, 4% in the living room, and the remaining 6% in other areas. This surveillance system will help us use the study to clarify the causes of falls in the elderly and identify and evaluate appropriate prevention efforts. It will also help others in designing and implementing other injury surveillance systems.     

Characteristics of falls in physically active community-dwelling older people

BACKGROUND: Falls are common in physically active older people due to their increased exposure to hazardous situations. However, most studies of the characteristics and circumstances of falls are based on frail older people. OBJECTIVE: To describe the location, time, cause, injuries and medical treatment associated with falls in a physically active group of older people. METHODS: Prospective falls data over a 12-month period were obtained from 293 people (163 men and 130 women) aged between 70 and 90 years who took part in the "Standfest im Alter" study, a randomized controlled trial conducted in Erlagen, Germany. RESULTS: During the study period, there were 322 falls. 122 participants (42%) fell at least once and 62 (21%) fell on multiple occasions. The typical fall occurred outside the home during leisure activities, at midday or in the afternoon and did not result in injury or admission to hospital. There were no differences in the rate of falls according to gender; however, fall location, time of fall, fall injury and visits to the doctor after the fall were all influenced by gender. CONCLUSIONS: The results of this study provide useful insights into the characteristics and circumstances of falls in physically active older people living in the community, which may assist with the development of future falls prevention activities.     

Evaluation of a nurse-led falls prevention programme versus usual care: a randomized controlled trial

OBJECTIVE: to evaluate a nurse-led management plan and care pathway for older people discharged from an Accident and Emergency Department after a fall. DESIGN: randomized controlled trial. SETTING: a large teaching hospital. SUBJECTS: 348 consecutive patients aged 65 or over attending the Accident and Emergency Department with a fall. INTERVENTIONS: we randomized patients to falls nurse intervention or usual care. Within 4 weeks, the intervention group received a home assessment to address easily modifiable risk factors for falls. This included assessments of medication, ECG, blood pressure, cognition, visual acuity, hearing, vestibular dysfunction, balance, mobility, feet and footwear. All patients were given advice and education about general safety in the home. MAIN OUTCOME MEASURES: Further falls, functional ability, re-attendance at the Accident and Emergency Department and admission to hospital. RESULTS: at 6 months post-Index fall, 36 patients in the intervention group and 39 patients in the control group had had 89 and 145 falls respectively. Although the intervention group had less falls, this was not significant (P>0.05). Similarly, the intervention group had fewer fall-related admissions and bed days (8 and 69 respectively) than the control group (10 and 233 respectively). The intervention group scored significantly higher in indicators of function (P<0.05) and mobility within the community (P<0.02). CONCLUSIONS: although the differences were not significant, patients in the intervention group had fewer falls, less hospital attendances and spent less time in hospital. Moreover, patients in the intervention group were more functionally independent at 6 months post-Index fall.     

Preventing falls and fall-related injuries in hospitals

Falls are a widespread concern in hospitals settings, with whole hospital rates of between 3 and 5 falls per 1000 bed-days representing around a million inpatient falls occurring in the United States each year. Between 1% and 3% of falls in hospitals result in fracture, but even minor injuries can cause distress and delay rehabilitation. Risk factors most consistently found in the inpatient population include a history of falling, muscle weakness, agitation and confusion, urinary incontinence or frequency, sedative medication, and postural hypotension. Based on systematic reviews, recent research, and clinical and ethical considerations, the most appropriate approach to fall prevention in the hospital environment includes multifactorial interventions with multiprofessional input. There is also some evidence that delirium avoidance programs, reducing sedative and hypnotic medication, in-depth patient education, and sustained exercise programs may reduce falls as single interventions. There is no convincing evidence that hip protectors, movement alarms, or low-low beds reduce falls or injury in the hospital setting. International approaches to developing and maintaining a fall prevention program suggest that commitment of management and a range of clinical and support staff is crucial to success.     

One-Leg Balance Is an Important Predictor of Injurious Falls in Older Persons

OBJECTIVE: To test the hypothesis that one-leg balance is a significant predictor of falls and injurious falls. DESIGN: Analysis of data from a longitudinal cohort study. SUBJECTS: Healthy, community-living volunteers older than age 60 enrolled in the Albuquerque Falls Study and followed for 3 years (N = 316; mean age 73 years). MAIN OUTCOME MEASURES: Falls and injurious falls detected via reports every other month. INDEPENDENT VARIABLES: Baseline measures of demographics, history, physical examination, Iowa Self Assessment Inventory, balance and gait assesessment, and one-leg balance (ability to stand unassisted for 5 seconds on one leg). RESULTS: At baseline, 84.5% of subjects could perform one-leg balance. (Impairment was associated with older age and gait abnormalities.) Over the 3-year follow-up, 71% experienced a fall and 22% an injurious fall. The only independent significant predictor of all falls using logistic regression was age greater than 73. However, impaired one-leg balance was the only significant independent predictor of injurious falls (relative risk: 2.13; 95% CI: 1.04, 4.34; P = .03). CONCLUSION: One-leg balance appears to be a significant and easy-to-administer predictor of injurious falls, but not of all falls. In our study, it was the strongest individual predictor. However, no single factor seems to be accurate enough to be relied on as a sole predictor of fall risk or fall injury risk because so many diverse factors are involved in falling.     

Veterans’ fall risk profile: a prevalence study

The Veterans Health Administration (VHA) serves the health care needs of an adult, predominantly male, and aging population. The aging profile of VHA patients is 25% greater than the civilian sector (DVA 2001). Aged patients are at higher risk for falls. In February 2002, 6 VHA medical centers profiled their inpatients’ fall risk profile as one aspect of program initiatives targeted at reducing veterans’ fall risk and fall-related injuries, participating in a one-day collection of fall risk measurement using the Morse Fall Scale (MFS) for all inpatients (n=1819), acute and long-term care units. Data results are reported for age, MFS score, and the relationship between age and score, and by type of ward/unit, ie, predominately acute and critical care or long-term care. The results of this prevalence study documented that the veteran inpatient population are at high-risk for anticipated physiological falls. This Veteran Integrated Services Network-wide Deployment of an Evidence-based Program to Prevent Patient Falls study was completed as part of a nationally funded clinical initiative, National Program Initiative 20-006-1.     

Retrospective analysis and nursing management of inpatient falls: Case series

Background:Falls are common adverse events: approximately 1 million falls occur in hospitals annually, accounting for approximately 70% of inpatient accidents.Objectives:This study aimed to identify the characteristics of adverse fall events in our hospital from January 2019 to October 2021; it also had the goal of formulating nursing management countermeasures to reduce the occurrence of falls in our hospital. Identify the impact of formulated fall prevention and Group standards.Methods:Details of falls were obtained from the nursing adverse event reporting system of the Affiliated Hospital of Nantong University from January 2019 to December 2020. We analyzed 76 falls reported to the nursing department using a nonpunitive reporting system. We established fall prevention and Group standards. And compared with falls from March to October 2021.Results:In the study period, before the intervention, 76 falls occurred in the hospital: 18 in the day shift and 58 in the night shift. Among the falls, 32 (42.1%) occurred at the bedside; that figure was followed by 26 in the toilet (34.2%) and 18 in other places outside the ward (23.7%). The top 3 causes of the falls accounted for 84.2% of the cases: 14 were caused by nurses; 20 were caused by the patients themselves; and 30 cases were caused by concomitant factors. Regarding the consequences of the falls, 18 patients were uninjured, 22 had a mild injury, 12 were moderately injured, and 24 suffered severe injuries. After the intervention, there were fewer falls per patient day and when patients were less likely to be injured in a fall (P < .05).Conclusions:Enhancing awareness of factors that lead to inpatients falls may reduce the risk of concomitant injuries. Group standards should be established to prevent falls. In accordance with standards, it is necessary to consider health education and process supervision; it is also important to encourage inpatients to participate in safety management and to effectively ensure the safety of patients.     

Preventing injuries in older people by preventing falls: a meta-analysis of individual-level data

OBJECTIVES: Our falls prevention research group has conducted four controlled trials of a home exercise program to prevent falls in older people. The objectives of this meta-analysis of these trials were to estimate the overall effect of the exercise program on the numbers of falls and fall-related injuries and to identify subgroups that would benefit most from the program. DESIGN: We pooled individual-level data from the four trials to investigate the effect of the program in those aged 80 and older, in those with a previous fall, and in men and women. SETTING: Nine cities and towns in New Zealand. PARTICIPANTS: One thousand sixteen community dwelling women and men aged 65 to 97. INTERVENTION: A program of muscle strengthening and balance retraining exercises designed specifically to prevent falls and individually prescribed and delivered at home by trained health professionals. MEASUREMENTS: Main outcomes were number of falls and number of injuries resulting from falls during the trials. RESULTS: The overall effect of the program was to reduce the number of falls and the number of fall-related injuries by 35% (incidence rate ratio (IRR) = 0.65, 95% confidence interval (CI) = 0.57-0.75; and, respectively IRR = 0.65, 95% CI = 0.53-0.81.) In injury prevention, participants aged 80 and older benefited significantly more from the program than those aged 65 to 79. The program was equally effective in reducing fall rates in those with and without a previous fall, but participants reporting a fall in the previous year had a higher fall rate (IRR = 2.34, 95% CI = 1.64-3.34). The program was equally effective in men and women. CONCLUSION: This exercise program was most effective in reducing fall-related injuries in those aged 80 and older and resulted in a higher absolute reduction in injurious falls when offered to those with a history of a previous fall.     

Exercise training for rehabilitation and secondary prevention of falls in geriatric patients with a history of injurious falls

OBJECTIVE: To determine the safety and efficacy of an exercise protocol designed to improve strength, mobility, and balance and to reduce subsequent falls in geriatric patients with a history of injurious falls. DESIGN: A randomized controlled 3-month intervention trial, with an additional 3-month follow-up. SETTING: Out-patient geriatric rehabilitation unit. PARTICIPANTS: Fifty-seven female geriatric patients (mean age 82 +/- 4.8 years; range 75-90) admitted to acute care or inpatient rehabilitation with a history of recurrent or injurious falls including patients with acute fall-related fracture. INTERVENTION: Ambulatory training of strength, functional performance, and balance 3 times per week for 3 months. Patients of the control group attended a placebo group 3 times a week for 3 months. Both groups received an identical physiotherapeutic treatment 2 times a week, in which strengthening and balance training were excluded. MEASUREMENTS: Strength, functional ability, motor function, psychological parameters, and fall rates were assessed by standardized protocols at the beginning (T1) and the end (T2) of intervention. Patients were followed up for 3 months after the intervention (T3). RESULTS: No training-related medical problems occurred in the study group. Forty-five patients (79%) completed all assessments after the intervention and follow-up period. Adherence was excellent in both groups (intervention 85.4 +/- 27.8% vs control 84.2 +/- 29.3%). The patients in the intervention group increased strength, functional motor performance, and balance significantly. Fall-related behavioral and emotional restrictions were reduced significantly. Improvements persisted during the 3-month follow-up with only moderate losses. For patients of the control group, no change in strength, functional performance, or emotional status could be documented during intervention and follow-up. Fall incidence was reduced nonsignificantly by 25% in the intervention group compared with the control group (RR:0.753 CI:0.455-1.245). CONCLUSIONS: Progressive resistance training and progressive functional training are safe and effective methods of increasing strength and functional performance and reducing fall-related behavioral and emotional restrictions during ambulant rehabilitation in frail, high-risk geriatric patients with a history of injurious falls.     

Functional Restriction for the Fear of Falling In Family Caregivers

Hip fractures often result from falls, and most family caregivers fear another fall. This study aimed to assess this fear in family caregivers and analyze its influence on functional recovery.This study was retrospectively performed by interview at the clinic or through telephone contact. The Falls Efficacy Scale International (FES-I) was used to assess fall-related feelings of patients and their family caregivers.Of the 539 patients studied, hip fracture was caused by a fall in 467 (86.6%). The mean FES-I value of the family caregivers was significantly lower than that of the patients (85.39 versus 99.02, P < 0.001). The mean patient functional recovery score (FRS) was 68.41. A fracture caused by a fall and recurrent fall-related fractures both reduced caregiver FES-I scores. The difference between patient and caregiver FES-I scores showed a significant positive correlation with the FRS (P < 0.001).Family caregivers were more concerned about falls than were patients. Furthermore, a greater difference in the fall-related reaction between caregivers and patients was associated with greater adverse effects on rehabilitation.     

An evaluation of footwear worn at the time of fall-related hip fracture

BACKGROUND: a range of footwear features have been shown to influence balance in older people, however, little is known about the relationships between inappropriate footwear, falls and hip fracture. OBJECTIVES: to describe the characteristics of footwear worn at the time of fall-related hip fracture and establish whether the features of the shoe influenced the type of fall associated with the fracture. METHODS: 95 older people (average age 78.3 years, SD 7.9) who had suffered a fall-related hip fracture were asked to identify the footwear they were wearing when they fell. Footwear characteristics were then evaluated using a standardised assessment form. Information was also collected on the type and location of fall. RESULTS: the most common type of footwear worn at the time of the fall was slippers (22%), followed by walking shoes (17%) and sandals (8%). Few subjects were wearing high heels when they fell (2%). The majority of subjects (75%) wore shoes with at least one theoretically sub-optimal feature, such as absent fixation (63%), excessively flexible heel counters (43%) and excessively flexible soles (43%). Subjects who tripped were more likely to be wearing shoes with no fixation compared to those who reported other types of falls [chi(2)=4.21, df=1, P=0.033; OR=2.93 (95%CI 1.03-8.38)]. CONCLUSIONS: many older people who have had a fall-related hip fracture were wearing potentially hazardous footwear when they fell. The wearing of slippers or shoes without fixation may be associated with increased risk of tripping. Prospective studies into this proposed association appear warranted.     

Sturzereignisse stationärer geriatrischer Patienten—

For a period of 3 consecutive years, all fall events were prospectively recorded in geriatric hospital in-patients by using a standardized protocol. The incidence was 9.1 fall events/1000 hospital days in 5946 patients, and 41.0/1000 hospital days in 1015 patients (17.0%) who actually had falls. The fall rate varied between 35.0-57.0/1000 hospital days according to the main diagnostic group. Fall events were more often recorded in men than women. Recurrent falls (> or =3 falls) which contributed 13% to the 1596 falls were recorded more frequently in male patients. The majority of fall events (73.5%) occurred in patient rooms, another 20% on the floor between the patient's bedroom and toilet/bath, or in the toilet/bath, respectively. The absolute numbers of falls during night and day were not different. However, there were different patterns in the time distribution of high fall frequencies according to the main diagnostic groups. Confusion and dehydration were recorded more frequently with fall events in patients 80 years and older, and more often in fall events during the night. Injuries due to falls which had to be treated were rare, and fall-related fractures were very rare. The average duration of in-hospital stay was longer for patients with than without falls.     

Pragmatic,Cluster Randomized Trial of a Policy to Introduce Low‐Low Beds to Hospital Wards for the Prevention of Falls and Fall Injuries

OBJECTIVES: To evaluate the efficacy of a policy to introduce low‐low beds for the prevention of falls and fall injuries on wards that had not previously accessed low‐low beds. DESIGN: This was a pragmatic, matched, cluster randomized trial with wards paired according to rate of falls. Intervention and control wards were observed for a 6‐month period after implementation of the low‐low beds on the intervention wards. Data from a 6‐month period before this were also collected and included in analyses to ensure comparability between intervention and control group wards. SETTING: Public hospitals located in Queensland, Australia. PARTICIPANTS: Patients of 18 public hospital wards. INTERVENTION: Provision of one low‐low bed for every 12 on a hospital ward, with written guidance for identifying patients at greatest risk of falls. MEASUREMENTS: Falls and fall injuries in the hospital measured using a computerized incident reporting system. RESULTS: There were 10,937 admissions to control and intervention wards combined during the pre‐intervention period. There was no significant difference in the rate of falls per 1,000 occupied bed days between intervention and control group wards after the introduction of the low‐low beds (generalized estimating equation coefficient=0.23, 95% confidence interval=?0.18–0.65, P=.28). The rate of bed falls, falls resulting in injury, and falls resulting in fracture also did not differ between groups. Some difficulties were encountered in intervention group wards in using the low‐low beds as directed. CONCLUSION: A policy for the introduction of low‐low beds did not appear to reduce falls or falls with injury, although larger studies would be required to determine their effect on fall‐related fractures.     

Fall prediction in inpatients by bedside nurses using the St. Thomas's Risk Assessment Tool in Falling Elderly Inpatients (STRATIFY) instrument: a multicenter study

OBJECTIVES: To assess the predictive value of the St. Thomas's Risk Assessment Tool in Falling Elderly Inpatients (STRATIFY) instrument, a simple fall-risk assessment tool, when administered at a patient's hospital bedside by nurses. DESIGN: Prospective multicenter study. SETTING: Six Belgian hospitals. PARTICIPANTS: A total of 2,568 patients (mean age+/-standard deviation 67.2+/-18.4; 55.3% female) on four surgical (n=875, 34.1%), eight geriatric (n=687, 26.8%), and four general medical wards (n=1,006, 39.2%) were included in this study upon hospital admission. All patients were hospitalized for at least 48 hours. MEASUREMENTS: Nurses completed the STRATIFY within 24 hours after admission of the patient. Falls were documented on a standardized incident report form. RESULTS: The number of fallers was 136 (5.3%), accounting for 190 falls and an overall rate of 7.3 falls per 1,000 patient days for all hospitals. The STRATIFY showed good sensitivity (> or = 84%) and high negative predictive value (> or = 99%) for the total sample, for patients admitted to general medical and surgical wards, and for patients younger than 75, although it showed moderate (69%) to low (52%) sensitivity and high false-negative rates (31-48%) for patients admitted to geriatric wards and for patients aged 75 and older. CONCLUSION: Although the STRATIFY satisfactorily predicted the fall risk of patients admitted to general medical and surgical wards and patients younger than 75, it failed to predict the fall risk of patients admitted to geriatric wards and patients aged 75 and older (particularly those aged 75-84).     

St��rze in der Geriatrie

Falls are among the most frequent adverse events in the life of an older person. Accident and emergency units, outpatient services and internal medicine wards should have a diagnostic concept for falls and fall-related injuries and implement an evidence-based risk management for fall prevention. The recently published Reviews of the Cochrane Collaboration and the revised guidelines of the Anglo-American medical societies are a proper basis to plan these steps. This, of course, has to be adapted for the needs of each institution. Currently, it is probable that at least 30% of all falls are preventable. A structured fall history and multifactorial assessment is not part of the routine of outpatient and inpatient services in Germany. The planned revision of the German nursing guideline on fall prevention and the current activities of the Aktionsbündnis Patientensicherheit will also lead to a legal dilemma for those institutions that have not implemented an adequate workup.     

Risk factors associated with falls among Chinese hospital inpatients in Taiwan

Falls among hospital inpatients were not uncommon and were associated with physical, functional and psychological morbidity for patients and excess cost, bed occupancy, complaints and litigation for hospitals. Risk factors for falls of hospital inpatients have been reported, but rarely in a case-control design. To our best knowledge, there was no case-control study for risk of fall among hospital inpatients in Taiwan, one of the most rapidly aging countries. The main purpose of this study was to determine risk factors for falls among hospital inpatients in Taiwan. A prospective multi-center case-control study was started in 2002. During the study period, all incident falls reported by ward nurses were carefully reviewed by research staff on the next day, and a matched control subject was generated according to the age, sex, diagnosis, and pre-event length of stay. Risk factors of falls, including physical conditions, pharmaceutical agents, and environmental factors were compared between fallers and controls. In total, 202 incident falls (202 fallers, none of them fell twice, mean age: 68.2+/-16.9 years, 73.8% males) were reported and the overall incidence of falls during the study period was 4.4 per 1000 bed days. Leg weakness (odds ratio (OR): 1.88, 95% confidence interval (CI): 1.16-3.05), reported insomnia at admission (OR: 2.28; 95% CI: 1.06-4.89), postural hypotension (OR: 5.57; 95% CI: 1.54-21.46), previous history of fall within 1 year before admissions (OR: 5.05, CI: 2.60-9.78), recent use of hypnotics (within 24h) (OR: 1.86, 95% CI: 1.10-3.14) were all significant risk factors (for all comparisons p<0.05), but family member's company may reduce in-hospital falls (OR: 0.51; 95% CI: 0.33-0.78). In conclusion, the incidence of falls among hospital inpatients was lower than that reported from other countries. Further study is needed to organize a comprehensive fall prevention program according to the risk factors identified in this study to reduce in-hospital falls in Taiwan.     

Long-term survival after falls among the elderly in institutional care

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.