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Predisposing and precipitating factors for falls among older people in residential care
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
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2002 (English)In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 116, no 5, 263-271 p.Article in journal (Refereed) Published
Abstract [en]

Falls and their consequences are serious health problems among older populations. To study predisposing and precipitating factors for falls among older people in residential care we used a cross-sectional study design with a prospective follow up for falls. Fifty-eight women and 25 men, with a mean age of 79.6 y, were included and prospectively followed up regarding falls for a period of 1 y after baseline assessments. All those who fell were assessed regarding factors that might have precipitated the fall. The incidence rate was 2.29 falls/person years. Antidepressants (selective serotonin reuptake inhibitors, SSRIs), impaired vision and being unable to use stairs without assistance were independently associated with being a 'faller'. Twenty-eight (53.8%) of the fallers suffered injuries as a result of their falls, including 21 fractures. Twenty-seven percent of the falls were judged to be precipitated by an acute illness or disease and 8.6% by a side effect of a drug. Acute symptoms of diseases or drug side effects were associated with 58% of the falls which resulted in fractures. We conclude that SSRIs seem to constitute one important factor that predisposes older people to fall, once or repeatedly. Since acute illnesses and drug side-effects were important precipitating factors, falls should be regarded as a possible symptom of disease or a side-effect of a drug until it is proven otherwise.

Place, publisher, year, edition, pages
2002. Vol. 116, no 5, 263-271 p.
Keyword [en]
accidental falls, residential care facility, older people, prediction, fractures
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:umu:diva-4068DOI: 10.1038/sj.ph.1900849PubMedID: 12209401OAI: oai:DiVA.org:umu-4068DiVA: diva2:143026
Available from: 2004-09-02 Created: 2004-09-02 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Falls in older people in geriatric care settings: predisposing and precipitating factors
Open this publication in new window or tab >>Falls in older people in geriatric care settings: predisposing and precipitating factors
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Falls and their consequences are a major health problem in the older population, increasing their immobility, morbidity and mortality. This thesis focuses on older people living in geriatric care settings, frail older people who are most prone to suffer falls. The aim was to study predisposing and precipitating factors associated with falls in older people with or without cognitive impairment.

In a cross-sectional study with a one-year prospective follow-up for falls 63% of the 83 residents suffered 163 falls and 65% of the fallers fell more than once. The antidepressants selective serotonine reuptake inhibitors (SSRIs), impaired vision and being unable to use stairs independently were the factors most strongly associated with sustaining falls. Acute diseases were judged to have precipitated 32 % of the falls and drug side effects 9%.

In another cross-sectional study with a one-year follow-up for falls, including 199 residents, previous falls and treatment with antidepressants (mainly SSRIs) were found to be the most important predisposing factor for falls. Acute disease was judged to be the precipitating factor alone or in combination, in 39% of the falls, medical drugs in 8%, external factors such as obstacles in 8% and other conditions both related to the individual and the environment, such as misinterpretation, misuse of roller walkers or mistakes made by the staff were judged to have precipitated 17% of the falls.

In a population-based cross-sectional study including 3604 residents in geriatric care settings more than 8% sustained a fall at least once during the preceding week. A history of falls, the ability to get up from a chair, the need for a helper when walking, pain, cognitive impairment, use of neuroleptics and use of antidepressants were all associated with falls in multivariate analyses. In the subgroup of people with cognitive impairment (2008 residents) more than 9% had sustained a fall at least once during the preceding week. As for the whole population, being able to get up from a chair, previous falls, needing a helper when walking with the addition of hyperactive symptoms were the factors independently associated with falls.

In a study with a one-year prospective follow up for falls, including 439 residents in residential care facilities, 63% sustained 1354 falls, corresponding to an incidence rate of 3.5 falls / person year. Thirty-three percent of the falls and 37% of the injurious falls occurred during the night (9pm-6am). There were significantly higher fall rates in the evening and in January, April, May, November and December. There were no associations between fall rates and any of the weather parameters studied.

In conclusion falls and fall-related injuries in older people in geriatric care settings are common. Both predisposing and precipitating factors contribute to the risk of falling. Addressing precipitating factors for falls seems to be important in an individualised preventive strategy among older people in geriatric care settings.

Publisher
80 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 902
Keyword
accidental falls, risk factors, older people, residential facilities, geriatric care, cognition, drug therapy, wounds and injuries, geriatric psychiatry, meteorological factors
Research subject
Geriatrics
Identifiers
urn:nbn:se:umu:diva-307 (URN)91-7305-689-8 (ISBN)
Public defence
2004-09-24, Sal Betula, 6M, 09:00
Opponent
Available from: 2004-09-02 Created: 2004-09-02 Last updated: 2010-08-02Bibliographically approved

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