umu.sePublications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Falls in older people in geriatric care settings: predisposing and precipitating factors
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
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.

Place, publisher, year, edition, pages
2004. , 80 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 902
Keyword [en]
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: urn:nbn:se:umu:diva-307ISBN: 91-7305-689-8 (print)OAI: oai:DiVA.org:umu-307DiVA: diva2:143031
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
List of papers
1. Predisposing and precipitating factors for falls among older people in residential care
Open this publication in new window or tab >>Predisposing and precipitating factors for falls among older people in residential care
Show others...
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.

Keyword
accidental falls, residential care facility, older people, prediction, fractures
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-4068 (URN)10.1038/sj.ph.1900849 (DOI)12209401 (PubMedID)
Available from: 2004-09-02 Created: 2004-09-02 Last updated: 2017-12-14Bibliographically approved
2. Why the elderly fall in residential care facilities, and suggested remedies.
Open this publication in new window or tab >>Why the elderly fall in residential care facilities, and suggested remedies.
Show others...
2004 (English)In: The Journal of family practice, ISSN 0094-3509, Vol. 53, no 1, 41-52 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To study precipitating factors for falls among older people living in residential care facilities. DESIGN: Prospective cohort study. SETTING: Five residential care facilities. PARTICIPANTS: 140 women and 59 men, mean age +/- SD 82.4 +/- 6.8 (range, 65-97). MEASUREMENTS: After baseline assessments, falls in the population were tracked for 1 year. A physician, a nurse, and a physiotherapist investigated each event, and reached a consensus concerning the most probable precipitating factors for the fall. RESULTS: Previous falls and treatment with antidepressants were found to be the most important predisposing factors for falls. Probable precipitating factors could be determined in 331 (68.7%) of the 482 registered falls. Acute disease or symptoms of disease were judged to be precipitating, alone or in combination in 186 (38.6%) of all falls; delirium was a factor in 48 falls (10.0%), and infection, most often urinary tract infection, was a factor in 38 falls (7.9%). Benzodiazepines or neuroleptics were involved in the majority of the 37 falls (7.7%) precipitated by drugs. External factors, such as material defects and obstacles, precipitated 38 (7.9%) of the falls. Other conditions both related to the individual and the environment, such as misinterpretation (eg, overestimation of capacity or forgetfulness), misuse of a roller walker, or mistakes made by the staff were precipitating factors in 83 (17.2%) of falls. CONCLUSION: Among older people in residential care facilities, acute diseases and side effects of drugs are important precipitating factors for falls. Falls should therefore be regarded as a possible symptom of disease or a drug side effect until proven otherwise. Timely correction of precipitating and predisposing factors will help prevent further falls.

Keyword
Accidental Falls/*statistics & numerical data, Acute Disease/epidemiology, Aged, Aged; 80 and over, Alcoholism/complications/epidemiology, Chronic Disease/epidemiology, Cohort Studies, Delirium/complications/epidemiology, Drug Therapy/adverse effects, Environment Design, Female, Hip Fractures/prevention & control, Humans, Male, Prospective Studies, Protective Devices/adverse effects, Residential Facilities, Stroke/complications/epidemiology, Sweden/epidemiology, Syncope/complications/epidemiology, Urinary Tract Infections/complications/epidemiology
National Category
Medical and Health Sciences
Research subject
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-6953 (URN)14709266 (PubMedID)
Available from: 2008-01-10 Created: 2008-01-10 Last updated: 2010-11-23Bibliographically approved
3. Drugs and falls in older people in geriatric care settings.
Open this publication in new window or tab >>Drugs and falls in older people in geriatric care settings.
2004 (English)In: Aging Clinical and Experimental Research, ISSN 1594-0667, E-ISSN 1720-8319, Vol. 16, no 4, 270-276 p.Article in journal (Refereed) Published
Abstract [en]

ACKGROUND AND AIMS: Falls and their consequences constitute serious health problems in the older population. The aim was to study predisposing factors for falls among older people in geriatric care settings, focusing on drugs. METHODS: This population-based study, with a cross-sectional design, analysed all geriatric care settings, comprising 68 residential care facilities, 31 nursing homes, 66 group dwellings for people with dementia, seven rehabilitation/short-stay units, two somatic geriatric and two psychogeriatric clinics, in the county of Västerbotten; 3604 residents with a mean age of 83.3+/-7.0 (65-103) years (68% women) were included. The residents were assessed by means of the Multi-Dimensional Dementia Assessment Scale (MDDAS) that measures, for example, mobility, paresis, vision, hearing, functions of activities of daily living (ADL), and behavioural and psychiatric symptoms. Drug consumption and falls during the previous week were recorded. RESULTS: Three hundred and one residents (8.4%) had sustained a fall at least once during the preceding week. Multivariate analyses showed that a history of falls, the ability to get up from a chair, the need for a helper when walking, pain, cognitive impairment, and use of neuroleptics or antidepressants were all associated with being a faller. Among the antidepressants, selective serotonin reuptake inhibitors (SSRIs) but not serotonin and noradrenalin reuptake inhibitors (SNRIs) were associated with falls. Cholinesterase inhibitors were not associated with falls. CONCLUSIONS: Like functional and cognitive impairment, treatments with antidepressants and neuroleptics are predisposing factors for falls in older people in residential care. However, there seem to be differences between subgroups among these drugs and, from the perspective of fall prevention, SNRIs rather than SSRIs should perhaps be preferred in the treatment of depression in older people.

Keyword
Accidental Falls/*statistics & numerical data, Activities of Daily Living, Aged, Aged; 80 and over, Analgesics/adverse effects, Antidepressive Agents/adverse effects, Antipsychotic Agents/adverse effects, Cross-Sectional Studies, Health Services for the Aged, Humans, Prescriptions; Drug/*statistics & numerical data, Residential Facilities, Risk Factors, Serotonin Uptake Inhibitors/adverse effects, Sweden
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-6743 (URN)15575120 (PubMedID)
Available from: 2008-01-17 Created: 2008-01-17 Last updated: 2017-12-14Bibliographically approved
4. Factors associated with falls among older, cognitively impaired people in geriatric care settings: a population-based study
Open this publication in new window or tab >>Factors associated with falls among older, cognitively impaired people in geriatric care settings: a population-based study
2005 (English)In: The American journal of geriatric psychiatry, ISSN 1064-7481, E-ISSN 1545-7214, Vol. 13, no 6, 501-509 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: The authors studied factors associated with falls among cognitively impaired older people in geriatric care settings.

Method: This was a study using all geriatric care settings in a county in northern Sweden. Residents were assessed by means of the Multi-Dimensional Dementia Assessment Scale, supplemented with questions concerning the use of physical restraints, pain, previous falls during the stay, and falls and injuries during the preceding week. Data about both falls and cognition were collected in 3,323 residents age 65 and older. Of these residents 2,008 (60.4%) were cognitively impaired, and they became the study population. Of the participants, 69% were women; mean age: 83.5 years.

RESULTS: Of 2,008 cognitively impaired residents, 189 (9.4%) had fallen at least once during the preceding week. Being able to get up from a chair, previous falls, needing a helper when walking, and hyperactive symptoms were the factors most strongly associated with falls.

CONCLUSION: Preventing falls in cognitively impaired older people is particularly difficult. An intervention strategy would probably have to include treatment of psychiatric and behavioral symptoms, improvement of gait and balance, and adjustment of drug treatment, as well as careful staff supervision.

National Category
Geriatrics
Identifiers
urn:nbn:se:umu:diva-6744 (URN)10.1176/appi.ajgp.13.6.501 (DOI)000229597600009 ()15956270 (PubMedID)
Available from: 2008-01-15 Created: 2008-01-15 Last updated: 2017-12-14Bibliographically approved
5. Weather and falls in older people in residential care
Open this publication in new window or tab >>Weather and falls in older people in residential care
Article in journal (Refereed) Submitted
Identifiers
urn:nbn:se:umu:diva-4072 (URN)
Available from: 2004-09-02 Created: 2004-09-02Bibliographically approved

Open Access in DiVA

fulltext(374 kB)3110 downloads
File information
File name FULLTEXT01.pdfFile size 374 kBChecksum SHA-1
9397158389f46c6fffc09fcc9cc4b64bb233f51db01bf0da1cf71511290e10aeb9e9f966
Type fulltextMimetype application/pdf

Search in DiVA

By author/editor
Kallin, Kristina
By organisation
Geriatric Medicine

Search outside of DiVA

GoogleGoogle Scholar
Total: 3110 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

isbn
urn-nbn

Altmetric score

isbn
urn-nbn
Total: 2069 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf