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Why the elderly fall in residential care facilities, and suggested remedies.
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
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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.

Place, publisher, year, edition, pages
2004. Vol. 53, no 1, 41-52 p.
Keyword [en]
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: urn:nbn:se:umu:diva-6953PubMedID: 14709266OAI: oai:DiVA.org:umu-6953DiVA: diva2:146623
Available from: 2008-01-10 Created: 2008-01-10 Last updated: 2010-11-23Bibliographically 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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