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Risk Factors for Injurious Falls: a Prospective Study
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1991
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We followed 325 community‑dwelling older adults who had fallen in the prior year, contacting them weekly for one year to record fall events and their circumstances. Of 539 falls, 6 % resulted in major injury, 55 % in minor injury, 10 % left the faller unable to rise for ≥5 minutes, and injury risk was similar across fall frequency but markedly higher for syncopal falls and for nonsyncopal falls involving prior fracture, slower Trail‑Making B, weaker grip, slower hand reaction, white race, stairs, or turning/reaching, showing that neuromuscular and cognitive deficits and fall circumstances drive injury risk.
We conducted a prospective study of the consequences of falls in 325 elderly community-dwelling persons, all of whom had fallen in the previous year. We contacted subjects every week for one year to ascertain falls and to determine the circumstances and consequences of falls. Only 6% of 539 falls resulted in a major injury (fracture, dislocation, or laceration requiring suture), but over half (55%) resulted in minor soft tissue injury. One in ten falls left the faller unable to get up for at least 5 minutes, and one in four falls caused subjects to limit their activities. The risk of injury per fall was about the same regardless of the number of falls a person had during follow-up. The risk of major injury was increased (age- and sex-adjusted odds ratio: 5.9; 95% confidence interval: 2.3–14.9) in falls associated with loss of consciousness compared to nonsyncopal falls. In multivariate analyses of nonsyncopal falls, the risk of major injury per fall was higher in persons having a previous fall with fracture (6.7; 2.1–21.5), a slower Trail Making B time (1.9; 1.1–3.2), and in whites (18.4; 7.5–44.6). The risk that a nonsyncopal fall would result in minor injury (versus no injury) was increased in persons with a slower hand reaction time (1.8; 1.0–3.2), decreased grip strength (1.5; 1.0–2.3), in whites (2.0; 1.0–3.7), in falls while using stairs and steps (2.2; 1.0–5.0), and turning around or reaching (3.5; 1.7–7.3). Our findings suggest that neuromuscular and cognitive impairment, as well as the circumstances of falls, affect the risk of injury when a fall occurs