Risk Factors for Major Injurious Falls among the Home-Dwelling Elderly by Functional Abilities

TLDR

Major injurious falls among home‑dwelling elderly are a serious health concern. The study assessed associations between injurious falls and various factors among disabled and independent elderly who had fallen during a 2‑year period to identify risk factors for preventing major injuries. A prospective population‑based study of 979 residents aged 70+ in five rural Finnish municipalities followed them for 2 years, recording injurious falls through telephone contacts, diaries, and medical record reviews. Among those who fell, 30 % sustained major injury, and multivariate analysis showed that in disabled elderly factors such as being unmarried, low BMI, impaired step continuity, poor distant vision, and long‑acting benzodiazepine use increased risk, whereas in independent elderly peripheral neuropathy and insomnia were key risk factors, indicating that prevention should be tailored to each group.

Abstract

<b>Background:</b> In order to identify the risk factors essential for preventing major injurious falls, the associations between injurious falls and certain factors were assessed among disabled and independent elderly, respectively, who had fallen during a 2-year period. <b>Methods:</b> A prospective population-based study was conducted in five rural northern Finnish municipalities. The series consisted of all inhabitants aged 70 years or over, initially 979 persons. During a 2-year follow-up period, all injurious falls were recorded on the basis of telephone contacts, diary reporting and a review of the medical records of the participants. <b>Results:</b> Thirty percent of the subjects having fallen sustained a major injury. The multivariate model applied to the disabled elderly showed the following variables to be related to a high risk for major injurious falls: divorced, widowed or unmarried marital status (odds ratio = 2.2), a low body mass index (odds ratio = 3.1), incomplete step continuity (odds ratio = 2.2), poor distant visual acuity (odds ratio = 2.3) and the use of long-acting benzodiazepines (odds ratio = 2.4). Among the independent elderly, the risk of a fall resulting in major injury was high among the subjects who had peripheral neuropathy (odds ratio = 2.5) or were suffering from insomnia (odds ratio = 4.1). <b>Conclusions:</b> The risk factors for major injuries in fall occurrences differ between the disabled and independent elderly. Preventive measures should be targeted according to the disabilities of the population.