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Health Changes and Fall Prevention in Community-dwelling Elderly Fallers
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Objective - In the first year, this study described fall mechanisms, injury patterns, and post-fall management and determined factors associated with injury severity, receiving medical care, decline of activity of daily living (ADL), and increase of fear of falling among elderly fallers living in communities.
Methods - We randomly selected 2250 people aged 65 and over from the elderly population living in the Shin-Sher Township at Taichung County of central Taiwan, and as a result, 1200 completed the baseline assessment. At then, these participants were asked to report by telephone if a fall occurred; furthermore, one researcher called these subjects every three months to follow up their fall status. Fall-related information was collected within two weeks when subjects were known to have falls. During a 10-month follow-up period, 94 persons had falls.
Results - Compared with all participants, the fallers were older and being female and have more previous falls, higher levels of fear of falling and poorer cognitive status. Of these falls, 58.5% took place indoor and 41.5% on concrete floor. Of these fallers, 65.9% had activities with small shift of center of gravity when falling, 27.7% got drop attacks, 44.3% fell on the front direction, 86.8% tried to rise from the ground, and 57.2% had medications within 24 hours before falling. As for injury patterns and post-fall management, 55.4% of fallers had upper extremities contact the floor first, 32.6% were injured to upper extremities and 23.9% to lower extremities, 27.9% had scores of the Abbreviated Injury Scale (AIS) as 2 or higher, 16.9% spent a time length of rising from the ground greater than 5 minutes, 68.8% sought for medical care and 15% were hospitalized. Of these fallers who sought for medical care, 45.3% had the care after 1 hour and 34.4% after 2 hours. Two weeks after falling, 23.4% of fallers still had lower level of ADL independence and 66% had higher levels of fear of falling than their own levels at the baseline assessment. The results of the multiple logistic regression model show that higher AIS scores were independently associated with upper and lower extremities; seeking medical care was positively associated with widowed/divorced/single, lower scores of the Timed Up and Go test, and higher AIS scores; the ADL decline after falling was positively associated with higher levels of ADL at baseline and higher AIS scores; and the increase of fear of falling was positively associated with lower scores of fear of falling at baseline and living alone.
Conclusion The reduction of fall severity can reduce medical cost, fall-related ADL dependence, and fear of falling. Since the severe injuries to the extremities are more likely from doing housework, it is sensible to reduce housework loading or avoid specific dangerous housework to prevent these injuries. Furthermore, social supports and home care can be provided to lower fear of falling for of elderly fallers, particularly for those who live alone or without spouse and who have balance and mobility impairment.
Key words:community, falls, older people, secondary prevention, risk factor