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