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At least 19 recordsLinked to original sources
PubMed1991

Falls and fear of falling among elderly persons living in the community: occupational therapy interventions.

Each year, about one third of the population over 65 years of age experiences at least one fall (Perry, 1982). Assessment of the incidence of falls and the prevalence, intensity, and covariates of fear of falling among community-based elderly persons was conducted through interviews of 115 residents in a housing development (mean age = 78 years). Fifty-three percent reported having fallen in recent years, 32% in the last year. Fear of falling ranked first when compared with other common fears. In a logistic regression model predicting limitation of activity independent of risk factors for falling, fear of falling was marginally significant (p = .06). The results of the study show that falls are frequent and fear of falling prevalent among the community-based elderly. A comprehensive program designed to reduce the risk of falls is presented.

Accidental Falls↗
PubMed1992

[Accidental falls in nursing homes. A study of the extent and circumstances of accidental falls in nursing homes].

Accidental falls in 54 nursing homes with 2228 elderly residents aged 65 years and over were registered during a period of seven months. During the seven months, 512 of the elderly residents fell on a total of 934 occasions. Forty-two fractures of the neck of the femur occurred. The risk of falls for elderly residents of nursing homes is very high, but the majority of falls do not result in permanent damage. In this investigation, no differences could be demonstrated between staff groups or circumstances concerning falls with and without resultant damage. All falls should be regarded as warnings and result in detailed investigation of the circumstances of the fall in view of prophylactic measures. Accidental falls are caused by a complex interaction between a series of health, therapy, furnishing and attitudes. Various circumstances are emphasized in this investigation which are connected with an increased risk of falling, e.g. vertigo, problems of balance, certain aids and activities in connection with toileting.

Accidental Falls↗
PubMed1977

A longitudinal study of falls in an elderly population II. Some circumstances of falling.

Some of the circumstances surrounding 651 falls which occurred in elderly residents of a standard care unit in a home for the aged are described. Falls occurred as frequently at night as during the day-time, and there was no significant variation by day of the week or by season. The great majority occurred inside the home, mainly in the resident's own suite. The subsequent morbidity varied according to the place of occurrence, the percentage of severe injuries being lower in falls occurring in toilets and elevators, and to a lesser extent hallways, compared with those occurring in other inside locations and outside. The commonest activity associated with falling was going to or returning from the toilet. However, one-third of day-time falls occurred when the resident was sitting in a chair. The severity of injury did not vary with associated activity. Possible explanations for these findings are discussed, particularly from the preventive viewpoint.

Accidents↗
PubMed1992

[Accidental falls in nursing homes. A study on the role of drugs in accidental falls in nursing homes].

The drug consumptions of 2228 residents in nursing homes aged 65 years and over were investigated and related to accidental falls during a period of seven months. 95% of the residents received treatment with one or more drugs and 33% with six or more drugs. The risk of accidental falls was significantly increased in persons receiving hypnotics, psychomarmaca and anti-Parkinson medicine. Individuals receiving diuretics, particularly thiazides, were less at risk for accidental falls. This investigation revealed an increased risk of falls particularly when residents were receiving treatment with a short-term hypnotic (Triazolam). It is recommended that this finding should be investigated further.

Accidental Falls↗
PubMedDate not supplied

A calcaneal fracture from a fall or a fall from a calcaneal fracture?

A case of a calcaneal avulsion fracture from a relatively minor traumatic incident is presented. The mechanism of calcaneal avulsion fractures is discussed. Special attention is given to the possibility of a pathologic fracture. The literature is reviewed and treatment is discussed.

Accidental Falls↗
PubMed1991

Risk factors for injurious falls: a prospective study.

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.

Accidental Falls↗
PubMed1992

Characteristics and predictors of falls in elderly patients.

BACKGROUND: Poor performance on mobility testing is one of a number of factors associated with increased falls in community-dwelling elderly. The significance of these associations has not previously been tested in a sample drawn exclusively from a primary care practice. METHODS: This 1-year prospective study recorded falls, fall injuries, and related factors in 120 ambulatory geriatric outpatients of a family medicine practice. The association of mobility score, physician's estimate of mobility score, physician's estimate of likelihood to fall, and other fall risk factors was assessed with whether participants fell. Subjects recorded falls and injuries on weekly postcards. Follow-up by telephone was done to ensure compliance. RESULTS: Thirty-seven (36%) of the 102 participants who completed the study fell once or more. There were 56 total falls, of which 27 (48%) caused injuries. Thirty-six (64% of total) falls occurred in or around the subject's home, and significantly more (chi 2 = 10.93, P less than .001) of these falls had intrinsic causes compared with falls away from home. Prestudy history of subject's falls was significantly associated with subjects' falls during the study, although its sensitivity was only 41%. All other factors studied, including mobility score and the physician's estimates, were not significantly associated with fall status. CONCLUSIONS: This study did not support the use of risk-factor determination to select primary care patients who should be assessed further for fall risk. The high prevalence of falls and injuries in this sample suggests that all elderly patients should be given fall prevention advice.

Accidental Falls↗
PubMed1992

The impact of falls in an inner-city elderly African-American population.

OBJECTIVE: To describe the impact of falls in an elderly African-American urban community and to identify predictors of poor recovery from falls. DESIGN: Prospective cohort study. SETTING: Emergency departments of 11 hospitals in western Philadelphia. SUBJECTS: Interviews were conducted with 197 African-American persons 65 years and older residing in West Philadelphia who were treated at an emergency department because of a fall. Second interviews were conducted a median of 7 months after the fall with a sample of 70 patients who had not recovered at the time of the first interview. MAIN OUTCOME MEASURES: Information abstracted from emergency department medical records and information on recovery obtained from two subsequent interviews. RESULTS: A median of 8 weeks after the fall occurred, 43% of persons reported continued pain or restriction in their usual activities as a result of the fall. Predictors of poor recovery included the presence of grandchildren in the household, hearing impairment, severity of the injury, and injury to the lower extremities. Having someone present at the time of the fall was associated with a lower risk of poor recovery. Forty-one percent of the 70 persons interviewed a second time reported continued pain or restriction in usual activities a median of 7 months after the fall occurred. However, only 7% and 39% had received the services of a home health aide or physical therapist, respectively, and only 14% reported that a physician or other health professional had been particularly helpful since the fall had occurred. CONCLUSIONS: A large proportion of elderly African-American persons treated at emergency departments for falls experience continued pain and restriction of activities after the fall. Many individuals have not recovered 7 months or longer after the fall and few persons report that a physician or other health professional has been particularly helpful since the fall occurred. We suggest that follow-up programs be developed for elderly persons in minority communities who come to emergency departments after a fall.

Accidental Falls↗
PubMed1992

[A study of falls experienced by institutionalized elderly].

This study was conducted to determine what factors are related to falls, conditions contributing to falls and the associated injuries. Subjects who had lived in 3 institutions for the elderly in the western region of Shizuoka Prefecture were chosen. Subjects (n = 181) had an average age of 76.4 +/- 7.8 years, and all were interviewed regardless of their history of falls. For those who had experienced falls further interviews were conducted. The following results were obtained: 1) There were 64 subjects (35.4% of the subjects) who had experienced falls, some having experienced multiple falls (for a total count of 89 falls). 2) The frequency of falls of differed by sex or age was significantly. The frequency of females was significantly higher than that of males. The frequency for those in their 70's was lower than in other age groups. 3) At the time of experiencing falls the majority of subjects had hypertension, eye symptoms, insomnia, paralysis, functional restrictions, were going up or down stairs, working, and had difficulty reading characters in newspapers, had experiences of stumbling or need of medical attention within for the past 2 years. Results of this study showed that, while the use of tranquilizers or hypnotics were not statistically significant, they were closely connected to and increase in falls among the aged. 4) In the causes of falls, intrinsic factors figured in 34 (34.0%) cases, and the extrinsic factors in 66 (66.0%). 5) Both falls and fall-caused external injuries were higher among females than males. Furthermore, female subjects mainly suffered contusions and fractures while male subjects mainly suffered abrasions.

Accidental Falls↗
PubMed1992

Patients presenting to family physicians after a fall: a report from the Ambulatory Sentinel Practice Network.

BACKGROUND: Patients who fall present a diagnostic challenge to family physicians. The diagnostic workup of these patients must be thorough enough to detect and treat important causes of the fall yet not subject patients to unnecessary tests. Previous studies have provided only limited guidance for primary care physicians because in general they occurred in settings other than primary care and focused on a single age group. METHODS: The Ambulatory Sentinel Practice Network (ASPN) conducted a 6-month study of primary care patients of all ages presenting after a fall, or with medical problems resulting from a fall. ASPN clinicians collected information about the history, physical examination findings, and follow-up of these patients. Causes of falls were grouped into three categories: external reasons for falling, internal reasons related to gait, and internal reasons unrelated to gait. RESULTS: Participating clinicians identified 431 patients who had falls out of the 256,680 seen for any reason during the study period. The patients ranged in age from 1 to 94 years. The rate of falls for patients increased rapidly after age 65 years. Most falls occurred for reasons external to the patient, but internal reasons, both nonlocomotor and locomotor, increased after age 65 years. No nonlocomotor causes for a fall were found in patients younger than 65 years of age. Also, the rate of hospitalization of patients seen for falls was greater in the geriatric age group. CONCLUSIONS: The results highlight the need for further research about falls, particularly those occurring in pediatric and young adult patients. Furthermore, correcting environmental hazards and modifying gait problems in the elderly by increasing lower extremity and truncal strength could decrease the risk of falling.

Accidental Falls↗
PubMedDate not supplied

Times, places, and mechanisms of falls among the elderly.

Elderly persons among the population aged 65 years or over in the town of Pori, Finland, falls leading to medical treatment experiencing during one year, are described by age, sex, month, time of day, place, mechanism, estimated cause, previous falls, symptoms before falling, and activity when falling. Results indicate that the falls can be divided into two main categories: falls due to an extrinsic mechanism such as slipping or stumbling, and falls due to an intrinsic or unknown mechanism. Extrinsic mechanisms are more common in the younger age group (65-74 years), in whom falls are dependent on the time of day and amount of activity, and frequently happen outdoors while walking. Thus, slipping is a common extrinsic mechanism. Intrinsic or unknown mechanisms are more common in the older age group (75 years and above), in which estimated causes, such as orthostatic hypotension, fever, dementia, or joint disorders, can in many cases be detected. These cases are not dependent on time of day or month. Falls due to intrinsic or unknown mechanisms are related to rising from a lying or sitting position and lifting the head or turning the body before the fall. Before falling, some kinds of symptoms are more commonly experienced by persons falling due to an intrinsic or unknown mechanism than by those falling due to an extrinsic mechanism.

Accidental Falls↗
PubMed1991

Prevalence, characteristics and factors associated with falls among the elderly living at home.

Attempts to determine the underlying causes of falls have come to conflicting conclusions, partly because subject groups studied have not been representative of all elderly people. Two hundred and three randomly selected people of 75 years and over, living at home, were visited and questioned about falls experienced in the previous 12 months, and about factors that might be related to falling. Eighty-six subjects (42.4%) had suffered one or more falls during this time, and of fallers, 49 (59.3%) were injured, 9 of them seriously. Women were slightly more likely to have had falls and were more likely to have suffered injury, but no increase in frequency of falls with age was demonstrated. Only a minority of fallers (43.0%) sought medical attention following their fall. Falls outside the home accounted for 39.5% of falls and these were more likely to be due to simple trips or slips. Analysis of the factors related to falls showed a considerable overlap between fallers and non-fallers. Fallers had significantly greater dependency and cognitive impairment, more physical symptoms, and higher scores for anxiety and depression, but there was no association with postural hypotension, neurological abnormalities, or measurements relating to nutritional state. The factors found to be significant on discriminant analysis were combined to determine a "fall risk score". This type of easily calculated score might be of use to medical and paramedical personnel for assessing the risk of falling among the elderly living at home.

Accidental Falls↗
PubMed1991

Injuries in infants and small children resulting from witnessed and corroborated free falls.

The height of a free fall necessary to cause injury to infants and small children is a confusing and controversial issue among health care, law enforcement, and legal professionals responsible for evaluating cases of possible child abuse. To resolve this confusion, the circumstances of falls were recorded prospectively for 398 consecutive victims of falls seen at Children's Hospital, Oakland, California. From these cases, 106 were selected for further analysis where the falls were witnessed by a second person other than the caretaker and the circumstances of the fall were documented. No injuries occurred in 15 patients, including seven falling more than 10 feet. Mild bruises, abrasions, or simple fractures occurred in 77 patients, including 43 falling more than 10 feet. Severe injuries, including intracranial hemorrhages, cerebral edema, depressed skull fractures, and compound or comminuted fractures occurred in 14 patients falling between 5 and 40 feet. However, no life-threatening injuries occurred in the 3 patients who fell less than 10 feet. These three had small, depressed skull fractures without loss of consciousness, from falling against an edged surface. Only one death occurred in this series, resulting from a fall of 70 feet. In conclusion, infants and small children are relatively resistant to injuries from free falls, and falls of less than 10 feet are unlikely to produce serious or life-threatening injury.

Accidental Falls↗
PubMed1991

Falls in the elderly: reliability of a classification system.

To determine risk factors for falls, previous studies have classified falls according to the contribution of factors both intrinsic and extrinsic to the host. Due partly to the lack of operational definitions and the absence of information on reliability, no consensus on classification has been reached. Consequently, in a 3-year prospective study of falls occurring in a probability sample of community-dwelling elderly (n = 1,358), a fall classification system was developed and tested for interrater reliability. The 366 falls in the first year of the study were independently classified by two reviewers on the basis of a narrative description and structured interview. The falls in the four major categories of the classification system included: falls related to extrinsic factors (55%), falls related to intrinsic factors (39%), falls from a non-bipedal stance (8%) and unclassified falls (7%). The interrater reliability for the four major categories was 89.9% with a kappa of 0.828. The system provides operational definitions for types of falls and a reliable and flexible method for classifying falls in the elderly.

Accidental Falls↗
PubMed1992

An investigation of dust generation by free falling powders.

To identify the dust generation processes, aluminum oxide powder was dropped as a free falling slug in a test chamber. The effect of the slug's mass, diameter, and drop height upon the aerosol concentration and size distribution was measured with an aerodynamic particle sizer. To differentiate between aerosol generated during the free fall and at the end of the fall, the slug was dropped either onto a flat surface or into a container of water that suppressed dust generation associated with the impact at the end of the fall. Aerosol generation occurred during the slug's free fall as well as at the end of the fall. The falling solid induced an airflow that followed the falling solid to the end of the fall. This induced airflow contained the aerosol generated during the free fall. At the end of the free fall, the induced airflow, combined with air jets created on impact, dispersed the aerosol throughout the test chamber. Additional measurements were made by using "neutral buoyancy" helium-filled bubbles to visualize the airflow in the test chamber. The airflow and ensuing turbulence were sufficient to keep large, inspirable particles suspended throughout the test chamber for periods greater than 10 min. During experimental work, the effect of drop height, mass, and slug diameter upon aerosol generation by a single slug of powder was studied. The results indicated that the manner in which a powder is handled may be as important as material dustiness as measured by a dustiness tester. Aerosol generation can be reduced by minimizing the contact between the falling powder and the air.

Aerosols↗