Abstract
BackgroundFall-related injuries in older people are a leading cause of morbidity and mortality. Self-reported fall events in the last year is often used to estimate fall risk in older people. However, it remains to be investigated if the fall frequency and the consequences of the falls have an impact on the risk for subsequent injurious falls in the long term. The objective of this study was to investigate if a history of one single non-injurious fall, at least two non-injurious falls, or at least one injurious fall within 12 months increases the risk of sustaining future injurious falls.MethodsCommunity-dwelling individuals 75–93 years of age (n = 230) were initially followed prospectively with monthly calendars reporting falls over a period of 12 months. The participants were classified into four groups based on the number and type of falls (0, 1, ≥2 non-injurious falls, and ≥1 injurious fall severe enough to cause a visit to a hospital emergency department). The participants were then followed for several years (mean time 5.0 years ±1.1) regarding injurious falls requiring a visit to the emergency department. The Andersen–Gill method of Cox regression for multiple events was used to estimate the risk of injurious falls.ResultsDuring the long-term follow-up period, thirty per cent of the participants suffered from at least one injurious fall. Those with a self-reported history of at least one injurious fall during the initial 12 months follow-up period showed a significantly higher risk for sustaining subsequent injurious falls in the long term (hazard ratio 2.78; 95% CI, 1.40–5.50) compared to those with no falls. No other group showed an increased risk.ConclusionsIn community-dwelling people over 75 years of age, a history of at least one self-reported injurious fall severe enough to cause a visit to the emergency department within a period of 12 months implies an increased risk of sustaining future injurious falls. Our results support the recommendations to offer a multifactorial fall-risk assessment coupled with adequate interventions to community-dwelling people over 75 years who present to the ED due to an injurious fall.
Highlights
Fall-related injuries in older people are a leading cause of morbidity and mortality
Based on number of and severity of their self-reported falls during the monitoring period, participants were classified as no falls (n = 119; 52%); one fall without injuries (n = 51; 22%); two or more falls without injuries (n = 40; 17%); or one injurious fall (n = 20; 9%)
Analyses of the long-term follow-up of registered injurious falls showed that the group with at least one selfreported injurious fall during the initial monitoring 12 months showed a significantly higher risk for sustaining subsequent injurious falls severe enough to cause a visit to the emergency department (ED) in the long term compared to those with no falls (Table 3 and Figure 1)
Summary
Fall-related injuries in older people are a leading cause of morbidity and mortality. Self-reported fall events in the last year is often used to estimate fall risk in older people. It remains to be investigated if the fall frequency and the consequences of the falls have an impact on the risk for subsequent injurious falls in the long term. Falls are a major health concern among older adults, and fall-related injuries are a leading cause of morbidity and mortality [1]. Older people presenting to the ED for any reason are more likely to sustain fall-related injuries the following six months after discharge [11]. The costs involved with injurious falls are substantial, and may have the greatest consequences for people’s health [15], including increased risk of placement in long-term care facilities [3,16]
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