Epidemiological surveillance of falls in the elderly in France

Abstract

Introduction Falls in the elderly (65 years and over) are responsible for a great part of morbidity and mortality in all countries and represent a major public health issue. As stated by the demographic previsions, the proportion of elderly in population will grow in the next decades and will therefore emphasize this public health issue. Methods Epidemiological surveillance of falls is based on several data sources, each one having its own objectives: French Health Barometer Surveys, the Permanent Home and Leisure Injury Survey (“Enquete permanente sur les accidents de la vie courante” - EPAC), the French medicalized information system program (“Programme de medicalisation des systems d’information” - PMSI), data based on death certificates. Results In 2010, according to the Health Barometer Survey, nearly one out of twelve people aged 55 to 85 years old (7.8%) reported at least one injury during the last twelve months, followed by a medical or hospital consultation. Those victims reported mostly falls (56.5%). In 2010, according to the EPAC Survey, among 65 years old and over, 85% of emergency visits for home and leisure injuries (HLI) were due to a fall. This proportion increases with age: 71% from 65 to 69 years, up to 95% at 90 years and over. According to the PMSI, in 2014, 76,100 hospitalizations were due to a fracture of the upper femur among patients aged 65 years old and over, three times more often in women than in men. Nine times out of ten, these fractures happened as a result of a fall. In 2013, in Metropolitan France, according to the death certificates, 9334 people over 65 years old died as a result of an accidental fall (11.2/100,000), including 3737 men (13.1/100,000) and 5597 women (10.1/100,000). Mortality rates due to falls increase with age. Conclusion Currently available surveys provide the overall epidemiological monitoring of falls, although they do not contribute to the design of targeted prevention actions. In the future, data from the OSCOUR-SURSAUD French Network may partially meet the demand for measurement of trends in the use of emergency services due to falls. The Survey on falls of the elderly at home (“Chutes des personnes âgees a domicile” - ChuPADom) will establish the profiles of fallers aged 65 years and over based on their sociodemographic and economic characteristics, the presence of chronic diseases and/or multiples diseases, their mental health, their (multiple) medication, pre-fall autonomy, home care, extrinsic risk factors (housing, products involved in the fall, activity before falling, etc.), physical and psychological sequelae, and the quality of life one year after the fall. This survey may significantly contribute to targeted prevention actions.