Falls among the elderly—Human and environmental factors

Abstract

A study was made of 150 persons age 60 or older in Chittenden County, Vermont who were treated in an emergency department for injuries from falls, and compared them with 150 elderly neighbors not known to have such injuries. About 19 out of every 1000 elderly persons in the county are treated for falls annually but at least a third of persons in this age range have falls each year, usually not requiring treatment. A third of the treated falls were precipitated by an acute health problem, usually an exacerbation of a more chronic condition, and an additional 8% involved impairment attributable to alcohol, commonly by a person with a history of frequent, heavy drinking. Problems with canes, walkers or wheelchairs appeared to contribute to several falls among impaired persons. Persons with falls because of acute impairment had chronic limitations of mobility, vision or sensorium significantly more often than did persons with other falls or with no falls. Over half of the falls not attributable to acute impairment were caused by slippery or uneven ground. The data do not support the hypothesis that falls of the elderly commonly occur because of fractures of hips or vertebrae, but they do suggest that brittleness of bone, small muscle mass or both are substantial contributors to fractures in the elderly once the fall has been initiated. The nature of the surface struck is less important, but not entirely irrelevent, in determining the severity of injury to persons in this age range. Once injury occurred appropriate first aid was rarely provided and the injured commonly delayed for six hours or longer before seeking care and used methods of transportation to the hospital that were not conducive to limiting exacerbation of the injury. Forty-four per cent of the injured were hospitalized and, of these, 22% died within a year after injury, usually within 3 months. However, the fall injury was only rarely listed on the death certificate as an associated cause of death or significant other condition although it probably should have been listed in most cases.