Prevalence, risk factors and disability associated with fall-related injury in older adults in low- and middle-incomecountries: results from the WHO Study on global AGEing and adult health (SAGE).

Jennifer Stewart Williams,Tristan O’Driscoll,Alfred Yawson,Richard Biritwum,Betty Manrique Espinoza,Tamara Maximova,Somnath Chatterji,Fan Wu,Heather Hestekin,Aarón Salinas Rodríguez,Paul Kowal,Karl Peltzer,Perianayagam Arokiasamy

doi:10.1186/s12916-015-0390-8

Abstract

BackgroundIn 2010 falls were responsible for approximately 80 % of disability stemming from unintentional injuries excluding traffic accidents in adults 50 years and over. Falls are becoming a major public health problem in low- and middle-income countries (LMICs) where populations are ageing rapidly.MethodsNationally representative standardized data collected from adults aged 50 years and over participating in the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) Wave 1 in China, Ghana, India, Mexico, the Russian Federation and South Africa are analysed. The aims are to identify the prevalence of, and risk factors for, past-year fall-related injury and to assess associations between fall-related injury and disability. Regression methods are used to identify risk factors and association between fall-related injury and disability. Disability was measured using the WHO Disability Assessment Schedule Version 2.0 (WHODAS 2.0).ResultsThe prevalence of past-year fall-related injuries ranged from 6.6 % in India to 1.0 % in South Africa and was 4.0 % across the pooled countries. The proportion of all past-year injuries that were fall-related ranged from 73.3 % in the Russian Federation to 44.4 % in Ghana. Across the six countries this was 65.7 %. In the multivariable logistic regression, the odds of past-year fall-related injury were significantly higher for: women (OR: 1.27; 95 % CI: 0.99,1.62); respondents who lived in rural areas (OR: 1.36; 95 % CI: 1.06,1.75); those with depression (OR: 1.43; 95 % CI: 1.01,2.02); respondents who reported severe or extreme problems sleeping (OR: 1.54; 95 % CI: 1.15,2.08); and those who reported two or more (compared with no) chronic conditions (OR: 2.15; 95 % CI: 1.45,3.19). Poor cognition was also a significant risk factor for fall-related injury.The association between fall-related injury and the WHODAS measure of disability was highly significant (P<0.0001) with some attenuation after adjusting for confounders. Reporting two or more chronic conditions (compared with none) was significantly associated with disability (P<0.0001).ConclusionsThe findings provide a platform for improving understanding of risk factors for falls in older adults in this group of LMICs. Clinicians and public health professionals in these countries must be made aware of the extent of this problem and the need to implement policies to reduce the risk of falls in older adults.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-015-0390-8) contains supplementary material, which is available to authorized users.

Highlights

In 2010 falls were responsible for approximately 80 % of disability stemming from unintentional injuries excluding traffic accidents in adults 50 years and over
The prevalence of past-year fall-related injuries ranged from 6.6 % in India to 1.0 % in South Africa and was 4.0 % in the pooled countries
The findings provide evidence of prevalence and risk factors associated with self-reported fall-related injury in older adults, and the extent to which fall-related injury affects disability in this group of six low- and middle-income countries (LMICs)

Summary

Introduction

In 2010 falls were responsible for approximately 80 % of disability stemming from unintentional injuries excluding traffic accidents in adults 50 years and over. In 2010, falls were responsible for approximately 80 % of disability stemming from unintentional injuries excluding traffic accidents in adults aged 50 years and over [2]. Falls are a major public health concern for older adults, and with the growing numbers of older people in populations in all parts of the world, research is urgently needed in order to establish effective policies to reduce risk. Every year one-third of community-dwelling older adults fall. 3 % of community-dwelling older adults sustain significant injuries due to falls in any given year [6], resulting in substantial costs to individuals and society [1, 7,8,9,10]

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