Abstract
BackgroundDespite extensive research on risk factors associated with falling in older adults, and current fall prevention interventions focusing on modifiable risk factors, there is a lack of detailed accounts of sex differences in risk factors, circumstances and consequences of falls in the literature. We examined the circumstances, consequences and resulting injuries of indoor and outdoor falls according to sex in a population study of older adults.MethodsMen and women 65 years and older (N = 743) were followed for fall events from the Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly (MOBILIZE) Boston prospective cohort study. Baseline measurements were collected by comprehensive clinical assessments, home visits and questionnaires. During the follow-up (median = 2.9 years), participants recorded daily fall occurrences on a monthly calendar, and fall circumstances were determined by a telephone interview. Falls were categorized by activity and place of falling. Circumstance-specific annualized fall rates were calculated and compared between men and women using negative binomial regression models.ResultsWomen had lower rates of outdoor falls overall (Crude Rate Ratio (RR): 0.72, 95% Confidence Interval (CI): 0.56-0.92), in locations of recreation (RR: 0.34, 95% CI: 0.17-0.70), during vigorous activity (RR: 0.38, 95% CI: 0.18-0.81) and on snowy or icy surfaces (RR: 0.55, 95% CI: 0.36-0.86) compared to men. Women and men did not differ significantly in their rates of falls outdoors on sidewalks, streets, and curbs, and during walking. Compared to men, women had greater fall rates in the kitchen (RR: 1.88, 95% CI: 1.04-3.40) and while performing household activities (RR: 3.68, 95% CI: 1.50-8.98). The injurious outdoor fall rates were equivalent in both sexes. Women’s overall rate of injurious indoor falls was nearly twice that of men’s (RR: 1.98, 95% CI: 1.44-2.72), especially in the kitchen (RR: 6.83, 95% CI: 2.05-22.79), their own home (RR: 1.84, 95% CI: 1.30-2.59) and another residential home (RR: 4.65, 95% CI: 1.05-20.66) or other buildings (RR: 2.29, 95% CI: 1.18-4.44).ConclusionsSignificant sex differences exist in the circumstances and injury potential when older adults fall indoors and outdoors, highlighting a need for focused prevention strategies for men and women.
Highlights
Despite extensive research on risk factors associated with falling in older adults, and current fall prevention interventions focusing on modifiable risk factors, there is a lack of detailed accounts of sex differences in risk factors, circumstances and consequences of falls in the literature
Women are believed to experience a greater number of falls and higher risk of injury from falling due to poorer lower extremity strength, more difficulties with activities of daily living and higher prevalence of osteoporosis, making them more susceptible to fracture compared to men [12]
Near equal indoor fall rates between men and women, women had significantly higher rates of injurious indoor falls. These results suggest that fall injury prevention strategies need to consider sex differences in activity patterns, space use and fall-related behaviors
Summary
Despite extensive research on risk factors associated with falling in older adults, and current fall prevention interventions focusing on modifiable risk factors, there is a lack of detailed accounts of sex differences in risk factors, circumstances and consequences of falls in the literature. Consequences and resulting injuries of indoor and outdoor falls according to sex in a population study of older adults. Most falls in the older population are results of an inter-play of predisposing and precipitating factors. The predisposing factors previously identified have included increasing age, sex, age-associated changes in strength and balance, sensory impairments and chronic disease. Since older men and women may differ in behaviors, prevalence of fall-related medical conditions and physical functions, risk factors as well as fall injuries likely differ by sex. Women are believed to experience a greater number of falls and higher risk of injury from falling due to poorer lower extremity strength, more difficulties with activities of daily living and higher prevalence of osteoporosis, making them more susceptible to fracture compared to men [12]
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