Fall-related Hospital Admissions Research Articles

Population-based interventions for preventing falls and fall-related injuries in older people.

Population-based interventions for preventing falls and fall-related injuries in older people.

The epidemiology of falls in Portugal: An analysis of hospital admission data.

Falls are a common cause of injury and pose an increased risk of morbidity, mortality, and lifelong disability. Falls encompass a troublesome definition and can pose challenges in epidemiological studies. Data on fall-related hospital admissions in Portugal remain unpublished. This study aimed to examine the epidemiology of fall-related hospital admissions in the Portuguese population between 2010 and 2018. It also aimed to examine annual rates of fall-related hospital admissions using three methodological approaches. The Portuguese Hospital Morbidity Database was used to identify all cases resulting in one or more inpatient admission in public hospitals related to falls from 2010 to 2018. Fall-related hospital admissions were described by age groups, sex, geographical area of residence, and type of fall. Annual rates were computed using three approaches: i) based on the number of inpatient admissions with an ICD code of fall, ii) based on the number of patients admitted to inpatient care with an ICD code of fall, and iii) based on the number of inpatient admissions with a principal diagnosis of injury. Between 2010 and 2018, 383,016 fall-related admissions occurred in 344,728 patients, corresponding to 2.1% of the total number of hospitalizations during the same period. Higher rates were seen among the younger (20-25) and the oldest age groups (+85), males until the age of 60, females from the age of 60, and areas of residence with a higher aging index. An overall rate of falls per 100,000 population was estimated at 414 (based on number of admissions), 373 (based on number of patients) and 353 (based on number of admissions with a principal diagnosis of injury). This study provides an overall picture of the landscape of falls in a scarcely explored setting. The results aim to contribute to identifying appropriate preventive interventions and policies for these populations.

Prevalence, Risk Factors, and Cost Burden of Fall-Related Hospital Admissions in india.

OBJECTIVE: To assess prevalence, risk factors, and cost burden of fall-related hospital admissions among older people in India. Previous studies conducted in India have not focused on the number of fall-related hospital admissions.<br/> DESIGN: A prospective observational study was carried out over 12 months. Socio-demographic, medical and medication details were collected from the patients, medical records, and treating physicians.<br/> SETTING: The study was conducted in internal medicine, orthopedics, and emergency departments of a tertiary care teaching hospital in Mysuru, Southern India.<br/> PARTICIPANTS: Patients 60 years of age or older, of any gender, admitted to hospital were included in this study.<br/> MAIN OUTCOME MEASURE: Prevalence of fall-related hospital admission, fall-related hospital admission associated with medication use, and direct cost incurred due to fall-related hospital admission.<br/> RESULTS: A total of 1,036 patients [Males 53.6%] with a mean (SD) age of 69.3 (8.1) years were included in the study. A total of 188 patients were admitted due to falling with the prevalence of 18.1%. The majority of patients fell due to environmental factors [105 (55.8%)]. Among medication-related falls (20), the majority were associated with the use of antihyperglycemics and antihypertensives. Increasing age, female gender, and multiple comorbidities were identified as risk factors for fall-related hospital admissions.<br/> CONCLUSIONS: Falls are a common reason for hospital admission among older populations. Clinicians need to focus on modifiable risk factors to reduce the prevalence of falls and advise patients and their caregivers about appropriate self-care behaviors.

Prevalence, Risk Factors, and Cost Burden of Fall-Related Hospital Admissions in india

OBJECTIVE: To assess prevalence, risk factors, and cost burden of fall-related hospital admissions among older people in India. Previous studies conducted in India have not focused on the number of fall-related hospital admissions.&lt;br/&gt; DESIGN: A prospective observational study was carried out over 12 months. Socio-demographic, medical and medication details were collected from the patients, medical records, and treating physicians.&lt;br/&gt; SETTING: The study was conducted in internal medicine, orthopedics, and emergency departments of a tertiary care teaching hospital in Mysuru, Southern India.&lt;br/&gt; PARTICIPANTS: Patients 60 years of age or older, of any gender, admitted to hospital were included in this study.&lt;br/&gt; MAIN OUTCOME MEASURE: Prevalence of fall-related hospital admission, fall-related hospital admission associated with medication use, and direct cost incurred due to fall-related hospital admission.&lt;br/&gt; RESULTS: A total of 1,036 patients [Males 53.6%] with a mean (SD) age of 69.3 (8.1) years were included in the study. A total of 188 patients were admitted due to falling with the prevalence of 18.1%. The majority of patients fell due to environmental factors [105 (55.8%)]. Among medication-related falls (20), the majority were associated with the use of antihyperglycemics and antihypertensives. Increasing age, female gender, and multiple comorbidities were identified as risk factors for fall-related hospital admissions.&lt;br/&gt; CONCLUSIONS: Falls are a common reason for hospital admission among older populations. Clinicians need to focus on modifiable risk factors to reduce the prevalence of falls and advise patients and their caregivers about appropriate self-care behaviors.

Secular trends in fall-related hospitalizations in adolescents, youth and adults: a population-based study

BackgroundFalls are one of the major causes of injury globally. However, there is a lack of population-based studies on falls among adolescents, young and middle-aged adults. We therefore aimed to conduct a large-scale population study on the secular trend in incidence of fall-related hospitalization. MethodsA population-wide electronic database, Hong Kong's Clinical Data Analysis and Reporting System (CDARS), was used in this retrospective cohort study. Patients aged≥10, hospitalized with diagnosis of accidental falls (ICD-9-CM E880-E888) from 2005-2018, were included. Outcome measures included the number, age- and sex-standardized incidence rate of fall-related hospital admissions, their length of stay (LOS) and 1-year all-cause mortality. Linear regression and average annual percentage change (AAPC) using joinpoint regression were computed for trend analysis. FindingsFrom 2005 to 2018, a total of 336,439 patients aged≥10 were identified with fall-related hospitalization. Among these fall patients, 33.7% occurred at age<60. The number of fall-related hospital admissions episodes increased significantly by 83.7% during the study period. The standardized incidence rate of falls per 1000 person-years increased from 3.67 (95% CI 3.62-3.72) in 2005 to 4.79 (95% CI 4.74-4.84) in 2018. Although the total hospitalized bed-days increased from 178,723 days in 2005, to 299,273 days in 2018 (+67.5%,p<.0001), the median length of stay per episode of falls decreased from 4.90 days to 3.79 days (p<.0001). InterpretationContinuous increase in the incidence of fall-related hospitalization in people aged≥10 was observed. This suggested that falls are a public health issue in all ages. Further studies on the differences in the underlying risk factors and comorbidities between younger and older fall patients are warranted. FundingNone.

Providing fall prevention services in the emergency department: Is it effective? A systematic review and meta-analysis.

To assess the effects of fall prevention services initiated in the emergency department (ED) to support patients after discharge. A systematic review and meta-analysis were conducted. Analysis of pooled data used random-effects modelling with results presented as a risk ratio (RR). Eleven studies were identified (n=4,018). The proportion of older adults who fell did not differ between the intervention and control groups (RR 0.93; 95% CI, 0.82-1.06, I2 68%, P=0.28). There was a significant (P=0.01) reduction in the monthly rate of falling (RR 0.69; 95% CI, 0.52-0.91, I2 93%), fall-related injuries (RR 0.72; 95% CI, 0.59-0.88, I2 0%, P=0.001), and hospital admissions (RR 0.76; 95% CI, 0.64-0.90, I2 0%, P=0.002). ED fall prevention services did not significantly reduce the proportion of older adults who had future falls. However, multifactorial intervention significantly reduced fall-related injuries and hospital admissions with low heterogeneity.

The Stepping On Fall Prevention Program Scale-Up in NSW: Program Reach and Fall-Related Health Service Use

IntroductionFalls in older adults are associated with increased healthcare costs. Falls may be prevented or minimised with multifactorial interventions including exercise and behavioural modification.&#x0D; Objectives and ApproachTo describe the reach of the scale-up of Stepping On, a fall prevention program targeting community-dwellers aged 65 years and older in NSW, Australia; and fall-related ambulance service use and fall-related hospitalisations after scale-up. Routinely-collected data on program reach, fall-related ambulance usage and fall-related hospital admissions in NSW residents aged ≥65 years between 2009 and 2015 were compared within Statistical Local Areas prior to and following implementation of Stepping On using multilevel models.&#x0D; ResultsFrom 2009 to 2014 the program was delivered in 1,077 sites to 10,096 people with an average (SD) age of 81.0 (7.2) years. Rates of fall-related ambulance use and hospital admissions per 100-person-years were 1-2 in people aged 66-74, 4-5 in people aged 75-84 and 12-13 in people aged ≥85. These rates increased over time (p&lt;.001). Overall, the interaction between time and program delivery was not significant for fall-related ambulance use or hospital admissions. The time-related increase in fall-related ambulance usage in people aged 75-84 years may have been moderated by Stepping On (RR 0.97, 95% CI 0.93–1.00, p=.045).&#x0D; Conclusion / ImplicationsThere was no indication of either a reduced rate of fall-related ambulance use or hospital admissions across the entire sample. There was a suggestion of a reduction in ambulance call-outs for falls in people aged 75-84. The lack of a detectable impact on fall-related health service usage may be due to the use of routinely collected data not intended for research purposes or inability to remove those who would be ineligible for Stepping On from the data analyses. Increasing the program reach and targeting groups contributing most to health service utilisation may improve program outcomes.

Polypharmacy is a risk factor for hospital admission due to a fall: evidence from the English Longitudinal Study of Ageing

BackgroundFalls amongst older people are common; however, around 40% of falls could be preventable. Medications are known to increase the risk of falls in older adults. The debate about reducing the number of prescribed medications remains controversial, and more evidence is needed to understand the relationship between polypharmacy and fall-related hospital admissions. We examined the effect of polypharmacy on hospitalization due to a fall, using a large nationally representative sample of older adults.MethodsData from the English Longitudinal Study of Ageing (ELSA) were used. We included 6220 participants aged 50+ with valid data collected between 2012 and 2018.The main outcome measure was hospital admission due to a fall. Polypharmacy -the number of long-term prescription drugs- was the main exposure coded as: no medications, 1–4 medications, 5–9 medications (polypharmacy) and 10+ medications (heightened polypharmacy). Competing-risk regression analysis was used (with death as a potential competing risk), adjusted for common confounders, including multi-morbidity and fall risk-increasing drugs.ResultsThe prevalence of people admitted to hospital due to a fall increased according to the number of medications taken, from 1.5% of falls for people reporting no medications, to 4.7% of falls among those taking 1–4 medications, 7.9% of falls among those with polypharmacy and 14.8% among those reporting heightened polypharmacy. Fully adjusted SHRs for hospitalization due to a fall among people who reported taking 1–4 medications, polypharmacy and heightened polypharmacy were 1.79 (1.18; 2.71), 1.75 (1.04; 2.95), and 3.19 (1.61; 6.32) respectively, compared with people who were not taking medications.ConclusionsThe risk of hospitalization due to a fall increased with polypharmacy. It is suggested that prescriptions in older people should be revised on a regular basis, and that the number of medications prescribed be kept to a minimum, in order to reduce the risk of fall-related hospital admissions.

Scale-up of the Stepping On fall prevention program amongst older adults in NSW: Program reach and fall-related health service use.

We describe the reach of the scale-up of Stepping On, a fall prevention program targeting community-dwellers aged ≥65years in NSW, along with fall-related ambulance service use and fall-related hospitalisations after scale-up. Data on program provision were received from Local Health Districts. Routinely collected fall-related ambulance usage and hospital admissions in NSW residents aged ≥65years between 2009 and 2015 were compared within Statistical Local Areas prior to and following the implementation of Stepping On using multilevel models. Between 2009 and 2014 the program was delivered in 1077 sites to 10096 older adults. Rates of fall-related ambulance use and hospital admissions per 100-person-years were 1-2 in people aged 66-74, 4-5 in people aged 75-84 and 12-13 in people aged ≥85. These rates increased over time (P<.001). The interaction between time and program delivery was not significant for fall-related ambulance use or hospital admissions. The time-related increase in fall-related ambulance usage in people aged 75-84years may have been moderated by the Stepping On program (rate ratio 0.97, 95% CI 0.93-1.00, P=.045). There was no indication of a reduced rate of fall-related ambulance use or hospital admissions across the entire sample. Ambulance call-outs for falls in people aged 75-84years may have reduced following program participation. SO WHAT?: Program scale-ups need to reach a large proportion of the target population with a focus on those groups contributing most to fall-related health service utilisation. Linking individual participants' health data as part of large-scale evaluations may provide better insights into program outcomes.

Interventions for preventing falls in people after stroke.

Background: falls are one of the most common medical complications after stroke with a reported incidence of 7% in the first week after stroke onset. Studies investigating falls in the later phase after stroke report an incidence of up to 73% in the first year post-stroke. Objectives: to evaluate the effectiveness of interventions aimed at preventing falls in people after stroke. Search methods: we searched the trials registers of the Cochrane Stroke Group (November 2012) and the Cochrane Bone, Joint and Muscle Trauma Group (May 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library 2012, Issue 5, MEDLINE (1950 to May 2012), EMBASE (1980 to May 2012), CINAHL (1982 to May 2012), PsycINFO (1806 to May 2012), AMED (1985 to May 2012) and PEDro (May 2012). We also searched trials registers, checked reference lists and contacted authors. Selection criteria: randomised controlled trials of interventions where the primary or secondary aim was to prevent falls in people after stroke. Data collection and analysis: review authors independently selected studies for inclusion, assessed trial quality, and extracted data. We used a rate ratio and 95% confidence interval (CI) to compare the rate of falls (e.g. falls per person year) between intervention and control groups. For risk of falling we used a risk ratio and 95% CI based on the number of people falling (fallers) in each group. We pooled results where appropriate. Main results: we included 10 studies with a total of 1004 participants. One study evaluated the effect of exercises in the acute and subacute phase after stroke but found no significant difference in rate of falls (rate ratio 0.92, 95% CI 0.45 to 1.90, 95 participants). The pooled result of four studies investigating the effect of exercises on preventing falls in the chronic phase also found no significant difference for rate of falls (rate ratio 0.75, 95% CI 0.41 to 1.38, 412 participants). For number of fallers, one study examined the effect of exercises in the acute and subacute phase after stroke but found no significant difference between the intervention and control group (risk ratio 1.19, 95% CI 0.83 to 1.71, 95 participants). The pooled result of six studies examining the effect of exercises in the chronic phase also found no significant difference in number of fallers between the intervention and control groups (risk ratio 1.02, 95% CI 0.83 to 1.24, 616 participants). The rate of falls and the number of fallers was significantly reduced in two studies evaluating the effect of medication on preventing falls; one study (85 participants) compared vitamin D versus placebo in institutionalised women after stroke with low vitamin D levels, and the other study (79 participants) evaluated alendronate versus alphacalcidol in hospitalised people after stroke. One study provided single lens distance glasses to regular wearers of multifocal glasses. In a subgroup of 46 participants post-stroke there was no significant difference in the rate of falls (rate ratio 1.08, 95% CI 0.52 to 2.25) or the number of fallers between both groups (risk ratio 0.74, 95% CI 0.47 to 1.18). Authors' conclusions: there is currently insufficient evidence that exercises or prescription of single lens glasses to multifocal users prevent falls or decrease the number of people falling after being discharged from rehabilitation following their stroke. Two studies testing vitamin D versus placebo and alendronate versus alphacalcidol found a significant reduction in falls and the number of people falling. However, these findings should be replicated before the results are implemented in clinical practice

Fall-related healthcare use and mortality among older adults in the Netherlands, 1997-2016.

Fall-related injuries are a leading cause of morbidity among older adults, leading to a high healthcare consumption and mortality. We aim to describe and quantify time trends of fall-related healthcare use and mortality among adults aged ≥65 years in the Netherlands, 1997-2016. Data were extracted from the Dutch Injury Surveillance System, Dutch Hospital Discharge Registry, and Cause-of-Death Statistics Netherlands, by age, sex, diagnosis, injury location, and year. Absolute numbers and age-standardized rates of fall-related Emergency Department (ED) visits, hospital admissions, and fatalities, as well as average length of hospital stay (LOS) were calculated. Between 1997 and 2016, absolute numbers of fall-related ED visits increased by 48%, hospital admissions increased by 59%, and mortality showed an almost threefold increase. These absolute numbers doubled among adults aged ≥85 years. A shift in fall-related injury diagnosis was observed over the years with a growing share of skull/brain injuries. In contrast to the increase in absolute numbers, standardized incidence rates of ED visits decreased by 30% (p = 0.00), whereas incidence rates of hospital admissions and mortality did not significantly change over time. Furthermore, the absolute number of hospital admission days almost halved, due to a reduced average LOS from 18.5 (95% confidence interval (CI): 18.2-18.8) days (1997) to 6.1 (95% CI, 6.1-6.2) days (2016). Even though the standardized incidence rates of ED visits decreased in the past twenty years, the absolute number of fall-related ED visits increased. The number of hospital admissions has also increased, but the total number of admission days has almost halved during the same period. If the observed trends would continue, this may have implications for healthcare resource allocation, as the burden of care in EDs increases, and the admission duration reduces.

Reliability, validity, and clinical utility of a self-reported screening tool in the prediction of fall incidence in older adults

Background: The Chinese HomeFAST self-reported screening tool was developed to measure the number of hazards and the risk of home falls and other accidents for community-living older adults.Methods: This reliability, validity, and clinical utility study consisted of three phases. The tool’s linguistic validity was established in the first phase of study, with a panel of domiciliary healthcare experts. In the second phase, the instrument yielded inter-rater reliability between community-living older adults and a group of experienced occupational therapists. Furthermore, in the third phase of study, factor analysis of the Chinese Home-FAST self-reported screening tool was conducted.Results: There was good linguistic validity, test-retest reliability and good to excellent internal consistency of the Chinese Home-FAST self-reported screening tool among older adults living in the community. Moreover, a structure with three factors – namely “Home Environment and Furniture,” “Capability in Activities of Daily Living,” and “Use of Devices” – was yielded from categorical principal components analysis. Clinically, the incidence of falls among this group of recruited older adults in a six-month period was 18%. The identification of seven or more hazards was associated with prediction of unplanned fall-related hospital admission with sensitivity of 83.33% and specificity of 95.83%. Conclusion: The Chinese HomeFAST self-reported screening tool is thus demonstrated to be a valid and reliable tool for measuring home hazards and can predict home falls in Chinese-speaking older adults.Implications for rehabilitationTo develop an easily understandable screening tool for older adults.Older adults can perform home safety screening on their own, and can identify potential risk of falls and other accidents at home.This can serve as a communication tool between older adults and healthcare professionals.Identified hazards can be reported to healthcare professionals for further intervention.This validated instrument can help healthcare professionals to identify higher-risk older adults in the community and thus to better prioritize their provision of professional services.

Study protocol for investigating the impact of community home modification services on hospital utilisation for fall injuries: a controlled longitudinal study using data linkage

IntroductionThis study will evaluate the effectiveness of home adaptations, both in preventing hospital admissions due to falls for older people, and improving timely discharge. Results will provide evidence for services...

Temperature and Fall-Related Hospital Admissions in Hong Kong Sar, China

Background/AimPrevious studies have found increased fall incidence during winter months. However, most of the studies were conducted among the elderly only. Few studies have directly examined the impact of weather on the occurrence of falls. The findings of these studies are also not consistent. Therefore, this study aimed to explore the influences of temperatures on falls.MethodsBetween 1998 and 2011, daily falls-related hospital admission were obtained from Hong Kong Hospital Authority, which were compiled with daily meteorological and air pollutants data obtained from the Hong Kong Observatory and Environmental Protection Department, respectively. Generalized Additive Models were used to estimate the effects of daily mean temperature (&amp;#176;C) on daily falls-related hospital admissions while controlling for other meteorological factors, air pollutants, day of the week, seasonality and long-term trends. Lagged effects were also considered.ResultsA total of 400,737 fall-related hospital admissions were analyzed. The highest falls incidence rate was observed in January, while the lowest in May. A reverse J-shaped association was found. Below a threshold temperature of 28.5&amp;#176;C, daily mean temperature was significantly negatively associated with fall-related hospital admissions. A daily mean temperature of 19.5&amp;#176;C (25th percentile) and 14.5&amp;#176;C (5th percentile) over lags 0-7 were associated with a 11% higher [95% confidence interval (CI): 1.07, 1.15] and 21% higher [95% CI: 1.15, 1.21] falls risks when compared to 28.5&amp;#176;C, respectively.ConclusionsA reverse J-shaped association was found between ambient temperature and falls in the general population in a subtropical Asian city. Since falls are predicted to become the 17th leading cause of death by 2030, it is important to better understand the impacts of the changing climate on falls. Preventive plans such as providing proper heating may help decrease the risk of falls associated with low temperatures.

Multifactorial and multiple component interventions for preventing falls in older people living in the community.

Multifactorial and multiple component interventions for preventing falls in older people living in the community.

Medication Use and Fall-Related Hospital Admissions from Long-Term Care Facilities: A Hospital-Based Case-Control Study.

Falls are a leading cause of preventable hospitalizations from long-term care facilities (LTCFs). Polypharmacy and falls-risk medications are potentially modifiable risk factors for falling. This study investigated whether polypharmacy and falls-risk medications are associated with fall-related hospital admissions from LTCFs compared with hospital admissions for other causes. This was a hospital-based, case-control study of patients aged ≥65years hospitalized from LTCFs. Cases were patients with falls and fall-related injuries, and controls were patients admitted for infections. Conditional logistic regression was used to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between polypharmacy (defined as the use of nine or more regular pre-admission medications) and falls-risk medications (categorized as psychotropic medications and those that can cause orthostatic hypotension) with fall-related hospital admissions. There was no association between polypharmacy and fall-related hospital admissions (adjusted OR 0.97, 95% CI 0.63-1.48); however, the adjusted odds of fall-related hospital admissions increased by 16% (95% CI 3-30%) for each additional falls-risk medication. Medications that can cause orthostatic hypotension (adjusted OR 1.25, 95% CI 1.06-1.46), but not psychotropic falls-risk medications (adjusted OR 1.02, 95% CI 0.88-1.18) were associated with fall-related hospital admissions. The association between medications that can cause orthostatic hypotension and fall-related hospital admissions was strongest among residents with polypharmacy (adjusted OR 1.44, 95% CI 1.08-1.92). Polypharmacy was not an independent risk factor for fall-related hospital admissions; however, medications that can cause orthostatic hypotension were associated with fall-related hospital admissions, particularly among residents with polypharmacy. Falls-risk should be considered when prescribing medications that can cause orthostatic hypotension.

Fall-related hospitalization in people with Parkinson's disease.

Falls are common in people with Parkinson's disease (PD) but few data exist on fall-related hospitalizations in this group. This population-based study compared fall-related hospital admissions, injury rates and consequences in people with and without PD, and determined whether PD was an independent predictor of fall-related hospital length of stay. This was a retrospective study using probabilistic linkage of hospital data in people aged ≥65 years hospitalized for a fall between 1 July 2005 and 31 December 2013 in New South Wales, Australia. Rates of hospital admissions and injuries per person admitted over the study period were compared between people with and without PD using Poisson or negative binomial regression. Multilevel linear modelling was used to analyse length of stay by clustering individuals and adjusting for possible confounders. There were 342 265 fall-related hospital admissions in people aged ≥65 years during the study period, of which 8487 (2.5%) were for people with PD. Sixty-seven per cent of fall-related PD admissions were associated with injury and 35% were associated with fracture. People with PD had higher rate ratios for fall admissions (1.63, 95% confidence interval 1.59-1.67) and injury (1.47, 95% confidence interval 1.43-1.51) and longer median length of stay [9 (interquartile range 1-27) vs. 6 (interquartile range 1-20) days in people without PD; P < 0.001]. PD remained associated with increased length of stay after controlling for comorbidity, age, sex and injury (P < 0.001). This study provides important benchmark data for hospitalizations for falls and fall injuries for older people with PD, which may be used to monitor the effect of fall prevention programmes.

Trends in fall-related ambulance use and hospitalisation among older adults in NSW, 2006-2013: a retrospective, population-based study.

Retrospective population-based descriptive study. Fall-related ambulance use and hospital admissions for all falls and injurious falls in NSW residents aged ≥65 years between 2006 and 2013 were obtained from two discrete sources of routinely collected data. Rates of use are presented descriptively. There were 314041 occasions of fall-related ambulance use by older adults and 331311 fall-related hospitalisations, of which 69% (n=227753) were for injurious falls. Fractures accounted for 57% of injurious hospitalisations. Slips and trips were the most common mechanism of falls requiring hospitalisation (52%). Residents of aged care facilities had a greater proportion of fall injury hospitalisations compared with people living in the community (85% and 65%, respectively). Rates of fall-related ambulance use and hospitalisation were similar and continued to increase over time. Increased effort is needed to prevent falls and associated injury among older people in NSW, particularly among people living in aged care facilities. Ongoing monitoring of rates and the characteristics of people who fall are needed to determine the long-term impact of fall prevention interventions.

Effect of structured physical activity on prevention of serious fall injuries in adults aged 70-89: randomized clinical trial (LIFE Study)

Objective To test whether a long term, structured physical activity program compared with a health education program reduces the risk of serious fall injuries among sedentary older people with functional...

Fall-related admissions after fast-track total hip and knee arthroplasty - cause of concern or consequence of success?

BackgroundTotal hip (THA) and knee arthroplasty (TKA) are common procedures in elderly persons, who are at potential increased risk of postoperative fall due to loss of muscle strength and impaired balance. Fast-track surgery with early mobilization and opioid-sparing analgesia have improved outcomes after these procedures, but early mobilization and short hospitalization length of stay (LOS) could potentially increase the risk of falls after discharge. We investigated injuries, circumstances, and the timing of fall-related hospital admissions 90 days after fasttrack THA and TKA.MethodsThis was a prospective, descriptive multicenter study on fall-related hospital admissions, in 5145 elective fast-track THA and TKA patients, with complete 90-day follow up through the Danish National Patient registry and medical charts.ResultsOf 83 (1.6%) fall-related hospital admissions, 43 (51.8%) were treated in the Emergency Room and 40 (48.2%) were admitted to a regular ward. The median LOS after surgery was 3 days (interquartile range [IQR]: 2–3) in fallers versus (vs) 2 days (IQR: 2–3) (P=0.022) in patients without falls. Injuries were classified as “none” or minor in 39.8%, moderate in 9.6%, and major in 50.6%. Most falls (54.8%) occurred within 1 month of discharge. Falls due to physical activity (12.0%) and extrinsic factors (14.5%) occurred later than did surgery-related falls (73.5%), contributing to 40% of all falls >30 days after discharge. In multivariate analysis, age (odds ratio [OR]: 1.05; 95% confidence interval [CI]: 1.0–1.08) (P=0.001), living alone (OR: 2.09; 95% CI: 1.20–3.62) (P=0.009), and psychiatric disease (OR: 2.80; 95% CI: 1.42–5.50) (P=0.001) were associated with surgery-related falls, whereas the use of a walking aid (OR: 1.20; 95% CI: 0.67–2.16) (P=0.544) and LOS ≤4 days (OR:1.19; 95% CI: 0.52–1.28) (P=0.680) was not.ConclusionHospital admissions due to falls are most frequent within the first month after fast-track THA and TKA. The overall incidence of surgery-related falls amongst these patients is low, declines after the first month, and is related to patient characteristics rather than short LOS. The effect of interventions aimed at surgery-related falls should focus on the first 30 days after surgery and differentiate between the causes of falling.