Incidence Of Fall-related Injuries Research Articles

Incidence and clinical characteristics of fall-related injuries among older inpatients at a tertiary grade a hospital in Shandong province from 2018 to 2020

BackgroundFalls are an important cause of injury and death of older people. Hence, analyzing the multifactorial risk of falls from past cases to develop multifactorial intervention programs is clinically significant. However, due to the small sample size, there are few studies on fall risk analysis of clinical characteristics of fallers, especially among older hospitalized patients.MethodsWe collected data on 153 inpatients who fell (age ≥ 60 years) from the hospital nursing adverse event reporting system during hospitalization at Shandong Provincial Hospital Affiliated to Shandong First Medical University, China, from January 2018 to December 2020. Patient characteristics at the time of the fall, surrounding environment, primary nurse, and adverse fall events were assessed. The enumeration data were expressed as frequency and percentage, and the chi-squared was performed between recurrent fallers and single fallers, and non-injurious and injurious fall groups.ResultsCross-sectional data showed 18.3% of the 153 participants experienced an injurious fall. Compared with single fallers, a large proportion of older recurrent fallers more often experienced preexisting conditions such as cerebrovascular disease or taking hypoglycemic drugs. They were exposed to higher risks and could experience at least 3 fall times in 3 months. Besides, the credentials of their responsible nurses were often higher. Factors that increased the risk of a fall-related injury were hypoglycemic drugs (OR 2.751; 95% CI 1.114–6.795), and nursing adverse events (OR 47.571; 95% CI 14.392–157.247). Older inpatients with bed rails (OR 0.437; 95% CI 0.190–1.005) or falling at the edge of the bed (OR 0.365; 95% CI 0.138–0.964) were less likely to be injured than those without bed rails or not falling at the edge of the bed. Fall risks were significantly correlated with more severe fall-related injuries. Older patients with moderate (OR 5.517; CI 0.687–44.306) or high risk (OR 2.196; CI 0.251–19.219) were more likely to experience fall-related injuries than those with low risk.ConclusionsOlder inpatient falls are an ongoing challenge in hospitals in China. Our study found that the incidence of fall-related injuries among inpatients aged ≥ 60 years remained at a minor level. However, complex patient characteristics and circumstances can contribute to fall-related injuries.This study provides new evidence on fall-related injuries of older inpatients in China. Based on the factors found in this study, regular fall-related injury epidemiological surveys that investigate the reasons associated with the injuries were crucial when considering intervention measures that could refine fall-related injuries. More prospective studies should be conducted with improved and updated multidisciplinary fall risk assessment and comprehensive geriatric assessment as part of a fall-related injury prevention protocol.

Effects of ambient temperature and fall-related injuries in Ma'anshan, Anhui Province, China: a distributed lag nonlinear analysis.

Despite the significant economic cost of falls and injuries to individuals and communities, little is known about the impact of meteorological factors on the incidence of fall-related injuries (FRIs). Therefore, a time-series study was conducted to explore the effects of meteorological factors on FRIs in Ma'anshan City, East China. Injury data from 2011 to 2017 were collected from the National Injury Monitoring Station in Ma'anshan City. A distributed lag nonlinear model was used in this study to evaluate the correlation between ambient temperature and fall injuries. The results showed a significant exposure-response relationship between temperature and FRIs in Ma'anshan City. The high temperatures increased the risk of FRIs (RR = 1.110; 95% CI, 1.005-1.225; lag 0). The lag effect appeared at lag 10 (RR = 1.032; 95% CI, 1.003-1.063), and then gradually remained stable after lag 25 (RR = 1.077; 95% CI, 1.045-1.110). The effect of ambient temperature varied with age and gender. The lag effect of high temperature appeared in the male group after lag 15 (RR = 1.042; 95% CI, 1.006-1.079). In contrast, the effect of the female group appeared for the first time at lag 0 (RR = 1.187; 95% CI, 1.042-1.352). And the ≥ 60 years subgroup seemed to be more sensitive in low temperature (RR = 1.017; 95% CI, 1.004-1.031; lag 0; RR = 1.003; 95% CI, 1.000-1.007; lag 25). The cumulative result is similar to the single-day effect. From the results, this study would help the establishment of fall-related injury prediction and provide evidence for the formulation and implementation of preventive strategies and measures in the future.

Increased Risk of Falls, Fall-related Injuries and Fractures in People with Type 1 and Type 2 Diabetes - A Nationwide Cohort Study.

People with diabetes could have an increased risk of falls as they show more complications, morbidity and use of medication compared to the general population. This study aimed to estimate the risk of falls and to identify risk factors associated with falls in people with diabetes. The second aim was to estimate fall-related injuries, such as lesions and fractures, including their anatomic localization in people with diabetes compared with the general population. From the Danish National Patient Register, we identified people with Type 1 Diabetes (T1D) (n=12,975) Type 2 Diabetes (T2D) (n=407,009). The cohort was divided into two groups, with respective control groups matched on age and sex (1:1). All episodes of people hospitalized with a first fall from 1996 to 2017 were analyzed using a Cox proportional-hazards model. Risk factors such as age, sex, diabetic complications, a history of alcohol abuse and the use of medication were included in an adjusted analysis. The incidence rate, incidence rate difference and incidence rate ratio (IRR) of falls and the anatomic localization of fall-related injuries as lesions and fractures were identified. The cumulative incidence, of falls requiring hospital treatment, was 13.3% in T1D, 11.9% in T2D. In the adjusted analysis, T1D and T2D were associated with a higher risk of falls [T1D, Hazard Ratio (HR): 1.33 (95% CI: 1.25 - 1.43), T2D, HR: 1.19 (95% CI:1.16 - 1.22), respectively]. Women [group 1, HR 1.21 (CI:95%:1.13 - 1.29), group 2, HR 1.61 (CI:95%:1.58-1.64)], aged >65 years [groups 1, HR 1.52 (CI:95%:1.39 - 1.61), group 2, HR 1.32 (CI:95%:1.58-1.64)], use of selective serotonin receptor inhibitors (SSRI) [group 1, HR 1.35 (CI:95%:1.1.30 - 1.40), group 2, HR 1.32 (CI:95%:1.27-1.38)], opioids [group 1, HR 1.15 (CI:95%:1.12 - 1.19), group 2, HR 1.09 (CI:95%:1.05-1.12)] and a history of alcohol abuse [group 1, HR 1.77 (CI:95%:1.17 - 2.15), group 2, HR 1.88 (CI:95%:1.65-2.15)] were significantly associated with an increased risk of falls in both groups. The IRR of fall-related injuries as hip, radius, humerus and skull/facial fractures were higher in people with T2D than controls [IRR 1.02 (CI:95%:1.01-1.04), IRR 1.39 (CI:95%: 1.18-1.61), IRR 1.24 (CI:95%: 1.12-1.37) and IRR 1.15 (CI:95%:1.07-1.24)]. People with T1D had a higher IRR of hip fractures than controls [IRR: 1.11 (CI:95%:1.02 - 1.23)]. People with diabetes have an increased risk of first fall and a higher incidence of fall- related injuries, including fractures. Advanced aging and sex are non-modifiable risk factors, whereas diabetes, the use of SSRIs and opioids and alcohol abuse could be potentially modifiable risk factors for falls. Gaining information on risk factors for falls could guide the management of diabetes treatment, i.e., choice of drugs, which enables us to improve treatment, particularly in people with a high risk of falls and fractures associated with high mortality.

Exploration of Machine Learning to Identify Community Dwelling Older Adults with Balance Dysfunction Using Short Duration Accelerometer Data.

The incidence of fall-related injuries in older adults is high. Given the significant and adverse outcomes that arise from injurious falls in older adults, it is of the utmost importance to identify older adults at greater risk for falls as early as possible. Given that balance dysfunction provides a significant risk factor for falls, an automated and objective identification of balance dysfunction in community dwelling older adults using wearable sensor data when walking may be beneficial. In this study, we examine the feasibility of using wearable sensors, when walking, to identify older adults who have trouble with balance at an early stage using state-of-the-art machine learning techniques. We recruited 21 community dwelling older women. The experimental paradigm consisted of two tasks: Normal walking with a self-selected comfortable speed on an instrumented treadmill and a test of reflexive postural response, using the motor control test (MCT). Based on the MCT, identification of older women with low or high balance function was performed. Using short duration accelerometer data from sensors placed on the knee and hip while walking, supervised machine learning was carried out to classify subjects with low and high balance function. Using a Gradient Boosting Machine (GBM) algorithm, we classified balance function in older adults using 60 seconds of accelerometer data with an average cross validation accuracy of 91.5% and area under the receiver operating characteristic curve (AUC) of 0.97. Early diagnosis of balance dysfunction in community dwelling older adults through the use of user friendly and inexpensive wearable sensors may help in reducing future fall risk in older adults through earlier interventions and treatments, and thereby significantly reduce associated healthcare costs.

Balance, risk of falls, risk factors and fall-related costs in individuals with diabetes

AimsSensory loss and impaired balance are considered risk factors of incident falls. The aim of this study was to assess the relationship between degree of foot sensation and balance, risk of falls, incidence of fall-related injuries and costs in a cohort of patients with diabetes. Methods(Non)-neuropathic subjects participating in the Rotterdam Diabetic Foot Study were followed prospectively. Subjects underwent sensory testing of the feet (39 item Rotterdam Diabetic Foot Study Test Battery (RDF-39)); balance was assessed at the second follow-up (Brief-BESTest) as were data on incident falls. Medical records and financial data were abstracted to estimate fall-related morbidity and in-hospital costs. ResultsA higher RDF-39 score, cerebral artery disease, type 2 diabetes, height and age were predictors of the Brief-BESTest total score. 41/296 patients (13.9%) reported two or more falls during follow-up. Predictors for recurrent falls were a higher RDF-39 score (aOR: 1.124, p < 0.0005), male gender (aOR: 0.319, p = 0.016), age (aOR: 0.938, p = 0.003) and type 2 diabetes (aOR: 3.157, p = 0.100). Thirty-one patients used medical resources (median US$ 440.45 (IQR: 179–1162). ConclusionsDegree of sensory loss correlates significantly with an increased imbalance and risk of falls. The RDF-39 may be used as stratification tool in medical decision-making and patient information.

Incidence of fall related injury in people aged 50 and above and risk factors in 8 provinces in China: a cross-sectional study

Objective: To estimate the incidence and distribution characteristics of fall related injury in people aged ≥50 years in 8 provinces in China and related physiological, psychological and social risk factors. Methods: Cross-sectional data were collected from adults aged ≥50 years participating in the World Health Organization (WHO) study on global ageing and adult health (SAGE) round 1 in China. Two-level hierarchical logistic model was used to identify the related factors for fall-related injury. All the models were stratified by living area (urban/rural). Results: Estimated incidence of fall related injury (road traffic injury was not included) was 3.2%. Ageing and multiple chronic conditions (OR=2.55, 95%CI: 1.41-4.64) was significantly associated with the incidence of fall related injury in urban area. In rural area, depression (OR=4.33, 95% CI: 2.52-7.42) and multiple chronic conditions (OR=2.46, 95%CI: 1.37-4.41) were associated with the incidence of fall related injury. Conclusions: This study estimated the incidence of fall related injury in adults aged ≥50 years in 8 provinces in China. A significant association between multiple chronic conditions and fall related injury were found in both urban and rural residents. Targeted measures should be taken for the prevention and control of chronic diseases in elderly population.

Epidemiological profile of injuries due to fall reporting to a tertiary care centre in a rural area of Northern India

Background: Fall is an important contributor to injury and studies conducted over a period of time have established reliable estimates of the incidence of fall-related injury. The current study was aimed at identifying the epidemiological profile of injuries due to fall. Materials and Methods: A hospital-based descriptive study was conducted for a period of 1 year starting June 2014. The study population comprised all consecutive cases of injuries due to fall reporting to the Department of Orthopedics during the study except for those who denied consent to be included in the study. Results: Males and age group 26–45 (n = 222/795, 27.9%) are more prone to injuries due to fall. It is seen that out of 795 cases, most of the participants were students (n = 219/795, 27.5%). The common mode of injuries is fall from stairs 16 (13.2%). It is seen that population educated up to middle standard (n = 155/795, 19.5%) or primary level educated (n = 145/795, 18.2%) had higher incidence of fall events. It is observed that fall occurring outside home (n = 535/795, 67.3%) are higher than fall at home (n = 240/795, 30.2%). Conclusions: Falls are an important contributor to injury affecting the productive and otherwise healthy age group of 15–45 years in majority.

Fall Risk Assessment Through Automatic Combination of Clinical Fall Risk Factors and Body-Worn Sensor Data.

Falls are the leading global cause of accidental death and disability in older adults and are the most common cause of injury and hospitalization. Accurate, early identification of patients at risk of falling, could lead to timely intervention and a reduction in the incidence of fall-related injury and associated costs. We report a statistical method for fall risk assessment using standard clinical fall risk factors (N = 748). We also report a means of improving this method by automatically combining it, with a fall risk assessment algorithm based on inertial sensor data and the timed-up-and-go test. Furthermore, we provide validation data on the sensor-based fall risk assessment method using a statistically independent dataset. Results obtained using cross-validation on a sample of 292 community dwelling older adults suggest that a combined clinical and sensor-based approach yields a classification accuracy of 76.0%, compared to either 73.6% for sensor-based assessment alone, or 68.8% for clinical risk factors alone. Increasing the cohort size by adding an additional 130 subjects from a separate recruitment wave (N = 422), and applying the same model building and validation method, resulted in a decrease in classification performance (68.5% for combined classifier, 66.8% for sensor data alone, and 58.5% for clinical data alone). This suggests that heterogeneity between cohorts may be a major challenge when attempting to develop fall risk assessment algorithms which generalize well. Independent validation of the sensor-based fall risk assessment algorithm on an independent cohort of 22 community dwelling older adults yielded a classification accuracy of 72.7%. Results suggest that the present method compares well to previously reported sensor-based fall risk assessment methods in assessing falls risk. Implementation of objective fall risk assessment methods on a large scale has the potential to improve quality of care and lead to a reduction in associated hospital costs, due to fewer admissions and reduced injuries due to falling.

Deaths and Injuries in Single-Unit Truck Crashes: Quantifying Risk and Identifying Where Countermeasures Are Needed

s / Annals of Epidemiology 24 (2014) 682e702 692 improved with higher educational attainment of mothers (P<0.005) and increased socioeconomic status. Nonfatal drowning was more common when the main caregiver was not the mother (P<0.001). Forward likelihood ratio logistic regression indicated mothers’ lower educational status as the best predictor of nonfatal drowning. Conclusion: Better child care and prevention of nonfatal drowning might be ensured through increasing mothers’ educational attainment and improvements in socioeconomic status. P41. Deaths and Injuries in Single-Unit Truck Crashes: Quantifying Risk and Identifying Where Countermeasures Are Needed Elisa R. Braver PhD, Ivan Cheung PhD, Nathan A. Doble MS. National Transportation Safety Board Purpose: Single-unit trucks pose a hazard to automobile occupants in crashes due to marked differences in weight and bumper height and also injure pedestrians/bicyclists. However, these 8.2 million trucks are exempt from some safety rules for tractor-trailers, despite having similar weight and height characteristics. This study quantified deaths and injuries in singleunit truck crashes and identified specific safety risks requiring countermeasures. Methods: National US crash databases were used in addition to state databases linking police accident reports and hospital data. Risks were compared between single-unit trucks and tractor-trailers during 2005i€2009. Vehicle identification numbers (VINs) were decoded to classify vehicles. Results: Single-unit trucks aremisclassified and undercounted in federal and state databases, including about 19 percent of fatal crashes. On average,1,662 single-unit trucks were in fatal crashes and 1,817 people died in these crashes nationwide each year during 2005i€2009 comparedwith 3,175 tractor-trailer crash deaths. National estimates, based on state data, were as follows for single-unit truck crashes vs. tractor-trailer crashes each year: 2,459 people receiving serious or worse injuries vs. 2,833; 5,720 hospitalizations vs. 5,987; and 56,359 emergency department visits vs. 36,887. Safety problems included blind spots, nighttime visibility, and rear and side underride. Conclusions: Adverse effects of single-unit truck crashes are underestimated by using police vehicle type codes; this undercounting can be addressed by using VINs to classify vehicles. Although tractor-trailer crashes result in more deaths and serious injuries, the numbers of deaths, injuries, and hospital visits from single-unit truck crashes warrant improved safety regulations for these trucks. P42. Fall-Related Injuries: A Leading Cause of Injury Among Army Soldiers Deployed to Iraq and Afghanistan Geeta Kersellius MPH, MBS, Bonnie Taylor PhD, Keith Hauret MSPH, MPT, Bruce Jones MD, MPH. U.S. Army Institute of Public Health Introduction: Falls are the leading cause of occupational morbidity and mortality in the United States. During the Persian Gulf War, falls (19%) were the second leading cause for non-battle injury (NBI) hospital admissions of soldiers. Falls (18%) were also the second leading cause for air evacuation from Iraq and Afghanistan (2001-2006). Purpose: The objective of this investigationwas to utilize air evacuation data to describe the incidence of serious fall-related NBIs of Army soldiers deployed to Iraq or Afghanistan. Methods: Army soldiers whoweremedically evacuated for NBIs from Iraq or Afghanistan (October 2001-December 2012) were identified from air evacuation records. Patient history and diagnoses were used to determine the cause of injury, fall type and injury type. Descriptive statistics were used to report incidence of fall-related injuries (including near-falls), fall types, and injury types. Results: Overall 21,972 soldiers were air evacuated for an NBI. Of injuries with an identifiable cause (n1⁄415,428), falls were the leading injury cause comprising 28% of NBIs (n1⁄44,331; rate: 3/1,000 person-years). Fall types included falls/jumps (60%), near-falls (21%), falls in sports/physical training (10%), boarding/alighting vehicles (7%), and air transport vehicles (1%). Leading fall injury types were fractures (37%), dislocations (18%), and sprains/ strains/ruptures (14%). Conclusions: Consistent with previous findings, falls remain a leading cause of air evacuation from Iraq and Afghanistan for a severe NBI. Fall-related injuries have a direct negative impact on personal and unit readiness. Injury prevention programs focused on fall types are needed to decrease the burden of NBIs in the military.

A 50-year follow-up of the incidence of traumatic spinal cord injuries in Western Norway

Retrospective population-based epidemiological study. To assess the prevalence and temporal trends in the incidence of traumatic spinal cord injuries (TSCI), and demographic and clinical characteristics of an unselected, geographically defined cohort in the period 1952-2001. The patients were identified from hospital records. Crude rates and age-adjusted rates were calculated for each year. The multivariate relationship between cause of injury, age at injury, decade of injury and gender was examined using a Poisson regression model. Of 336 patients, 199 patients were alive on 1 January 2002, giving a total prevalence of 36.5 per 100,000 inhabitants. The average annual incidence increased from 5.9 per million in the first decade to 21.2 per million in the last. Mean age at injury was 42.9 years and the male to female ratio 4.7:1. Fall was the most common cause of injury (45.5%), followed by motor vehicle accidents (MVA) (34.2%). The incidence of MVA-related injuries increased during the observation period, especially among men <30 years. The lesion level was cervical in 52.4%, thoracic in 29.5% and lumbar/sacral in 18.2%. The lesion was clinically incomplete in 58.6% and complete in 41.4%. The incidence of fall-related injuries and the proportion of incomplete cervical lesions increased during the observation period, especially among men >60 years. The incidence of TSCI has increased during the past 50 years. Falls and MVA are potentially preventable causes. The increasing proportion of older patients with cervical lesions poses a challenge to the health system.