The epidemiology of falls and syncope
Section snippets
Incidence of falls
Prospective studies have reported that 30% to 60% of community-dwelling older adults fall each year [6], [11], [47], [52], [62], [92], with approximately half of them experiencing multiple falls. Fall incidence rates for community-dwelling older populations range from 0.2 to 1.6 falls per person per year, with a mean of approximately 0.7 falls per year (Table 1). The incidence rises steadily after middle age and tends to be highest among individuals 80 years of age and older [10]. These
Causes of falls
Determining the major causes of falls has been an objective of many studies; however, the comparability of findings has been limited by the following factors:
Differences in diagnostic approaches used between studies
Differences in study populations
Differences in classification methods (e.g., single best diagnosis versus multiple diagnoses used for classifying each fall and varying importance placed on coexisting environmental hazards)
Variable patient recall
Multifactorial causality of many falls
Causes of syncope
As with falls, syncope can be caused by a multitude of different conditions, some of which are relatively benign and others potentially life threatening. A number of studies have evaluated patients carefully after a syncopal episode to determine the most likely cause. Table 4 lists those studies that included primarily elderly patients. The study populations range from outpatients evaluated in a clinic setting to patients admitted to hospital intensive care units. Consequently, the causes
Risk factors
Because a single specific cause for falling often cannot be identified and because falls are usually multifactorial in their origin, many investigators have performed epidemiologic case-control studies to identify specific risk factors, the presence of which places individuals at an increased likelihood of falling. The idea behind these studies is that, by identifying risk factors early, preventive strategies can be devised and instituted. Table 5 lists the major fall risk factors that were
Risk factors for syncope
Fewer studies have reported risk factors associated with syncope. As evidenced by the research on syncope causes, the presence of cardiac disease is undoubtedly an important underlying risk factor, as are any conditions or medications that cause orthostatic hypotension. In a prospective study of 97 nursing home residents, multivariate analysis identified five independent risk factors for syncope: coronary artery disease, functional impairment, postural hypotension, aortic stenosis, and insulin
Summary
Falls, syncope, and the associated complications are among the most serious problems that face the elderly population. The most common underlying causes and risk factors for falls include muscle weakness, gait and balance problems, visual impairment, cognitive impairment, depression, functional decline, and particular medications (especially in the presence of environmental hazards). Studies have identified the relative risks for these factors that enable a fairly accurate prediction of who is
Acknowledgements
This work was supported by the Department of Veterans Affairs, Health Services Research and Development Service project #89-101.
References (102)
- et al.
Fall injuries in the elderly
Clin Geriatr Med
(1985) - et al.
Falls and staffing in a residential home for elderly people
Public Health
(1986) - et al.
Risk of syncope in the elderly and consumption of drugs: A case-control study
J Clin Epidemiol
(1997) - et al.
Incidence rates of falls among Japanese men and women living in Hawaii
J Epidemol
(1997) - et al.
Evaluation and outcome of emergency room patients with transient loss of consciousness
Am J Med
(1982) - et al.
Is syncope a risk factor for poor outcomes? Comparison of patients with and without syncope
Am J Med
(1996) - et al.
Syncope in the elderly
Am J Med
(1986) - et al.
Effect of external hip protectors on hip fractures
Lancet
(1993) - et al.
Syncope in institutionalized elderly: The impact of multiple pathological conditions and situational stress
J Chron Dis
(1986) - et al.
Incidence rate of falls in an aged population in northern Finland
J Clin Epidemiol
(1994)
Risk factors for recurrent falls in the elderly in long-term institutional care
Public Health
Clinical characteristics of vasodepressor, cardioinhibitory, and mixed carotid sinus syndrome in the elderly
Am J Med
Falls in old people at home: intrinsic versus environmental factors in causation
Public Health
Fall risk index for elderly patients based on number of chronic disabilities
Am J Med
Association of postprandial hypotension with incidence of falls, syncope, coronary events, stroke, and total mortality at 29-month follow-up in 499 older nursing home residents
J Am Geriat Soc
Correlates of recurrent falling in independent community-dwelling older adults
J Motor Behav
Circumstances and consequences of falls in independent community-dwelling older adults
Age Ageing
Detrimental incidents, including falls, in an elderly institutional population
J Am Geriatr Soc
Fractures of the femur in old age: A two-centre study of associated clinical factors and the cause of the fall
Age Ageing
Risk factors for falls in a community-based prospective study of people 70 years and older
J Gerontol
Circumstances and consequences of falls experienced by a community population 70 years and over during a prospective study
Age Ageing
Factors in fracture of the female femur: a clinical study of the environmental, physical, medical, and preventative aspects of this injury
Gerontol Clin
Home, safe home
J Gerontol Nurs
Falls presenting to the accident and emergency department: Types of presentation and risk factor profile
Age Ageing
Risk factors for falls and for serious injuries on falling among older Japanese women in Hawaii
J Am Geriatr Soc
Accidents in the skilled nursing facility
N Y State J Med
Syncope: Etiology, prognosis, and relationship to age
Aging
Functional consequences of aging: Clinical manifestations
Falls in the elderly: Balance, strength, and flexibility
Arch Phys Med Rehabil
Epidemiology of syncope in hospitalized patients
J Gen Intern Med
Medications and diagnoses in relation to falls in a long-term care facility
J Am Geriatr Soc
Monitoring risk factors in nursing homes
J Gerontol Nurs
A longitudinal study of falls in an elderly population: incidence and morbidity
Age Ageing
Characteristics and predictors of falls in elderly patients
J Fam Pract
Injury in late life: I. Epidemiology. II. Prevention
J Am Geriatr Soc
Effects of neurological disorders on postural movement strategies in the elderly
Prognosis of falls among elderly nursing home residents
Aging Clin Exp Res
Hypotensive responses to common daily activities in institutionalized elderly: a potential risk for recurrent falls
Arch Intern Med
Falls in the institutionalized elderly
J Am Geriatr Soc
The role of medication in falls among the elderly in a long-term care facility
Mt Sinai J Med
Identifying nursing home residents at risk for falling
J Am Geriatr Soc
Falls in community-dwelling older persons
J Am Geriatr Soc
Drugs and falls in older people: a systematic review and meta-analysis. Psychotropic drugs
J Am Geriatr Soc
Drugs and falls in older people: A systematic review and meta-analysis: Cardiac and analgesic drugs
J Am Geriatr Soc
Postprandial blood pressure reduction in healthy elderly
J Am Geriatr Soc
Causes and correlates of recurrent falls in ambulatory frail elderly
J Gerontol
Syncope in an elderly, institutionalized population: Prevalence, incidence, and associated risk
Q J Med
Physiological factors associated with falls in older community-dwelling women
J Am Geriatr Soc
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