Circumstances leading to injurious falls in older men and women in the Netherlands

Abstract

Background

Fall-induced injuries in persons aged 65 years and older are a major public health problem. Data regarding circumstances leading to specific injuries, such as traumatic brain injury (TBI) and hip fractures in older adults are scarce.

Objective

To investigate the activity distributions leading to indoor and outdoor falls requiring an emergency department (ED) visit, and those resulting in TBIs and hip fractures.

Participants

5880 older adults who visited the ED due to a fall.

Methods

Data is descriptive and stratified by age and gender.

Results

Two-thirds of all falls occurred indoors. However, there were higher proportions of outdoor falls at ages 65–79 years (48%). Walking up or down stairs (51%) and housekeeping (17%) were the most common indoor activities leading to a TBIs. Walking (42%) and sitting or standing (16%) was the most common indoor activities leading to a hip fracture. The most common outdoor activities were walking (61% for TBIs and 57% for hip fractures) and cycling (10% for TBIs and 24% for hip fractures).

Conclusion

In the present study we found that the indoor activities distribution leading to TBIs and hip fractures differed. Notably, about half of the traumatic brain injuries and hip fractures in men and women aged 65–79 years occurred outdoors. This study provides new insights into patterns leading to injurious falls by age, gender and injury type, and may guide the targeting of falls prevention at specific activities and risk groups, including highly functional older men and women.

Introduction

Falls affect approximately a third of the population aged 65 years and older, and are associated with major adverse consequences such as disability, loss of quality of life, institutionalisation, and high morbidity and mortality rates [1], [2], [3], [4], [5], [6], [7], [8]. Furthermore, falls place a substantial burden on healthcare systems due to the large amount of visits to emergency departments, hospital admissions, admissions to long-term care and rehabilitation facilities, and related healthcare costs [3], [4], [7], [9], [10], [11] making falls prevention a public health priority [12], [13].

The most common injuries due to falls in the population aged 65 years and older in the Netherlands are superficial injuries, hip fractures, upper extremity fractures, and traumatic brain injury (TBI) [10]. Approximately 30% of people with a hip fracture will die within a year, and many more will experience significant functional loss [2]. Similarly, TBI is associated with serious consequences. Falls cause 61% of TBIs among persons aged 65 years and older in the United States [14]. Furthermore, recent studies in the United States [14], the Netherlands [15], and Finland [16] showed an increase in fall-related TBIs.

An important yet overlooked aspect regarding falls in the elderly is the paucity of evidence regarding patterns in the circumstances leading to injurious falls. Falls are the most important cause of TBIs and hip fractures in older adults, thus these patterns are valuable because they could highlight subgroups that may benefit from targeted falls prevention strategies [2], [15], [17]. However, data on circumstances leading to major consequences of falls in older adults, such as hip fractures and TBIs are scarce; and the number of events in the available studies is relatively low [18], [19], [20], [21].

In this study, we investigated the indoor and outdoor activities leading to injurious falls in a large number of older men and women who visited the emergency department (ED) after experiencing a fall.