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Health Informatics Unit
The University of Adelaide
SA 5005 Australia
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The Significance and Prevention of Falls in the Elderly

Little, K., Pradhan, M. and Cleland, L.

Falls in the frail elderly are a major public health problem. The prevalence of falls in one year in those aged 65 years and over ranges form 30 to 60 percent [ 1 2 3 4 5 6 7 8 9 10 11 ] . Whilst most do not result in serious injury, Australian statistics have shown falls to be the leading cause of accidental death in this age group [ 12 ] . Fragility fractures (especially hip) are the most common reason for hospital admission following a fall [ 13 14 ] .

Besides bearing a considerable human cost, falls are a drain of monetary resources. For example, the hospital costs alone for one hip fracture are approximately $10,000.

A number of interventions exist that address the problem of falls. Home assessment and modification reduces the risk of falling by adapting homes of individuals at risk (e.g. introducing grab rails, replacing stairs with ramps, removing rugs and other obstacles). Exercise programs aimed at improving balance and mobility can decrease the risk. Thorough medical assessment accompanied by appropriate adjustments to medical management can reduce pathological and pharmacological risk factors for falls.

Other interventions address outcomes of falls. Hip protectors are shields worn over the greater trochanter designed to distribute impact forces away from the hip into the soft tissues. Hip fracture appears to be a rare event when hip protectors are worn at the time of a fall. Distress alarms are devices typically worn around the neck which when activated alert others of the need for intervention. They are particularly useful when an individual is unable to get up after a fall.

Whilst the above interventions are effective against falls; they are expensive to administer. Resources are limited and therefore must be allocated to those interventions that bring the greater benefit. At-risk populations need to be identified and intervention efforts concentrated on these groups.

References

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9. Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med 1988;319(26):1701-7.

10. Dolinis J, Harrison JE, Andrews GR. Factors associated with falling in older Adelaide residents. Aust N Z J Public Health 1997;21(5):462-8.

11. Prudham D, Evans JG. Factors associated with falls in the elderly: a community study. Age Ageing 1981;10(3):141-6.

12. Harrison J, Dolinis, J. Australian Injury Prevention Bulletin no.10 Adelaide: AIHW National Injury Surveillance Unit. Injury Mortality Australia 1993 1995.

13. Lauritzen JB, McNair PA, Lund B. Risk factors for hip fractures. A review. Dan Med Bull 1993;40(4):479-85.

14. Cummings SR, Nevitt MC, Browner WS, Stone K, Fox KM, Ensrud KE, et al. Risk factors for hip fracture in white women. Study of Osteoporotic Fractures Research Group [see comments]. N Engl J Med 1995;332(12):767-73.