The circumstances, orientations, and impact locations of falls in community-dwelling older women

Abstract

Objective: We sought to characterize the circumstances, orientations, and impact locations of falls in community-dwelling, ambulatory, older women.

Methods: For this longitudinal, observational study, 125 community-dwelling women age≥65years were recruited. Over 12-months of follow-up, fall details were recorded using twice-monthly questionnaires.

Results: More than half (59%) of participants fell, with 30% of participants falling more than once (fall rate=1.3 falls per person-year). Slips (22%) and trips (33%) accounted for the majority of falls. Approximately 44% of falls were forward in direction, while backward falls accounted for 41% of falls. About a third of all falls were reported to have lateral (sideways) motion. Subjects reported taking a protective step in response to 82% of forward falls and 37% of backward falls. Of falls reporting lateral motion, a protective step was attempted in 70% of accounts. Common impact locations included the hip/pelvis (47% of falls) and the hand/wrist (27%). Backwards falls were most commonly reported with slips and when changing direction, and increased the risk of hip/pelvis impact (OR=12.6; 95% CI: 4.7-33.8). Forward falls were most commonly reported with trips and while hurrying, and increased the risk of impact to the hand/wrist (OR=2.6; 95% CI: 1.2-5.9).

Conclusion: Falls in older ambulatory women occur more frequently than previously reported, with the fall circumstance and direction dictating impact to common fracture locations. Stepping was a common protective recovery strategy and that may serve as an appropriate focus of interventions to reduce falls in this high risk population.

Keywords: Balance; Fracture; Injury; SAFER; Slips; Trips.

Figure 1. The percentage of all falls (n=158) experienced under certain contexts in 125 ambulatory, community-dwelling women age ≥ 65 years

Forward falls, backward falls, falls in neither direction, and falls in which such directions were not reported are distinguished by different shades of gray. Seven fall records did not indicate a time of day. Six fall records did not indicate if it was at home or away from home (four of which were outside, two of which also did not indicate indoor/outdoor status). Six at-home fall records and one away-from-home fall record did not indicate if the fall was outside or not. Five fall records did not indicate any concurrent activity.

Figure 2. Fall Orientations and Impacts

A. Body orientations of falls reported in the forwards or backwards direction (20 fall records did not report this information, leaving blank responses, so percentages are based on n=138 falls). Forward falls were identified from the four leftmost orientations, and backward falls were identified as the remaining six figures. B. Body orientations of falls also reporting lateral (sideways) motion (32 fall records did not report this information, leaving blank responses, so percentages are based on n=126 falls). C. Sites of fall impact, with 87 falls recording more than one impact location (12 fall records did not indicate an impact region, leaving blank answers, so percentages are based on n=146 falls). Note that fall impacts were sometimes reported on the front and back of the same region, or impacts may have been reported to both the left and right analogous regions. Therefore, the sum of percentages in a specific region (e.g. 42% for the hand/wrist) will not equal the results presented in the text (e.g. 27% of falls had a hand/wrist impact).

Figure 3. Odds ratios and 95% confidence intervals of fall impact locations as a function of the fall direction or disturbance type

Odds ratios are displayed on a log10 scale. Confidence intervals above 1 are denoted with an *. Confidence intervals below 1 are denoted with a #.