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Who is at risk and why

Adults :: Falls :: Who is at risk and why

The risk of falling increases with age and frailty for a number of reasons. Risk factors for falls include:


• Balance or mobility problems including those due to degenerative joint disease and motor disorders such as stroke and Parkinson's disease
• Taking four or more medications, particularly sedating or blood pressure lowering drugs.
• Certain drugs, e.g., alcohol, psychotropic drugs, benzodiazepines and antidepressants [1]
• Visual impairment
• Impaired cognition or depression
• Postural hypertension
• Risk factors at home such as poor lighting, steep stairs, loose carpet, slippery/rough floors and obstacles can cause falls for all people but particularly for older people who may already have other risk factors [2]
• Certain demographic groups, e.g., older populations (aged 85+), females, those from the least advantaged social groups [3] These risk factors become more common with age and there is therefore a high prevalence of falls related injury amongst older people: more than 30% of people aged <65 and 50% of people aged >80 fall each year. Multiple factors, many of which are modifiable, can combine to cause falls. Identifying and modifying risk factors is therefore vital to falls prevention.

Older people who experience a fall are also more likely to fall again. Figure 1 shows that Medway's hospital admission rates for all falls increased with age in 2012. It should be noted that calendar year, rather than financial year, has been used throughout this needs assessment due to the availability of more current data with this method. A particularly rapid acceleration in the rate occurred from age 70–74 years onwards, with the rate for females aged 85+ reaching almost 12%.

Figure 1: Falls related hospital admission rate (all falls) in Medway by age and gender, 2012.
Figure 1: Falls related hospital admission rate (all falls) in Medway by age and gender, 2012 Source: Secondary Uses Service via KMHIS data warehouse and Office for National Statistics.

Osteoporosis is most common in older white women. After the menopause, osteoporosis prevalence in women increases markedly with age from approximately 2% at 50 years to more than 25% at 80 years. [4] The most common osteoporotic fractures resulting from a fall occur in the hip, spine and wrist. These often result in substantial morbidity and mortality: the risk of death in older people following a hip fracture is approximately 11–23% at six months and 22–29% at a year after injury. [1] In the UK, 1 in 2 women and 1 in 5 men will suffer a fracture after the age of 50. [5]

Figure 2 shows that the Medway hospital admission rate in 2012 for hip fractures in both men and women increased with age and was by far the highest in those aged 85 years and above.

Figure 2: Falls related hospital admission rate (all falls) in Medway by age and gender, 2012.
Figure 2: Falls related hospital admission rate for fractured neck of femur in Medway by age and gender, 2012 Source: Secondary Uses Service via KMHIS data warehouse and Office for National Statistics.

Falls in older persons are around three times more common in residential care settings than in the community, reflecting a higher incidence of risk factors such as poor mobility, visual impairment and dementia in these settings. [6] Up to 75% of nursing home residents fall annually — twice as high as older people living in the community. An estimated 10–25% of falls in institutional settings result in fracture or injury requiring hospital attention, compared with 5% in the community. [7]


References

[1]   Leipzig R, Cumming R, Tinetti M. Drugs and falls in older people: a systematic review and meta-analysis: I. Psychotropic drugs Journal of the American Geriatrics Society 1999; 47 (1): 30-39.
[2]   Connell B. Role of the environment in falls prevention Clinics in Geriatric Medicine 1996; 12(4): 589-80.
[3]   Department of Health. National Service Framework for Older People 2001; Department of Health. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/198033/National_Service_Framework_for_Older_People.pdf .
[4]   National Hip Fracture Database. National Hip Fracture Database National Report 2012; National Hip Fracture Database. http://www.nhfd.co.uk/003/hipfractureR.nsf/luMenuDefinitions/CA920122A244F2ED802579C900553993/$file/NHFD%20National%20Report%202012.pdf?OpenElement .
[5]   National Osteoporosis Society. Osteoporosis key facts and figures 2006; National Osteoporosis Society. http://www.nos.org.uk/Document.Doc?id=47 .
[6]   Handoll H. Prevention of falls and fall related injuries in older people in nursing homes and hospitals Injury Prevention 2010; 16: 137-138.
[7]   Rubenstein LZ, Powers CM, MacLean CH. Quality Indicators for the Management and Prevention of Falls and Mobility Problems in Vulnerable Elders Annals of Internal Medicine 2001; 135: 686-693.