Article
Client safety: how to predict fall
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Authors
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A. Bergland
- Oslo University College, Norway
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G.-B. Jarnlo
- Lund University, Sweden
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T. Bruun-Wyller
- Ullevaal University Hospital, Norway
| Published: | December 18, 2006 |
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Outline
Text
Objective
In the elderly, balance and walking impairments are assumed to play an important role in causing falls. The purpose of was to assessed prospectively the predictive ability of health, function and balance variables regarding falls and their location.
Methods
Falls which occurred during one year in a random sample of 307 women aged 75 years and over, were recorded, and related to base-line registrations of health, medication and tests of walking and balance.
Results
In all, 155 women (50.5%) reported 308 falls. Outdoor falls were significantly more frequent than indoor falls (57.5 % vs. 42.5%). Near 2/3 (62.8%) of the falls occurred during walking, 33 (10.7%) were related to climbing stairs, and a further 20(6.5%) took place during transfer from bed or chair. In all, 156 of the falls resulted in an injury, and in 74 cases (24.0%) this was categorised as severe. Forty falls (13.0%) resulted in fractures. An additional 34 falls (11%) resulted in soft tissue injuries that required medical treatment. The variables having had a fall before the start of the study, osteoporosis, hypertension, feeling depressive, unable to climb 40 cm high steps and walking slowly all independently predicted a higher number of falls overall. Regarding fall location, having experienced a fall before study start was associated with more falls indoors as well as outdoors. Vision impairment, symptoms of depression, a faster comfortable walking speed, and being able to cope with higher steps were all independent predictors of more outdoor falls also after adjustment for outdoor exposure. A slower comfortable walking speed, a higher amplitude of the center of pressure movements in the frontal plane, a poorer score on the timed up & go test, multimorbidity, poor cognition and hypertension were independent risk factors for indoor falls.
Conclusion
Outdoor falls have a higher incidence than indoor ones among elderly Norwegian women. These two types of falls are predicted differently, and an association between morbidity and falling exists for indoors falls. Location of falling is an important confounder when studying the predictive validity of tests of balance and walking in the elderly.
