Study of factors associated with fall-related injuries among frail older adults




Scott, Victoria Janice

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Falls are the most frequent cause of injury-related hospitalization and death for people 65 years and older in Canada (Canadian Institute of Health Information, 1998; Langlois et al., 1995; Raina & Torrance, 1996). Studies show the etiology of a falls to be a complex combination of factors that reflect physical, behavioral and social conditions operating alone, or in conjunction with environmental hazards (Speechley & Tinetti, 1991; O'Loughlin et al., 1993). However, the particular role of these factors in relation to falls that result in injury— the subject of this study— is less well understood. Fall-related injuries among frail, older, community-dwelling adults are the focus of this study due to the growing numbers of seniors living in the community who have multiple chronic conditions, the serious consequences of many of these events for this population, and the mounting costs related to treatment. The purpose of this study was to understand the extent and nature of fall-related injuries among frail older adults and to examine the patterns and compounding effects of a wide range of variables representing biological, behavioural, environmental, social and economic risk factors. Differences were examined for risk factors among fallers, nonfallers, injured and non-injured persons. The secondary data used for this study were provided through the University of Victoria Centre on Aging in British Columbia and are based on the Capital Regional District (CRD) Patterns of Care Survey 1995-96 (Centre on Aging, 1996). The data from the CRD Survey are based on interviews with frail community-dwelling seniors represented by two purposefully selected groups. One group consisted of over 3,000 seniors in the CRD receiving publicly-funded home support services in 1995, and the other, a matched sample of 810 seniors screened by age, gender and functional limitations, drawn from the 56,774 seniors in the CRD not receiving home support services. Five hundred and six participants were randomly selected from each group. Of the 1012 respondents to the CRD Survey, 245 reported a fall with an injury, 91 reported falling without an injury and 675 were non-fallers (fall data were missing for one case). Findings showed that 72.9% of those who fell reported being injured as a result of one or more of their falls. This injury rate is considerably higher than that found in other studies that look at the general population of persons aged 65 and over. These differences are explained by the precondition of frailty that defines the population in the CRD Survey. Findings also differ from most other studies in the lack of association found between falls with injury and advanced age or female gender, indicating the strong influence of frailty, regardless of age or gender, for this sample. The results indicate that considerable differences exist in the patterns and combined effect of multiple risk factors between older adults who fall and sustain an injury and those who do not. The findings both confirm and contradict the findings of earlier studies, as well as shedding light on factors not previously studied. This study was conducted from a critical gerontological perspective. This perspective is particularly relevant to the study of seniors’ issues that are influenced by a complex combination of factors— such as fall-related injuries— as it enables an examination of multiple perspectives of the issue within larger social, economic and political contexts. A critical gerontological framework was use in this study to guide the selection of variables, to explain the findings in light of previous knowledge, and to critically examine social policies that influence the ability to implement strategies for prevention.



Falls (Accidents) in old age