Abstract
Objectives
Falls are a major health concern for older adults. Understanding sex differences in
fall circumstances may guide the design of fall management plans specifically to men
and women. In this study, analyzed real-life falls captured on video to compare scenarios
leading to falls between men and women in 2 long-term care (LTC) facilities.
Design
Prospective cohort study.
Participants/Setting
A total of 529 participants residing in 2 LTC facilities in British Columbia, Canada.
Measurements
Between 2008 and 2016, we video-captured 1738 falls experienced by 231 men and 298
women (mean age = 83 ± 9 years). Each video was analyzed to determine the causes of
imbalance and the activities at time of falling. Using generalized estimating equation
models, we examined how fall circumstances associated with age, sex, and health status.
Results
Men were more likely than women to fall from loss of support with an external object
(odds ratio 1.37; 95% confidence interval 1.08–1.73) and less likely to fall from
tripping (0.72; 0.54–0.96). Men were more likely to fall while seated (1.42; 1.07–1.87)
or while rising (1.49; 1.11–1.99), and less likely to fall while walking (0.61; 0.50–0.75).
After adjusting for age and health status, sex remained significantly associated with
loss of support and walking. Furthermore, regardless of sex, falls from loss of support
were more common among individuals who were less independent in activities of daily
living, who used more medications, and who used diuretic. Individuals with independent
activities of daily living and intact cognition were more likely to fall while walking,
but less likely to fall while seated or while rising.
Conclusions
Our results elucidate differences between older men and women in the scenarios that
lead to falls, to inform sex-specific fall prevention strategies in the LTC setting.
Keywords
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References
Postl B, Wright J, Boileau L, et al. Health Care in Canada 2011, A Focus on Seniors and Aging 2011, Canadian Institute for Health Information: Ottawa, 2011.
- Falls in the nursing home.Ann Intern Med. 1994; 121: 442-451
- The costs of fatal and non-fatal falls among older adults.Inj Prev. 2006; 12: 290-295
- Prevention of falls among the elderly.N Engl J Med. 1989; 320: 1055-1059
- Circumstances and consequences of falls experienced by a community population 70 years and over during a prospective study.Age Ageing. 1990; 19: 136-141
Centers for Disease Control and Prevention NCfIPaC. Web–based Injury Statistics Query and Reporting System (WISQARS). Accessed September 15, 2017.
- Gender differences for non-fatal unintentional fall related injuries among older adults.Inj Prev. 2005; 11: 115-119
- A cross-sectional study of muscle strength and mass in 45- to 78-yr-old men and women.J Appl Physiol (1985). 1991; 71: 644-650
- Active and passive mobility of lower limb joints in elderly men and women.Am J Phys Med Rehabil. 1989; 68: 162-167
- Onset of mobility disability among community-dwelling old men and women. The role of tiredness in daily activities.Age Ageing. 2003; 32: 579-584
- Circumstances and consequences of falls in independent community-dwelling older adults.Age Ageing. 1997; 26: 261-268
- Clinical practice. Preventing falls in elderly persons.N Engl J Med. 2003; 348: 42-49
- Falls in older people: Epidemiology, risk factors and strategies for prevention.Age Ageing. 2006; 35: ii37-ii41
- Muscle strength and speed of movement in relation to age and muscle morphology.J Appl Physiol Respir Environ Exerc Physiol. 1979; 46: 451-456
- The association of changes in physical-activity level and other lifestyle characteristics with mortality among men.N Engl J Med. 1993; 328: 538-545
- Forgetting falls. The limited accuracy of recall of falls in the elderly.J Am Geriatr Soc. 1988; 36: 613-616
- Monitoring falls in cohort studies of community-dwelling older people: Effect of the recall interval.J Am Geriatr Soc. 2005; 53: 2190-2194
- Agreement between video footage and fall incident reports on the circumstances of falls in long-term care.J Am Med Dir Assoc. 2015; 16: 388-394
- Video capture of the circumstances of falls in elderly people residing in long-term care: An observational study.Lancet. 2013; 381: 47-54
- Development and validation of a questionnaire for analyzing real-life falls in long-term care captured on video.BMC Geriatr. 2013; 13: 40
- Development of the nursing home Resident Assessment Instrument in the USA.Age Ageing. 1997; 26: 19-25
- Scaling ADLs within the MDS.J Gerontol A Biol Sci Med Sci. 1999; 54: M546-M553
- MDS Cognitive Performance Scale.J Gerontol. 1994; 49: M174-M182
- Fall direction, bone mineral density, and function: Risk factors for hip fracture in frail nursing home elderly.Am J Med. 1998; 104: 539-545
- Risk factors for hip impact during real-life falls captured on video in long-term care.Osteoporos Int. 2016; 27: 537-547
- Circumstances surrounding falls in patients with dementia in a psychogeriatric ward.Arch Gerontol Geriatr. 2009; 49: 80-87
- Falls in the elderly related to postural imbalance.Br Med J. 1977; 1: 261-264
- Musculoskeletal study, grip strength, postural control, and functional leg power in a representative cohort of British men and women: Associations with physical activity, health status, and socioeconomic conditions.J Gerontol A Biol Sci Med Sci. 2005; 60: 224-231
- Leg extensor power and functional performance in very old men and women.Clin Sci (Lond). 1992; 82: 321-327
- A kinematic analysis of walking and physical fitness testing in elderly women.Can J Sport Sci. 1991; 16: 223-228
- Physical aggression in dementia patients and its relationship to depression.Am J Psychiatry. 1999; 156: 66-71
- Muscle weakness and falls in older adults: A systematic review and meta-analysis.J Am Geriatr Soc. 2004; 52: 1121-1129
- Attentional demands and postural recovery: The effects of aging.J Gerontol A Biol Sci Med Sci. 1999; 54: M165-M171
- Risk indicators for falls in institutionalized frail elderly.Am J Epidemiol. 2003; 158: 645-653
- New loop diuretic prescriptions may be an acute risk factor for falls in the nursing home.Pharmacoepidemiol Drug Saf. 2012; 21: 560-563
- Interventions for preventing falls in older people in care facilities and hospitals (Review).Cochrane Database Syst Rev. 2012 Dec12; 12 (CD005465)
- Physical rehabilitation for older people in long-term care.Cochrane Database Syst Rev. 2013; 2: CD004294
- Effect of structured physical activity on prevention of serious fall injuries in adults aged 70–89: Randomized clinical trial (LIFE Study).BMJ. 2016; 352: i245
- The effect of enhanced supervision on fall rates in residential aged care.Am J Phys Med Rehabil. 2009; 88: 823-828
Article info
Publication history
Published online: September 26, 2017
Footnotes
This study was funded by (1) Canadian Institute for Health Research (CIHR team grant Nos. 138295, AMG-100487, and TIR-103945); (2) AGE-WELL National Centers of Excellence (AW CRP 2015-WP5.2); (3) Canada Research Chair program (to SNR); (4) CIHR New Investigator Award and Michael Smith Foundation for Health Research (MSFHR) Scholar Award (to JSG); (5) MSFHR fellowship awards (Nos. 16556 and 16606, to YY and KS).
The authors declare no conflicts of interest.
Identification
Copyright
© 2017 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
