Risks factors for significant injury after geriatric falls


Risks factors for significant injury after geriatric falls


Jon D. Dorfman MD1, Allison Wyman MS2, Gordon FitzGerald PhD2, Timothy A. Emhoff MD1, Fred A. Anderson PhD2, Heena P. Santry MD MS3
1Department of Surgery, University of Massachusetts Memorial Medical Center Worcester, MA;
2University of Massachusetts Medical School, Worcester, MA; 3Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH (formerly at 1,2)


international journal of aging research

Elderly falls are a healthcare epidemic. We aimed to identify risk factors of serious falls by linking data on functional status from the Global Longitudinal Study of Osteoporosis in Women (GLOW) and our institutional trauma registry. 124 of 5,091 local women enrolled in GLOW were evaluated by our trauma team for injuries related to a fall during the study period. Median injury severity score was 9. The most common injuries were intertrochanteric femur fracture (n = 25, 9.8%) and skin contusion/hematoma to face (n = 12, 4.7%). Injured women were older than the uninjured cohort (median 80 versus 68 years), more likely to have cardiovascular disease and osteoarthritis, and less likely to have high cholesterol. Prospectively collected Short Form 36 (SF-36) baseline activity status revealed greater limitation in all assessed activities in women evaluated for fall-related injuries in our trauma center. In multivariable analysis, age (per 10 year increase) and two or more self-reported falls in the baseline survey were the strongest predictors of falling (both HR 2.4, p <0.0001 and p<0.001 respectively), followed by history of osteoarthritis (HR 1.6, p= 0.01). Functional status was no longer associated with risk of fall when adjusting for these factors.
Functional status appears to be a surrogate marker for frailty. With the aging of the US population and long lifespan of American women, this finding has important implications for both fall prevention strategies and research intended to better understand why aging women fall as burdensome validated metrics may not be the best indicators of fall risk.

The authors have no conflict of interests to declare. Funding statement: This work was partially supported by grants from NIH (8KL2TR000160-03), AHRQ (R01HS22694), and PCORI (ME-1310-07682) to HS.


Keywords: geriatric, falls, trauma


Free Full-text PDF


How to cite this article:
Jon D. Dorfman, Allison Wyman, Gordon FitzGerald, Timothy A. Emhoff, Fred A. Anderson, Heena P. Santry.Risks factors for significant injury after geriatric falls. International Journal of Aging Research, 2019, 2:27. DOI: 10.28933/ijoar-2018-12-2305


References:

1. Ortman, J. M., Velkoff, V. A., & Hogan, H. (2014). An aging nation: the older population in the United States (pp. 25-1140). United States Census Bureau, Economics and Statistics Administration, US Department of Commerce.
2. Stevens, J. A. (2010). A CDC compendium of effective fall interventions: What works for community-dwelling older adults.
3. Sterling, D. A., O’connor, J. A., & Bonadies, J. (2001). Geriatric falls: injury severity is high and disproportionate to mechanism. Journal of Trauma and Acute Care Surgery, 50(1), 116-119.
4. Bergeron, E., Clement, J., Lavoie, A., Ratte, S., Bamvita, J. M., Aumont, F., & Clas, D. (2006). A simple fall in the elderly: not so simple. Journal of Trauma and Acute Care Surgery, 60(2), 268-273.
5. Barnett, A., Smith, B., Lord, S. R., Williams, M., & Baumand, A. (2003). Community‐based group exercise improves balance and reduces falls in at‐risk older people: a randomised controlled trial. Age and ageing, 32(4), 407-414.
6. Li, F., Harmer, P., Fisher, K. J., McAuley, E., Chaumeton, N., Eckstrom, E., & Wilson, N. L. (2005). Tai Chi and fall reductions in older adults: a randomized controlled trial. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 60(2), 187-194.
7. Skelton, D., Dinan, S., Campbell, M., & Rutherford, O. (2005). Tailored group exercise (Falls Management Exercise—FaME) reduces falls in community-dwelling older frequent fallers (an RCT). Age and Ageing, 34(6), 636-639.
8. Cumming, R. G., Thomas, M., Szonyi, G., Salkeld, G., O’neill, E., Westbury, C., & Frampton, G. (1999). Home visits by an occupational therapist for assessment and modification of environmental hazards: a randomized trial of falls prevention. Journal of the American geriatrics society, 47(12), 1397-1402.
9. Gillespie, L. D., Robertson, M. C., Gillespie, W. J., Lamb, S. E., Gates, S., Cumming, R. G., & Rowe, B. H. (2009). Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev, 2(2).
10. Nikolaus, T., & Bach, M. (2003). Preventing falls in community‐dwelling frail older people using a home intervention team (HIT): results from the randomized Falls‐HIT trial. Journal of the American Geriatrics Society, 51(3), 300-305.
11. Hooven, F. H., Adachi, J. D., Adami, S., Boonen, S., Compston, J., Cooper, C., … & LaCroix, A. (2009). The Global Longitudinal Study of Osteoporosis in Women (GLOW): rationale and study design. Osteoporosis international, 20(7), 1107-1116.
12. Rotondo MF, Cribari C, Smith RS ed. (2014) Resources for the optimal care of the injured patient 6th edition. American College of Surgeons.
13. Ware JE, Kosinski M, Dewey JE (2000) How to score version 2 of the SF-36 Health Survey. Quality Metric, Lincoln
14. Lauretani, F., Russo, C. R., Bandinelli, S., Bartali, B., Cavazzini, C., Di Iorio, A., … & Ferrucci, L. (2003). Age-associated changes in skeletal muscles and their effect on mobility: an operational diagnosis of sarcopenia. Journal of applied physiology, 95(5), 1851-1860.
15. Landi, F., Liperoti, R., Russo, A., Giovannini, S., Tosato, M., Capoluongo, E., … & Onder, G. (2012). Sarcopenia as a risk factor for falls in elderly individuals: results from the ilSIRENTE study. Clinical nutrition, 31(5), 652-658.
16.Ambrose, A. F., Paul, G., & Hausdorff, J. M. (2013). Risk factors for falls among older adults: a review of the literature. Maturitas, 75(1), 51-61.
17.Van Voast Moncada, L. (2011). Management of falls in older persons: a prescription for prevention. American family physician, 84(11).
18. MacKenzie, E. J., Rivara, F. P., Jurkovich, G. J., Nathens, A. B., Frey, K. P., Egleston, B. L., … & Scharfstein, D. O. (2006). A national evaluation of the effect of trauma-center care on mortality. New England Journal of Medicine, 354(4), 366-378.
19. Santry HP, Psoinos CM, Wilbert CJ, Flahive JM, Kroll-Desrosiers AR, Emhoff TA, Kiefe CI. Quadrimodal distribution of death after trauma suggests that critical injury is potentially a terminal disease. (2015) J Critical Care, 30(3):656e1-656e7.
20. Mundi S, Pindiprolus B, Simunovic N, Bhandari M. Similar mortality rate in hip fracture patients over the past 31 years. Acta Orthpaedica (2014 ), 85(1):54-9.
21. Sasser, S. M., Hunt, R. C., Faul, M., Sugerman, D., Pearson, W. S., Dulski, T., … & Cooper, A. (2012). Guidelines for field triage of injured patients: recommendations of the National Expert Panel on Field Triage, 2011. Morbidity and Mortality Weekly Report: Recommendations and Reports, 61(1), 1-20.