Falls in older people: Examining risk factors in specific subgroups and the effectiveness of a specialist-led falls prevention intervention

Abstract

Accidental falls remain an important healthcare issue for older people. We report on three studies examining risk predictors for further falls, falls-related hospital attendances and mortality, and then test the effectiveness of a hospital-based falls prevention intervention. A prospective study of 498 older people who attended an Emergency Department (E.D.) with a fall showed that age 80 years and older was the greatest predictor of further falls, with a 2-fold increased adjusted risk by 5 years (HR 2.00; 95% C.I. 1.42 – 2.82). Mortality following an E.D. presentation with a fall was 19% at 1 year, increasing to 52% by 5 years. Increasing age and assistance with ADLs predicted both ED re-presentation and mortality. Being female and falls due to syncope were protective. The Concord Health and Ageing in Men (CHAMP), is a longitudinal study of 1705 men. Previous history of falls was the most significant predictor of future falls (IRR 3.12; 95% C.I. 2.49 – 3.91) and falls injury hospitalisations at 10 years (HR 1.48; 95% C.I. 1.09 – 1.99) in this cohort. Risk factors for falls included increasing age, disability in ADLs, being single, dementia, having 3 or more comorbidities, polypharmacy and reduced visual acuity. Dementia was associated with 2-fold increased risk of falls injury hospitalisation at 10 years (HR 2.67; 95% C.I. 1.69 – 4.22). Men born in a non-English-speaking country and men who were still working were less likely to be hospitalised die to a fall injury. A randomised controlled trial (n = 81) of a specialist-led CONFABs clinic versus enhanced G.P. coordinated care, showed an increased rate of falls (IRR 2.39; 95% C.I. 1.09 – 5.27) and risk of falls (RR 1.79; 95% C.I. 1.10 – 2.96) at 1 year with the CONFABS clinic intervention. There was no significant difference in the rate of injurious falls or in the number of fractures between the interventions. Compliance with recommendations was similar in both groups, although more falls prevention strategies were recommended to the falls clinic participants. There are shared risk factors for falls, fall hospitalisations and mortality, with increasing age, functional disability and dementia the most important to consider. Falls prevention strategies may be successfully provided in General Practice, supported by specialist risk assessment and recommendations.