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Fatal falls in the elderly and the presence of proximal femur fractures

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Abstract

Fatal falls are frequent and seem to be an increasing problem in the elderly. Especially ground level falls (GLFs) and falls on or from stairs and steps (stairs falls) are worth examining for forensic classification and in order to improve the development of preventive measures. We retrospectively analyzed 261 fatal falls of elderly age 65 + years, which were autopsied at the Institute of Legal Medicine in Munich between 2008 and 2014. After careful screening, the sub-set of all 77 GLFs and 39 stairs falls were analyzed towards socio-demographic characteristics, fall circumstances, injuries, and circumstances of death. A subsequent analysis of GLF cases regarding the presence of proximal femur fractures (PFF) was performed. The injury pattern of the GLFs and the stairs falls clearly differ with a higher share of injuries to the lower extremities in the GLFs. However, the most severely injured body region was the head in both groups (62% of the stairs cases, 49% of the GLF cases). Alcohol as contributing to the fall was seen more frequently in the stairs falls. PFF were not seen in the stairs falls, but then in 18 GLF cases. Yet, for 17 among them (22% of 77), their hip fracture was the only serious injury leading to hospitalization and death. Only one GLF case was already found dead. This finding indicates a potential of avoiding up to 22% of the GLF fatalities by preventing hip fractures by optimized hip protectors or other measures, especially for the elderly aged 75 + years.

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References

  1. WHO (2017) Falls. WHO media centre. http://www.who.int/mediacentre/factsheets/fs344/en/. Accessed 07.05.2018

  2. Varnaccia G, Rommel A, Saß A-C (2013) Das Unfallgeschehen bei Erwachsenen in Deutschland. In: Koch-Institut R (ed) Ergebnisse des Unfallmoduls der Befragung “Gesundheit in Deutschland aktuell 2010”

  3. Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C, Gates S, Clemson LM, Lamb SE (2012) Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 9:CD007146. https://doi.org/10.1002/14651858.CD007146.pub3

    Google Scholar 

  4. Kramarow E, Chen LH, Hedegaard H, Warner M (2015) Deaths from unintentional injury among adults aged 65 and over: United States, 2000–2013. National Center for Health Statistics, Hyattsville: NCHS data brief. Ctr Dis Control Prev pp 199. http://www.ncbi.nlm.nih.gov/pubmed/25973998

  5. Orces CH (2008) Trends in fall-related mortality among older adults in Texas. Tex Med 104(5):55–59

    PubMed  Google Scholar 

  6. Stevens JA, Rudd RA (2014) Circumstances and contributing causes of fall deaths among persons aged 65 and older: United States, 2010. J Am Geriatr Soc 62(3):470–475. https://doi.org/10.1111/jgs.12702

    PubMed  PubMed Central  Google Scholar 

  7. Brauer CA, Coca-Perraillon M, Cutler DM, Rosen AB (2009) Incidence and mortality of hip fractures in the United States. JAMA 302(14):1573–1579. https://doi.org/10.1001/jama.2009.1462

    PubMed  PubMed Central  CAS  Google Scholar 

  8. Cooper C, Cole ZA, Holroyd CR, Earl SC, Harvey NC, Dennison EM, Melton LJ, Cummings SR, Kanis JA, Epidemiology ICWGF (2011) Secular trends in the incidence of hip and other osteoporotic fractures. Osteoporos Int 22(5):1277–1288. https://doi.org/10.1007/s00198-011-1601-6

    PubMed  PubMed Central  CAS  Google Scholar 

  9. Icks A, Arend W, Becker C, Rapp K, Jungbluth P, Haastert B (2013) Incidence of hip fractures in Germany, 1995-2010. Arch Osteoporos 8:140. https://doi.org/10.1007/s11657-013-0140-5

    PubMed  Google Scholar 

  10. Korhonen N, Niemi S, Parkkari J, Sievanen H, Palvanen M, Kannus P (2013) Continuous decline in incidence of hip fracture: nationwide statistics from Finland between 1970 and 2010. Osteoporos Int 24(5):1599–1603. https://doi.org/10.1007/s00198-012-2190-8

    PubMed  CAS  Google Scholar 

  11. Sullivan MP, Baldwin KD, Donegan DJ, Mehta S, Ahn J (2014) Geriatric fractures about the hip: divergent patterns in the proximal femur, acetabulum, and pelvis. Orthopedics 37(3):151–157. https://doi.org/10.3928/01477447-20140225-50

    PubMed  Google Scholar 

  12. Cooper Z, Mitchell SL, Lipsitz S, Harris MB, Ayanian JZ, Bernacki RE, Jha AK (2015) Mortality and readmission after cervical fracture from a fall in older adults: comparison with hip fracture using National Medicare Data. J Am Geriatr Soc 63(10):2036–2042. https://doi.org/10.1111/jgs.13670

    PubMed  PubMed Central  Google Scholar 

  13. Wang Z, Bhattacharyya T (2011) Trends in incidence of subtrochanteric fragility fractures and bisphosphonate use among the US elderly, 1996-2007. J Bone Miner Res 26(3):553–560. https://doi.org/10.1002/jbmr.233

    PubMed  CAS  Google Scholar 

  14. Andrich S, Haastert B, Neuhaus E, Neidert K, Arend W, Ohmann C, Grebe J, Vogt A, Jungbluth P, Rosler G, Windolf J, Icks A (2015) Epidemiology of pelvic fractures in Germany: considerably high incidence rates among older people. PLoS One 10(9):e0139078. https://doi.org/10.1371/journal.pone.0139078

    PubMed  PubMed Central  Google Scholar 

  15. Boufous S, Finch C, Lord S, Close J (2005) The increasing burden of pelvic fractures in older people, New South Wales, Australia. Injury 36(11):1323–1329. https://doi.org/10.1016/j.injury.2005.02.008

    PubMed  Google Scholar 

  16. Nanninga GL, de Leur K, Panneman MJ, van der Elst M, Hartholt KA (2014) Increasing rates of pelvic fractures among older adults: the Netherlands, 1986-2011. Age Ageing 43(5):648–653. https://doi.org/10.1093/ageing/aft212

    PubMed  Google Scholar 

  17. Evans D, Pester J, Vera L, Jeanmonod D, Jeanmonod R (2015) Elderly fall patients triaged to the trauma bay: age, injury patterns, and mortality risk. Am J Emerg Med 33(11):1635–1638. https://doi.org/10.1016/j.ajem.2015.07.044

    PubMed  Google Scholar 

  18. Bergland A, Wyller TB (2004) Risk factors for serious fall related injury in elderly women living at home. Inj Prev 10(5):308–313. https://doi.org/10.1136/ip.2003.004721

    PubMed  PubMed Central  CAS  Google Scholar 

  19. Hirschfeld HP, Kinsella R, Duque G (2017) Osteosarcopenia: where bone, muscle, and fat collide. Osteoporos Int 28(10):2781–2790. https://doi.org/10.1007/s00198-017-4151-8

    PubMed  CAS  Google Scholar 

  20. Sarvi MN, Luo Y (2015) A two-level subject-specific biomechanical model for improving prediction of hip fracture risk. Clin Biomech (Bristol, Avon) 30(8):881–887. https://doi.org/10.1016/j.clinbiomech.2015.05.013

    Google Scholar 

  21. Merilainen S, Nevalainen T, Luukinen H, Jalovaara P (2002) Risk factors for cervical and trochanteric hip fracture during a fall on the hip. Scand J Prim Health Care 20(3):188–192

    PubMed  Google Scholar 

  22. Santesso N, Carrasco-Labra A, Brignardello-Petersen R (2014) Hip protectors for preventing hip fractures in older people. Cochrane Database Syst Rev (3):Cd001255. https://doi.org/10.1002/14651858.CD001255.pub5

  23. Prugger C, Keil U (2007) Entwicklung der Adipositas in Deutschland - Größenordnung, Determinanten und Perspektiven (development of obesity in Germany—prevalence, determinants and perspectives). Dtsch Med Wochenschr 132(16):892–897. https://doi.org/10.1055/s-2007-973636

    PubMed  CAS  Google Scholar 

  24. Ayoung-Chee P, McIntyre L, Ebel BE, Mack CD, McCormick W, Maier RV (2014) Long-term outcomes of ground-level falls in the elderly. J Trauma Acute Care Surg 76(2):498–503; discussion 503. https://doi.org/10.1097/TA.0000000000000102

    PubMed  Google Scholar 

  25. Ackland HM, Pilcher DV, Roodenburg OS, McLellan SA, Cameron PA, Cooper DJ (2016) Danger at every rung: epidemiology and outcomes of ICU-admitted ladder-related trauma. Injury 47(5):1109–1117. https://doi.org/10.1016/j.injury.2015.12.016

    PubMed  Google Scholar 

  26. Mitra B, Cameron PA, Gabbe BJ (2007) Ladders revisited. Med J Aust 186(1):31–34

    PubMed  Google Scholar 

  27. Sterbefälle durch Unfälle nach äußeren Ursachen und Unfallkategorien (ab 1998) (2017) Statistisches Bundesamt. http://www.gbe-bund.de/oowa921-install/servlet/oowa/aw92/WS0100/_XWD_FORMPROC?TARGET=&PAGE=_XWD_3698&OPINDEX=22&HANDLER=XS_ROTATE_ADVANCED&DATACUBE=_XWD_3726&D.000=ACROSS&D.001=PAGE&D.002=PAGE&D.003=PAGE&D.004=PAGE&D.946=DOWN&D.048=PAGE. Accessed 07.05.2018

  28. AAAM (2008) Abbreviated Injury Scale 2005, Update 2008. Barrington, IL, USA

  29. Thierauf A, Preuss J, Lignitz E, Madea B (2010) Retrospective analysis of fatal falls. Forensic Sci Int 198(1–3):92–96. https://doi.org/10.1016/j.forsciint.2010.01.010

    PubMed  Google Scholar 

  30. Koehler SA, Weiss HB, Shakir A, Shaeffer S, Ladham S, Rozin L, Dominick J, Lawrence BA, Miller TR, Wecht CH (2006) Accurately assessing elderly fall deaths using hospital discharge and vital statistics data. Am J Forensic Med Pathol 27(1):30–35. https://doi.org/10.1097/01.paf.0000202710.06605.20

    PubMed  Google Scholar 

  31. Bevölkerung (Zensus): Bundesländer, Stichtag, Geschlecht, Altersgruppen (2017) Statistisches Bundesamt https://www-genesis.destatis.de/genesis/online/data;jsessionid=96362C6CF5BDF6CA598A338E05CEFCD6.tomcat_GO_1_1?operation=abruftabelleBearbeiten&levelindex=1&levelid=1499698163671&auswahloperation=abruftabelleAuspraegungAuswaehlen&auswahlverzeichnis=ordnungsstruktur&auswahlziel=werteabruf&selectionname=12111-0104&auswahltext=%23SDLAND-09%23SALT040-ALT075UM%2CALT065B75%23Z-09.05.2011&werteabruf=Werteabruf. Accessed 07.05.2018

  32. Gale CR, Cooper C, Aihie Sayer A (2016) Prevalence and risk factors for falls in older men and women: The English Longitudinal Study of Ageing. Age Ageing 45(6):789–794. https://doi.org/10.1093/ageing/afw129

    PubMed  PubMed Central  Google Scholar 

  33. CDC (2008) Self-reported falls and fall-related injuries among persons aged > or =65 years—United States, 2006. MMWR Morb Mortal Wkly Rep 57(9):225–229

    Google Scholar 

  34. Ambrose AF, Paul G, Hausdorff JM (2013) Risk factors for falls among older adults: a review of the literature. Maturitas 75(1):51–61. https://doi.org/10.1016/j.maturitas.2013.02.009

    PubMed  Google Scholar 

  35. Peel NM, Kassulke DJ, McClure RJ (2002) Population based study of hospitalised fall related injuries in older people. Inj Prev 8(4):280–283

    PubMed  PubMed Central  CAS  Google Scholar 

  36. Stevens JA, Sogolow ED (2005) Gender differences for non-fatal unintentional fall related injuries among older adults. Inj Prev 11(2):115–119. https://doi.org/10.1136/ip.2004.005835

    PubMed  PubMed Central  CAS  Google Scholar 

  37. Wei F, Hester AL (2014) Gender difference in falls among adults treated in emergency departments and outpatient clinics. J Gerontol Geriatr Res 3:152. https://doi.org/10.4172/2167-7182.1000152

    PubMed  PubMed Central  Google Scholar 

  38. Bux R, Parzeller M, Bratzke H (2007) Causes and circumstances of fatal falls downstairs. Forensic Sci Int 171(2–3):122–126. https://doi.org/10.1016/j.forsciint.2006.10.010

    PubMed  Google Scholar 

  39. Preuss J, Padosch SA, Dettmeyer R, Driever F, Lignitz E, Madea B (2004) Injuries in fatal cases of falls downstairs. Forensic Sci Int 141(2–3):121–126. https://doi.org/10.1016/j.forsciint.2003.12.016

    PubMed  CAS  Google Scholar 

  40. Wyatt JP, Beard D, Busuttil A (1999) Fatal falls down stairs. Injury 30(1):31–34

    PubMed  CAS  Google Scholar 

  41. Hartshorne NJ, Harruff RC, Alvord EC Jr (1997) Fatal head injuries in ground-level falls. Am J Forensic Med Pathol 18(3):258–264

    PubMed  CAS  Google Scholar 

  42. Johansson B (1998) Fall injuries among elderly persons living at home. Scand J Caring Sci 12(2):67–72

    PubMed  CAS  Google Scholar 

  43. Aharonoff GB, Dennis MG, Elshinawy A, Zuckerman JD, Koval KJ (1998) Circumstances of falls causing hip fractures in the elderly. Clin Orthop Relat Res (348):10-14

    Google Scholar 

  44. Allen CJ, Hannay WM, Murray CR, Straker RJ, Hanna MM, Meizoso JP, Ray JJ, Livingstone AS, Schulman CI, Namias N, Proctor KG (2015) Causes of death differ between elderly and adult falls. J Trauma Acute Care Surg 79(4):617–621. https://doi.org/10.1097/TA.0000000000000811

    PubMed  Google Scholar 

  45. Hein PM, Schulz E (1989) Accidental fall-induced craniocerebral injury. Beitr Gerichtl Med 47:447–450

    PubMed  CAS  Google Scholar 

  46. Mallory A (2010) Head injury and aging: the importance of bleeding injuries. Ann Adv Automot Med 54:51–60

    PubMed  PubMed Central  Google Scholar 

  47. Hanif S, Abodunde O, Ali Z, Pidgeon C (2009) Age related outcome in acute subdural haematoma following traumatic head injury. Ir Med J 102(8):255–257

    PubMed  CAS  Google Scholar 

  48. Stitzel JD, Kilgo PD, Danelson KA, Geer CP, Pranikoff T, Meredith JW (2008) Age thresholds for increased mortality of three predominant crash induced head injuries. Ann Adv Automot Med 52:235–244

    PubMed  PubMed Central  Google Scholar 

  49. Benayoun MD, Allen JW, Lovasik BP, Uriell ML, Spandorfer RM, Holder CA (2016) Utility of computed tomographic imaging of the cervical spine in trauma evaluation of ground-level fall. J Trauma Acute Care Surg 81(2):339–344. https://doi.org/10.1097/TA.0000000000001073

    PubMed  Google Scholar 

  50. Korhonen N, Kannus P, Niemi S, Parkkari J, Sievanen H (2014) Rapid increase in fall-induced cervical spine injuries among older Finnish adults between 1970 and 2011. Age Ageing 43(4):567–571. https://doi.org/10.1093/ageing/afu060

    PubMed  Google Scholar 

  51. Joseph B, Pandit V, Khalil M, Kulvatunyou N, Zangbar B, Friese RS, Mohler MJ, Fain MJ, Rhee P (2015) Managing older adults with ground-level falls admitted to a trauma service: the effect of frailty. J Am Geriatr Soc 63(4):745–749. https://doi.org/10.1111/jgs.13338

    PubMed  Google Scholar 

  52. Verma SK, Willetts JL, Corns HL, Marucci-Wellman HR, Lombardi DA, Courtney TK (2016) Falls and fall-related injuries among community-dwelling adults in the United States. PLoS One 11(3):e0150939. https://doi.org/10.1371/journal.pone.0150939

    PubMed  PubMed Central  Google Scholar 

  53. Tinetti ME, Williams CS (1997) Falls, injuries due to falls, and the risk of admission to a nursing home. N Engl J Med 337(18):1279–1284. https://doi.org/10.1056/NEJM199710303371806

    PubMed  CAS  Google Scholar 

  54. Spaniolas K, Cheng JD, Gestring ML, Sangosanya A, Stassen NA, Bankey PE (2010) Ground level falls are associated with significant mortality in elderly patients. J Trauma 69(4):821–825. https://doi.org/10.1097/TA.0b013e3181efc6c6

    PubMed  Google Scholar 

  55. Mitchell SE, Aitken SA, Court-Brown CM (2013) The epidemiology of fractures caused by falls down stairs. ISRN Epidemiol 2013 (Article ID 370340):6. https://doi.org/10.5402/2013/370340

    Google Scholar 

  56. Sterling DA, O'Connor JA, Bonadies J (2001) Geriatric falls: injury severity is high and disproportionate to mechanism. J Trauma 50(1):116–119

    PubMed  CAS  Google Scholar 

  57. Cook A, Cade A, King B, Berne J, Fernandez L, Norwood S (2012) Ground-level falls: 9-year cumulative experience in a regionalized trauma system. Proc (Baylor Univ Med Cent) 25(1):6–12

    Google Scholar 

  58. Goldacre MJ, Roberts SE, Yeates D (2002) Mortality after admission to hospital with fractured neck of femur: database study. BMJ 325(7369):868–869

    PubMed  PubMed Central  Google Scholar 

  59. Greenspan SL, Myers ER, Kiel DP, Parker RA, Hayes WC, Resnick NM (1998) Fall direction, bone mineral density, and function: risk factors for hip fracture in frail nursing home elderly. Am J Med 104(6):539–545

    PubMed  CAS  Google Scholar 

  60. Nasiri Sarvi M, Luo Y (2017) Sideways fall-induced impact force and its effect on hip fracture risk: a review. Osteoporos Int 28:2759–2780. https://doi.org/10.1007/s00198-017-4138-5

    PubMed  CAS  Google Scholar 

  61. Carey BJ, Potter JF (2001) Cardiovascular causes of falls. Age Ageing 30(Suppl 4):19–24

    PubMed  Google Scholar 

  62. MedicalAdvisorySecretariat (2008) Prevention of falls and fall-related injuries in community-dwelling seniors: an evidence-based analysis. Ont Health Technol Assess Ser 8(2):1–78

    Google Scholar 

  63. Nordell E, Jarnlo GB, Jetsen C, Nordstrom L, Thorngren KG (2000) Accidental falls and related fractures in 65-74 year olds: a retrospective study of 332 patients. Acta Orthop Scand 71(2):175–179. https://doi.org/10.1080/000164700317413157

    PubMed  CAS  Google Scholar 

  64. Shaw BH, Loughin TM, Robinovitch SN, Claydon VE (2015) Cardiovascular responses to orthostasis and their association with falls in older adults. BMC Geriatr 15:174. https://doi.org/10.1186/s12877-015-0168-z

    PubMed  PubMed Central  Google Scholar 

  65. Ward RE, Leveille SG, Beauchamp MK, Travison T, Alexander N, Jette AM, Bean JF (2015) Functional performance as a predictor of injurious falls in older adults. J Am Geriatr Soc 63(2):315–320. https://doi.org/10.1111/jgs.13203

    PubMed  PubMed Central  Google Scholar 

  66. Cauley JA (2017) Osteoporosis: fracture epidemiology update 2016. Curr Opin Rheumatol 29(2):150–156. https://doi.org/10.1097/bor.0000000000000365

    PubMed  Google Scholar 

  67. Cauley JA, Cawthon PM, Peters KE, Cummings SR, Ensrud KE, Bauer DC, Taylor BC, Shikany JM, Hoffman AR, Lane NE, Kado DM, Stefanick ML, Orwoll ES (2016) Risk factors for hip fracture in older men: the osteoporotic fractures in men study (MrOS). J Bone Miner Res 31(10):1810–1819. https://doi.org/10.1002/jbmr.2836

    PubMed  PubMed Central  CAS  Google Scholar 

  68. Prior JC, Langsetmo L, Lentle BC, Berger C, Goltzman D, Kovacs CS, Kaiser SM, Adachi JD, Papaioannou A, Anastassiades T, Towheed T, Josse RG, Brown JP, Leslie WD, Kreiger N (2015) Ten-year incident osteoporosis-related fractures in the population-based Canadian Multicentre Osteoporosis Study—comparing site and age-specific risks in women and men. Bone 71:237–243. https://doi.org/10.1016/j.bone.2014.10.026

    PubMed  Google Scholar 

  69. Boon MY, Chu BS, Lee PC, Chiang TJ, Alshamli N, Alghamdi W, Lai J, Yeung W, Bridge C (2015) Perceptions of older people regarding their vision and incident causation. Optom Vis Sci 92(10):995–1002. https://doi.org/10.1097/OPX.0000000000000695

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Institute of Legal Medicine, Ludwig-Maximilians-University (LMU) Munich, Nussbaumstrasse 26, 80336, Munich, Germany

    Sylvia Schick, Daniela Heinrich, Matthias Graw, Raúl Aranda & Steffen Peldschus

  2. Department of Medicine IV, University Hospital, LMU Munich Ziemssenstrasse 1, 80336, Munich, Germany

    Uta Ferrari

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Highlights

• Of all autopsied fatal falls in the elderly, 30% were found to be ground level falls (GLFs) and 15% falls on and from stairs and steps

• In both fall categories, a head injury was the most severe injury most frequently

• Alcohol was contributing to the fatal fall more frequently in stairs falls

• Cervical spine fractures in fatal falls seem to indicate stairs falls but less likely GLFs

• In 22% of fatal GLFs of elderly, a proximal femur fracture was the only serious injury

• GLF fatalities with proximal femur fracture showed no further relevant injury, had only a maximum Abbreviated Injury Scale © severity value of 3 (MAIS 3), were typically 75 to 84 years old, fell in-doors, and in around 30% physical limitations in walking were pre-existent.

Appendix

Appendix

Coding details

For the time of fall, we defined night as the time from 06:00 pm to 05:59 am and day as 06:00 am to 05:59 pm. “Unknown” was attributed to cases for which the time of fall was not deductible, as the person was found already dead.

The number of falls in the case history was declared none, if no hints or information on prior falls was given.

The variable entries within the pre-existing conditions were extracted from all available information towards the case and from the autopsy results and declared as “yes” if enough facts were at hand, in the other cases it was declared “no” generously. In some cases, too much information was missing so that the decision for yes or no was not possible. In these cases, “unknown” was chosen.

For the condition “heart disease,” we included coronary artery sclerosis, hypertrophy, infarction, insufficiency, and rhythm disorders in medical history. The information on “hypertension” and “diabetes” (type I and II) was taken from the medical history. Cirrhosis, fatty liver, necrosis, hepatitis, and chronic stasis were included for “liver disease.” “Lung disease” was declared “yes,” if COPD, asthma, fibrosis, or emphysema was known or visible. “Renal failure” only includes known pre-existing renal insufficiency. For the variables “post-stroke,” “peripheral artery disease,” “indication of osteoporosis,” “cancer,” and “indication of dementia,” all available information and autopsy results were taken into account. For the variable anticoagulation (Marcumar and or ASS), “yes” and “no” were chosen very restrictively only if the information was given. In addition, “probable” was chosen in cases where valve transplants and stable coronary heart disease or atrial fibrillation was known. For other cases, “no information” was chosen.

For the contributing causes to the fall, all available information was taken to decide if the fall was most likely influenced by the following different reasons. In some cases, the information was only enough to decide that the contribution was probable. If the contribution was not likely, it was declared “no hint.” “Physical limitations” includes walking aids, knee problems, and other known restrictions in normal walking ability. The “cardiovascular system” as contributing to the fall was suspected if there were enough hints for fainting due to circulation problems by the confirmation of autopsy results or known rhythm disorders, the same for cerebral issues if medical history or findings in brain structures were able to explain syncope. “Alcohol” was thought as most likely contributing if confirmed by odor or blood analysis, as “probable” if information of relatives was given, or at the place of finding huge amounts of empty bottles were present together with further hints for alcohol consumption. “Others” is a collection of anemia, medicines, pneumonia, embolism, epilepsy, or in the course of a possible jostle. “Common circumstances” was attributed if slipping, stumbling, or an accidental false step was confirmed.

Table 5 Type of fall as found in official statistics and analyzed in autopsy register of LMU
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Schick, S., Heinrich, D., Graw, M. et al. Fatal falls in the elderly and the presence of proximal femur fractures. Int J Legal Med 132, 1699–1712 (2018). https://doi.org/10.1007/s00414-018-1876-7

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