Advertisement

Abstract

Until the 1940s, falls and fall-related injuries were considered accidents, that is “acts of God,” random or chance events without observable or understandable explanations.1 Beginning with the early studies by Droller,2 Sheldon,3 and Fine,4 however, falls have increasingly been recognized first as predictable, then as preventable, health problems worthy of careful evaluation and preventive efforts. As evidenced by the association with other functional problems such as incontinence, and by a high mortality rate not due to injury, falling is an important clinical marker of frailty. Because of its resulting morbidity, however, falling is also an important health problem in its own right among frail, as well as healthier, older persons.

Keywords

Nursing Home Elderly Person Nursing Home Resident Physical Restraint Gait Disorder 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Hogue CC. Epidemiology of injury in older age. In: Second Conference on the Epidemiology of Aging. NIH Publication No. 80–969. Washington, DC: NIH; 1980: 127–138.Google Scholar
  2. 2.
    Droller H. Falls among elderly people living at home. Geri- atrics. 1955;293–344. Google Scholar
  3. 3.
    Sheldon JH. On the natural history of falls in old age. Br Med J. 1960; 2: 1685–1690.PubMedCrossRefGoogle Scholar
  4. 4.
    Fine W. An analysis of 277 falls in hospital. Gerontol Clin. 1959; 1: 292–300.CrossRefGoogle Scholar
  5. 5.
    Kennedy TE, Coppard LC, eds. The prevention of falls in later life. Dan Med Bull. 1987; suppl 4.Google Scholar
  6. 6.
    Campbell AJ, Reinken J, Allan BC, et al. Falls in old age: a study of frequency, and related clinical factors. Age Ageing. 1981; 10: 264–270.PubMedCrossRefGoogle Scholar
  7. 7.
    Evans JG. Factors associated with falls in the elderly: a community study. Age Ageing. 1981; 10: 141–146.PubMedCrossRefGoogle Scholar
  8. 8.
    Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med. 1988; 319: 1701–1707.PubMedCrossRefGoogle Scholar
  9. 9.
    Tinetti ME, Liu WL, Claus EB. Predictors and prognosis of inability to get up after falls among elderly persons. JAMA. 1993; 269: 65–70.PubMedCrossRefGoogle Scholar
  10. 10.
    O’Loughlin JL, Robitaille Y, Boivin JF, Suissa S. Incidence of and risk factors for falls and injurious falls among the community-dwelling elderly. Am J Epidemiol. 1993; 137: 342–354.PubMedGoogle Scholar
  11. 11.
    Nevitt MC, Cummings SR, Hudes ES. Risk factors for injurious falls: a prospective study. J Gerontol. 1991; 46: M164 170.Google Scholar
  12. 12.
    Sattin RW. Falls among older persons: a public health perspective. Annu Rev Public Health. 1992; 13: 489–508.PubMedCrossRefGoogle Scholar
  13. 13.
    Sattin RW, Lambert Huber DA, DeVito CA, et al. The incidence of fall injury events among the elderly in a defined population. Am J Epidemiol. 1990; 131: 1028–1037.PubMedGoogle Scholar
  14. 14.
    Nevitt MC, Cummings SR, Kidd S, Black D. Risk factors for recurrent nonsyncopal falls: a prospective study. JAMA. 1989; 216: 2663–2668.CrossRefGoogle Scholar
  15. 15.
    Maki BE, Holliday PJ, Topper AK. Fear of falling and postural performance in the elderly. J Gerontol Med Sci. 1991; 46: M123–131.CrossRefGoogle Scholar
  16. 16.
    Arfken CL, Lach HW, Birge SJ, Miller JP. The prevalence and correlates of fear of falling in elderly persons living in the community. Am J Public Health. 1994; 84: 565–570.PubMedCrossRefGoogle Scholar
  17. 17.
    Tinetti ME, Mendes de Leon CF, Doucette JT, Baker DI. Fear of falling and fall-related efficacy in relationship to functioning among community-living elders. J Gerontol Med Sci. 1994; 49: M140 - M147.CrossRefGoogle Scholar
  18. 18.
    Kosorok MR, Omenn GS, Diehr P, Koepsell TD, Patrick DL. Restricted activity days among older adults. Am J Public Health. 1992; 82: 1263–1267.PubMedCrossRefGoogle Scholar
  19. 19.
    Grisso JA, Schwarz DF, Wolfson D, Polansky M, LaPenn K. The impact of falls in an inner-city elderly African-American population. J Am Geriatr Soc. 1992; 40: 673–678.PubMedGoogle Scholar
  20. 20.
    Wolinsky FD, Johnson RJ, Fitzgerald JF. Falling, health status, and the use of health services by older adults. Med Care. 1992;30:587–597. Google Scholar
  21. 21.
    Kiel DP, O’Sullivan P, Teno JM, Mor V. Health care utilization and functional status in the aged following a fall. Med Care. 1991; 29: 221–228.PubMedCrossRefGoogle Scholar
  22. 22.
    Dunn JE, Rudberg MA, Fumer SE, Cassel CK. Mortality, disability, and falls in older persons: the role of underlying disease and disability. Am J Public Health. 1992; 82: 395–400.PubMedCrossRefGoogle Scholar
  23. 23.
    Rubenstein LZ, Josephson KR, Robbins AS. Falls in the nursing home. Ann Intern Med. 1994; 121: 442–451.PubMedGoogle Scholar
  24. 24.
    Tinetti ME, Liu WI, Ginter SF. Mechanical restraint use and fall-related injuries among residents of skilled nursing facilities. Ann Intern Med. 1992; 116: 369–374.PubMedGoogle Scholar
  25. 25.
    Nutt JG, Marsden CD, Thompson PD. Human walking and higher level gait disorders, particularly in the elderly. Neu-rology. 1993; 43: 268–279.Google Scholar
  26. 26.
    Lach HW, Reed AT, Arfken CL, Miller P, Paige GD, Girge SJ, Peck WA. Falls in the elderly: reliability of a classifica-tion system. J Am Geriatr Soc. 1991; 39: 197–202.PubMedGoogle Scholar
  27. 27.
    Tinetti ME. Instability and falling in the elderly. Semin Neurol. 1989; 9: 39–45.PubMedCrossRefGoogle Scholar
  28. 28.
    Wolfson LI, Whipple RH, Amerman RM, et al. Gait and balance in the elderly: two functional capacities that link sensory and motor ability to falls. Clin Geriatr Med. 1985; 1: 649–659.PubMedGoogle Scholar
  29. 29.
    Tobis JS, Reinsch S, Swanson JM, Byrd M, Scharf T. Visual perception dominance of fallers among community-dwelling adults. J Am Geriatr Soc. 1985; 33: 330–333.PubMedGoogle Scholar
  30. 30.
    Hazel JWP. Vestibular problems of balance. Age Ageing. 1979; 8: 258–260.CrossRefGoogle Scholar
  31. 31.
    Wyke B. Cervical articular contributions to posture and gait: their relations to senile disequilibrium. Age Ageing. 1979; 8: 251–258.PubMedCrossRefGoogle Scholar
  32. 32.
    Whipple RH, Wolfson LI, Amerman PM. The relationship of knee and ankle weakness to falls in nursing home residents: an isokinetic study. J Am Geriatr Soc. 1987;35:13-20.Google Scholar
  33. 33.
    Lipsitz L. Orthostatic hypotension in the elderly. N Engl J Med. 1989; 321: 952–956.PubMedCrossRefGoogle Scholar
  34. 34.
    Ray WA, Griffin MR. Prescribed medications, and the risk of falling. Topics Geriatr Rehabil. 1990; 5: 12–20.Google Scholar
  35. 35.
    Robbins AS, Rubenstein LZ, Josephson KR, Schulman BL, Osterweil D, Fine G. Predictors of falls among elderly people. Results of two population-based studies. Arch Intern Med. 1989; 149: 1628–1633.PubMedCrossRefGoogle Scholar
  36. 36.
    Kapoor WN. Syncope in older persons. J Am Geriatr Soc. 1994; 42: 426–436.PubMedGoogle Scholar
  37. 37.
    Owens DH. Maintaining posture and avoiding tripping. Clin Geriatr Med. 1985; 1: 581–599.Google Scholar
  38. 38.
    Lipsitz LA, Jonsson PV, Kelley MM, Koestner JS. Causes and correlates of recurrent falls in ambulatory frail elderly. J Gerontol. 1991; 46: M114–122.PubMedCrossRefGoogle Scholar
  39. 39.
    Tinetti ME, Williams TF, Mayewski R. Fall risk index for elderly patients based on number of chronic disabilities. Am J Med. 1986; 80: 429–434.PubMedCrossRefGoogle Scholar
  40. 40.
    Melton LJ, Riggs BL. Risk factors for injury after a fall. Clin Geriatr Med. 1985; 1: 525–536.PubMedGoogle Scholar
  41. 41.
    Cummings SR, Nevitt MC. A hypothesis: the causes of hip fracture. J Gerontol. 1989; 45: M107–111.Google Scholar
  42. 42.
    Lord SR, McLean D, Stathers G. Physiological factors asso-ciated with injurious falls in older people living in the community. Gerontology. 1992; 38: 338–346.PubMedCrossRefGoogle Scholar
  43. 43.
    Kelsey JL, Browner WS, Seeley DG, et al. Risk factors for fractures of the distal forearm and proximal humerus. Am J Epidemiol. 1992; 135: 477–489.PubMedGoogle Scholar
  44. 44.
    Ryynanen OP, Kivela SL, Honkanen R, Laippala P. Recurrent elderly fallers. Scand J Prim Health Care. 1992; 10: 277–283.PubMedCrossRefGoogle Scholar
  45. 45.
    Greenspan SL, Myers ER, Maitland LA, Resnick NM, Hayes WC. Fall severity and bone mineral density as risk factors for hip fracture in ambulatory elderly. JAMA. 1994; 271: 128–133.PubMedCrossRefGoogle Scholar
  46. 46.
    Grisso JA, Kelsey JL, Strom BL, et al. Risk factors for falls as a cause of hip fracture in women. N Engl J Med. 1991; 324: 1326–1331.PubMedCrossRefGoogle Scholar
  47. 47.
    Myers AH, Baker SP, VanNatta ML, Abbey H, Robinson EG. Risk factors associated with falling and injuries among elderly institutionalized persons. Am J Epidemiol. 1991; 133: 1179–1190.PubMedGoogle Scholar
  48. 48.
    Sorock GS, Bush TL, Golden AL, et al. Physical activity and fracture risk in a free-living elderly cohort. J Gerontol. 1988; 43: M134–139.PubMedCrossRefGoogle Scholar
  49. 49.
    Speechley M, Tinetti M. Falls and injuries in frail and vigor-ous community elderly persons. J Am Geriatr Soc. 1991; 39: 46–52.PubMedGoogle Scholar
  50. 50.
    Tinetti ME, Speechley M, Prevention of falls among the elderly. N Engl J Med. 1989; 320: 1055–1059.CrossRefGoogle Scholar
  51. 51.
    Sudarsky L. Geriatrics: gait disorders in the elderly. N Engl J Med. 1990; 322: 1441–1446.PubMedCrossRefGoogle Scholar
  52. 52.
    MacPhee GJA, Crowther JA, McAlpine CH. A simple screening test for hearing impairment in elderly patients. Age Ageing. 1988; 17: 347–351.PubMedCrossRefGoogle Scholar
  53. 53.
    Maki BE, Holliday PJ, Topper AK. A prospective study of postural balance and risk of falling in an ambulatory and independent elderly population. J Gerontol. 1994; 49: M72–84.PubMedCrossRefGoogle Scholar
  54. 54.
    Mathias S, Nayak USL, Isaacs B. The “Get up and Go” test: a simple clinical test of balance in old people. Arch Phys Med Rehabil. 1986; 67: 387–389.PubMedGoogle Scholar
  55. 55.
    Tinetti ME. Performance-oriented assessment of mobility problems in elderly patients. J Am Geriatr Soc. 1986; 34: 119–126.PubMedGoogle Scholar
  56. 56.
    Tinetti ME, Ginter SF. Identifying mobility dysfunctions in elderly patients. JAMA. 1988; 259: 1190–1193.PubMedCrossRefGoogle Scholar
  57. 57.
    Judge JO, Whipple RH, Wolfson LI. Effects of resistive and balance exercises on isokinetic strength in older persons. J Am Geriatr Soc. 1994; 42: 937–946.PubMedGoogle Scholar
  58. 58.
    Tinetti ME, Baker DI, McAvay G, et al. A multifactorial intervention to reduce the risk of falling among elderly people living in the community. N Engl J Med. 1994; 331: 821–827.PubMedCrossRefGoogle Scholar
  59. 59.
    Koch M, Gottschalk M, Baker DI, et al. An impairment and disability assessment and treatment protocol for community-living elderly persons. Phys Ther. 1994; 74: 286–298.PubMedGoogle Scholar
  60. 60.
    Lauritzen JB, Petersen MM, Lund B. Effect of external hip protectors on hip fractures. Lancet. 1993; 341: 11–13.PubMedCrossRefGoogle Scholar
  61. 61.
    Winograd CH, Lemsky CM, Nevitt MC, et al. Development of a physical performance and mobility examination. J Am Geriatr Soc. 1994; 42: 743–749.PubMedGoogle Scholar
  62. 62.
    Rubenstein LZ, Robbins AS, Josephson KR, Schulman BL, Osterweil D. The value of assessing falls in an elderly population. A randomized clinical trial. Ann Intern Med. 1990; 113: 308–316.PubMedGoogle Scholar
  63. 63.
    Mulrow CD, Gerety MB, Kanten D, et al. A randomized trial of physical rehabilitation for very frail nursing home residents. JAMA. 1994; 271: 519–524.PubMedCrossRefGoogle Scholar
  64. 64.
    Fiatarone MA, O’Neill EF, Ryan ND, et al. Exercise training and nutritional supplementation for physical frailty in very elderly people. N Engl J Med. 1994; 330: 1769–1775.PubMedCrossRefGoogle Scholar
  65. 65.
    Miles SH, Irvine P. Deaths caused by physical restraints.Gerontologist. 1992; 32: 762–766.CrossRefGoogle Scholar
  66. 66.
    Evans LK, Strumpf NE. Tying down the elderly. A review of the literature on physical restraint. J Am Geriatr Soc. 1989; 37: 65–74.PubMedGoogle Scholar
  67. 67.
    Jonsson PV, Lipsitz LA, Kelley M, Koestner J. Hypotensive responses to common daily activities in institutionalized elderly. A potential risk for recurrent falls. Arch Intern Med. 1990; 150: 1518–1524.PubMedCrossRefGoogle Scholar
  68. 68.
    Granek E, Baker SP, Abbey H, et al. Medications and diagnoses in relation to falls in a long-term care facility. J Am Geriatr Soc. 1987; 35: 503–511.PubMedGoogle Scholar
  69. 69.
    Wells BG, Middleton B, Lawrence G, et al. Factors associ ated with the elderly falling in intermediate care facilities. Drug Intell Clin Pharm. 1985; 19: 142–145.PubMedGoogle Scholar
  70. 70.
    Kerman M, Mulvihill M. The role of medication in falls among the elderly in a long-term care facility. Mt Sinai J Med. 1990; 57: 343–347.PubMedGoogle Scholar
  71. 71.
    Campbell AI, Borrie MJ, Spears GF. Risk factors for falls in a community-based prospective study of people 70 years and older. J Gerontol. 1989; 44: M112 - M117.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1997

Authors and Affiliations

  • Mary E. Tinetti

There are no affiliations available

Personalised recommendations