Falls and their consequences—such as fractures and other injuries, fear of falling, impaired functions, and dependency—are serious health problems in the older population. Older people living in residential care facilities and those receiving long-term institutional care seem particularly prone to falling and fractures caused by falls. Almost half of all patients with hip fractures in Umea, Sweden, during the 1980s and the 1990s lived in residential care facilities, although fewer than 10 percent of the elderly population lived in such accommodations. Falls among people aged 60 and older have been estimated to account for one-third of the total cost of medical treatment for all injuries in the Swedish population.
This study aimed at identifying precipitating factors for falls among older people living in residential care facilities by analyzing the circumstances—related to the individual and to the environment—prevailing at the time of the fall.
This study utilized a prospective cohort study with baseline assessments, a prospective follow-up for falls, post-fall assessments, and post-fall conferences. Residents of five facilities, including senior citizens' apartments, old people's homes, and group dwellings for people with dementia, were asked to participate in the study. All participants were assessed at the start of the study. Social and medical data (including medications) were collected from the participants, medical records, caregivers, and relatives. Falls were recorded over 12 months or until participants died or moved. The post-fall assessments included interviews of the resident, the staff, and sometimes relatives, as well as physical examinations and laboratory tests when indicated. After data collection, the research study group evaluated the documentation on each fall and formed a consensus about the most probable precipitating factor for each fall.
Previous falls and treatment with antidepressants were found to be the most important predisposing factors for falls. Probable precipitating factors could be determined in 331 (68.7 percent) of the 482 registered falls. Acute disease or symptoms of disease were judged to be precipitating, alone or in combination in 186 (38.6 percent) of all falls; delirium was a factor in 48 falls (10.0 percent), and infection, most often urinary tract infection, was a factor in 38 falls (7.9 percent).
Benzodiazepines or neuroleptics were involved in the majority of 37 falls (7.7 percent) precipitated by drugs. External factors, such as material defects and obstacles, precipitated 38 (7.9 percent) of the falls. Other conditions both related to the individual and the environment, such as misinterpretation (e.g., overestimation of capacity or forgetfulness), misuse of a roller walker, or mistakes made by the staff were precipitating factors in 83 (17.2 percent) of falls.
Postprandial hypotension has been reported to be an important precipitating factor for falls in older people but was not assessed in this study. It cannot be excluded that other possible precipitating factors for falls also can have been overlooked or under diagnosed such as S5racope, especially in frail and cognitively impaired residents.