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Silva BC, Madeira M, d'Alva CB, Maeda SS, de Holanda NCP, Ohe MN, Szejnfeld V, Zerbini CAF, de Paula FJA, Bandeira F. Definition and management of very high fracture risk in women with postmenopausal osteoporosis: a position statement from the Brazilian Society of Endocrinology and Metabolism (SBEM) and the Brazilian Association of Bone Assessment and Metabolism (ABRASSO). ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2022; 66:591-603. [PMID: 36191263 PMCID: PMC10118822 DOI: 10.20945/2359-3997000000522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
Several drugs are available for the treatment of osteoporosis in postmenopausal women. Over the last decades, most patients requiring pharmacological intervention were offered antiresorptive drugs as first-line therapy, while anabolic agents were considered a last resource for those with therapeutic failure. However, recent randomized trials in patients with severe osteoporosis have shown that anabolic agents reduce fractures to a greater extent than antiresorptive medications. Additionally, evidence indicates that increases in bone mineral density (BMD) are maximized when patients are treated with anabolic agents first, followed by antiresorptive therapy. This evidence is key, considering that greater increases in BMD during osteoporosis treatment are associated with a more pronounced reduction in fracture risk. Thus, international guidelines have recently proposed an individualized approach to osteoporosis treatment based on fracture risk stratification, in which the stratification risk has been refined to include a category of patients at very high risk of fracture who should be managed with anabolic agents as first-line therapy. In this document, the Brazilian Society of Endocrinology and Metabolism and the Brazilian Association of Bone Assessment and Metabolism propose the definition of very high risk of osteoporotic fracture in postmenopausal women, for whom anabolic agents should be considered as first-line therapy. This document also reviews the factors associated with increased fracture risk, trials comparing anabolic versus antiresorptive agents, efficacy of anabolic agents in patients who are treatment naïve versus those previously treated with antiresorptive agents, and safety of anabolic agents.
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Affiliation(s)
- Barbara C Silva
- Unidade de Endocrinologia, Santa Casa de Belo Horizonte, Belo Horizonte, MG, Brasil
- Unidade de Endocrinologia, Hospital Felício Rocho, Belo Horizonte, MG, Brasil
- Departamento de Medicina, Centro Universitário de Belo Horizonte (UNI-BH), Belo Horizonte, MG, Brasil,
- Member of the Sociedade Brasileira de Endocrinologia e Metabolismo (SBEM)
| | - Miguel Madeira
- Divisão de Endocrinologia e Metabolismo, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
- Member of the Sociedade Brasileira de Endocrinologia e Metabolismo (SBEM)
| | - Catarina Brasil d'Alva
- Departamento de Medicina Clínica, Universidade Federal do Ceará (UFC), Fortaleza, CE, Brasil
- Member of the Sociedade Brasileira de Endocrinologia e Metabolismo (SBEM)
| | - Sergio Setsuo Maeda
- Unidade de Endocrinologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
- Member of the Associação Brasileira de Avaliação Óssea e Osteometabolismo (ABRASSO)
| | - Narriane Chaves Pereira de Holanda
- Divisão de Endocrinologia e Metabolismo, Universidade Federal da Paraíba, João Pessoa, PB, Brasil
- Member of the Sociedade Brasileira de Endocrinologia e Metabolismo (SBEM)
| | - Monique Nakayama Ohe
- Unidade de Endocrinologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
- Member of the Sociedade Brasileira de Endocrinologia e Metabolismo (SBEM)
| | - Vera Szejnfeld
- Divisão de Reumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
- Member of the Associação Brasileira de Avaliação Óssea e Osteometabolismo (ABRASSO)
| | - Cristiano A F Zerbini
- Centro Paulista de Investigação Clínica, São Paulo, SP, Brasil
- Member of the Associação Brasileira de Avaliação Óssea e Osteometabolismo (ABRASSO)
| | - Francisco José Albuquerque de Paula
- Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
- Member of the Sociedade Brasileira de Endocrinologia e Metabolismo (SBEM)
- Member of the Associação Brasileira de Avaliação Óssea e Osteometabolismo (ABRASSO)
| | - Francisco Bandeira
- Divisão de Endocrinologia e Metabolismo, Faculdade de Medicina, Universidade de Pernambuco, Recife, PE, Brasil
- Member of the Sociedade Brasileira de Endocrinologia e Metabolismo (SBEM)
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Vistamehr A, Neptune RR. Differences in balance control between healthy younger and older adults during steady-state walking. J Biomech 2021; 128:110717. [PMID: 34530294 DOI: 10.1016/j.jbiomech.2021.110717] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 08/04/2021] [Accepted: 08/23/2021] [Indexed: 11/29/2022]
Abstract
Each year approximately one third of older adults fall and experience extensive musculoskeletal injuries and functional disabilities. An important element in maintaining dynamic balance is the regulation of whole-body angular momentum, which is achieved by proper foot placement with respect to the body center-of-mass as well as generation of appropriate ground reaction forces. Analyzing these quantities in younger and older adults may provide insight into differences in their underlying mechanics for maintaining dynamic balance. This study examined three-dimensional whole-body angular momentum in 13 healthy older (71.8 ± 8.3 years) and 9 younger (23.2 ± 2.8 years) adults walking at their self-selected and fastest-comfortable speeds. The older adults had a significantly higher range of frontal-plane angular momentum compared to the younger adults at both speeds, suggesting poorer mediolateral balance control. This difference was related to the older adults having a wider foot placement with respect to the body center-of-mass, which when combined with the vertical ground reaction force, created a higher destabilizing external moment during single-limb stance that acts to rotate the body towards the contralateral swing leg. To counteract this destabilizing moment, the older adults generated a higher hip abduction moment. There were no differences in the range of sagittal- and transverse-plane angular momentum between age groups at either speed. These results suggest that control of dynamic balance in the frontal-plane is more challenging than in the sagittal-plane for older adults and highlight the importance of proper weight transfer mechanisms and hip abductor force production for maintaining mediolateral balance during walking.
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Affiliation(s)
- Arian Vistamehr
- Motion Analysis Center, Brooks Rehabilitation, Jacksonville, FL, USA.
| | - Richard R Neptune
- Walker Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX, USA
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Keglovits M, Clemson L, Hu YL, Nguyen A, Neff AJ, Mandelbaum C, Hudson M, Williams R, Silianoff T, Stark S. A scoping review of fall hazards in the homes of older adults and development of a framework for assessment and intervention. Aust Occup Ther J 2020; 67:470-478. [PMID: 32648268 DOI: 10.1111/1440-1630.12682] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 05/29/2020] [Accepted: 05/31/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Comprehensive evaluation and intervention provided by occupational therapists is effective in reducing the presence of fall hazards in the homes of older adults. The purpose of this study was to document known environmental hazards and to update a previous content analysis. A secondary goal reviewed a framework for evaluation and practice. METHODS A comprehensive scoping review of published academic articles was performed from 1996 to 2019 to answer: What environmental hazards have been associated with falls in the homes of community-dwelling older adults? Data was extracted in a standardised critical appraisal worksheet and content analysis was conducted. A review of a conceptual framework for assessment and intervention was conducted by international experts (n = 6) in face-to-face interviews. RESULTS Fourteen studies met the inclusion criteria for the scoping study. The studies reported 17 in-home environmental hazards: throw rugs/carpets, clutter, cords/wires, poorly placed light switches, items placed too low, items placed too high, no grab bars, toilet seats too low, uneven floor surfaces, slippery/wet surfaces, snowy/icy surfaces, backless/unsupportive shoes, unsteady stairs, inadequate lighting, inadequate heating/cooling, step stools without railings, and pets. CONCLUSION A comprehensive list of specific fall hazards in and around the homes of older adults and a guiding framework offers occupational therapists an evidence-based foundation for fall prevention efforts.
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Affiliation(s)
- Marian Keglovits
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Lindy Clemson
- Faculty of Medicine & Health, The University of Sydney, Sydney, NSW, Australia
| | - Yi-Ling Hu
- Institute of Gerontology, Wayne State University, Detroit, MI, USA
| | - An Nguyen
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Anna J Neff
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Caren Mandelbaum
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Margaret Hudson
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Rebecca Williams
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Tara Silianoff
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Susan Stark
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
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Kannus P, Niemi S, Sievänen H, Parkkari J. Declining incidence in fall-induced deaths of older adults: Finnish statistics during 1971–2015. Aging Clin Exp Res 2018; 30:1111-1115. [DOI: 10.1007/s40520-018-0898-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 01/16/2018] [Indexed: 11/30/2022]
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Deprey SM, Biedrzycki L, Klenz K. Identifying characteristics and outcomes that are associated with fall-related fatalities: multi-year retrospective summary of fall deaths in older adults from 2005-2012. Inj Epidemiol 2017; 4:21. [PMID: 28736795 PMCID: PMC5522812 DOI: 10.1186/s40621-017-0117-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 06/16/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Fall-related deaths continue to be the leading cause of accidental deaths in the older adult (65+ year) population. However, many fall-related fatalities are unspecified and little is known about the fall characteristics and personal demographics at the time of the fall. Therefore, this report describes the characteristics, circumstances and injuries of falls that resulted in older adult deaths in one U.S. County and explores the variables associated with fatal injuries from falls. METHODS This is a continued retrospective analysis of 841older adults whose underlying cause of death was due to a fall over an 8-year period (2005-2012). Demographics and logistic regression of fall characteristics and injuries were analyzed. RESULTS Falls that led to death most often occurred when walking in one's own home. Most of the residents in this study were community-dwellers who had previous comorbidities taking an average of six medications prior to their fall. Survival after a fall was on average 31 days. The two most common injuries after a fatal fall were hip fractures (54%), and head injuries (21%). A logistic regression identified two variables associated with hip fracture, advancing age (OR = 1.05, 95% confidence interval [CI] = 1.02-1.08) and diagnosis of a prior neurological condition (OR = 2.1, 95% CI = 1.4-3.1). Variables associated with head injuries included younger age (OR = .91, 95% CI = .89-.94), male gender (OR = 2.5, 95% CI = 1.7-3.8), prescribed anticoagulants (OR = 2.4, 95% CI = 1.5-3.9) and negative musculoskeletal comorbidity (OR = 1.9. 95% CI = 1.1-3.0). CONCLUSION Hip fractures and head injuries were the most common injury after a fall that led to death in older adults greater than 65 years. There are opposing risk factors for older adults who incur a hip fracture compared to a head injury. Thus, health professionals will need to individualize prevention efforts to reduce fall fatalities.
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Affiliation(s)
- Sara M. Deprey
- Carroll University, 100 N East Ave, Waukesha, WI 53186 USA
| | | | - Kristine Klenz
- Waukesha County Medical Examiner’s Office, Waukesha, 53188 USA
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Sànchez-Riera L, Wilson N. Fragility Fractures & Their Impact on Older People. Best Pract Res Clin Rheumatol 2017; 31:169-191. [PMID: 29224695 DOI: 10.1016/j.berh.2017.10.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 08/05/2017] [Accepted: 09/14/2017] [Indexed: 01/31/2023]
Abstract
Osteoporotic fractures, in particular hip and vertebral, are a major health burden worldwide. The majority of these fractures occur in the elderly population, resulting in one of the most important causes of mortality and disability in older ages. Their cost for societies is enormous and is forecast to steadily increase over the coming decades globally. Low bone mineral density (BMD) remains a key preventable risk factor for fractures. Screening and treatment of individuals with high risk of fracture is cost-effective. Predictive tools including clinical risk factors, minimisation of falls risk and public authorities' support to create Fracture Liaison Services are paramount strategies.
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Affiliation(s)
- Lídia Sànchez-Riera
- University Hospital Bristol NHS Foundation Trust, Bristol, UK; Institute of Bone and Joint Research, The Kolling Institute, Sydney Medical School, St Leonards, NSW, Australia.
| | - Nicholas Wilson
- Institute of Bone and Joint Research, The Kolling Institute, Sydney Medical School, St Leonards, NSW, Australia
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Yeh HF, Shao JH, Li CL, Wu CC, Shyu YIL. Predictors of postoperative falls in the first and second postoperative years among older hip fracture patients. J Clin Nurs 2017; 26:3710-3723. [DOI: 10.1111/jocn.13743] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/25/2016] [Indexed: 12/13/2022]
Affiliation(s)
- Hsiang-Fen Yeh
- Tzu Chi University of Science and Technology; Hualien City Taiwan
- Graduate Institute of Clinical Medical Sciences; Chang Gung University; Taoyuan Taiwan
- School of Nursing; College of Medicine; Chang Gung University; Taoyuan Taiwan
| | - Jung-Hua Shao
- School of Nursing; College of Medicine; Chang Gung University; Taoyuan Taiwan
| | - Chia-Lin Li
- Healthy Aging Research Center and Department of Health Care Management; College of Management; Chang Gung University; Taoyuan Taiwan
- Division of Endocrinology and Metabolism; Departments of Internal Medicine; Chang Gung Memorial Hospital; Taoyuan Taiwan
| | - Chi-Chuan Wu
- Department of Orthopedic Surgery; Chang Gung Memorial Hospital; Linkou Taoyuan Taiwan
| | - Yea-Ing L Shyu
- School of Nursing; College of Medicine; Chang Gung University; Taoyuan Taiwan
- Healthy Aging Research Center and Department of Health Care Management; College of Management; Chang Gung University; Taoyuan Taiwan
- Traumatological Division; Department of Orthopedics; Chang Gung Memorial Hospital; Linkou Taoyuan Taiwan
- Department of Nursing; Kaohsiung Chang Gung Memorial Hospital; Kaohsiung Taiwan
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Jung D, Shin S, Kim H. A fall prevention guideline for older adults living in long-term care facilities. Int Nurs Rev 2014; 61:525-33. [PMID: 25212122 DOI: 10.1111/inr.12131] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Falls are among the most frequent critical health problems for older adults over 65 years of age and often result in consequential injuries. AIM This study developed a guideline covering risk factors and interventions for falls in order to prevent them from occurring in long-term care facilities. METHODS This study was grounded in the methodological approach of the Scottish Intercollegiate Guideline Network for establishing evidence-based guidelines: (1) establishment of the target population and scope of the guideline, (2) systematic literature review and critical analysis, (3) determination of the recommendation grade, (4) development of a draft nursing intervention guideline and algorithm, (5) expert evaluation of the draft nursing intervention guideline, and (6) confirmation of the final intervention guideline and completion of the algorithm. RESULTS The resulting evidence-based fall prevention guideline consists of a three-step factor assessment and a three-step intervention approach. LIMITATIONS The resulting guideline was based on the literature and clinical experts. Further research is required to test the guideline's feasibility in across long term care facilities. CONCLUSION This guideline can be used by nurses to screen patients who are at a high risk of falling to provide patient interventions to help prevent falls. IMPLICATIONS FOR NURSING AND HEALTH POLICY Considering the high rate of falls at long-term care facilities and the absence of evidence-based guidelines to prevent them, additional studies on falls at long-term care facilities are necessary. Meanwhile, given prior research that indicates the importance of human resources in the application of such guidelines, continuous investigations are needed as to whether the research outcomes are actually conveyed to nurses.
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Affiliation(s)
- D Jung
- Soonchunhyang University, Choong-nam, Korea
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Kennedy B, Ibrahim JE, Bugeja L, Ranson D. Causes of death determined in medicolegal investigations in residents of nursing homes: a systematic review. J Am Geriatr Soc 2014; 62:1513-26. [PMID: 25040024 DOI: 10.1111/jgs.12929] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES To systematically review published research characterizing the nature and circumstances surrounding the death of older people in nursing homes specifically using information generated for medicolegal death investigations. DESIGN Systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement using the key words death, nursing homes, and medicolegal death investigation. SETTING Cross-sectional data from original, peer-reviewed articles published in English between 2000 and 2013 describing deaths of nursing home residents. MEASUREMENTS Information was extracted for analysis about study and population characteristics, number and type of deaths, study design, findings, and limitations. RESULTS Thirteen studies were identified. The studies examined external causes of deaths from suicide, choking, restraint or bed-related injuries, falls, and pressure injuries. Deaths were more frequent in women with existing comorbidities. Suicide was predominant in men. Identified risk factors and opportunities to reduce harm were identified at individual, organizational, and structural levels. Overall, the quality of the studies limited the aggregation and comparability of findings. CONCLUSION This systematic review informs researchers, clinicians and policy-makers about how to reduce external causes of death in nursing homes.
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Affiliation(s)
- Briohny Kennedy
- Department of Forensic Medicine, Monash University, Melbourne, Victoria, Australia
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Korhonen N, Kannus P, Niemi S, Palvanen M, Parkkari J. Fall-induced deaths among older adults: nationwide statistics in Finland between 1971 and 2009 and prediction for the future. Injury 2013; 44:867-71. [PMID: 23566705 DOI: 10.1016/j.injury.2013.03.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 02/24/2013] [Accepted: 03/10/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND Fall-related injuries and deaths of elderly people are a major public health concern. METHODS Using the Official Cause-of-Death Statistics of Finland we determined the current trends in the number and age-adjusted incidence (per 100,000 persons) of fall-induced deaths among older Finnish men and women by taking into account all persons 50 years of age or older who died because of a fall-induced injury between 1971 and 2009. RESULTS Among elderly Finnish men, the number of deaths due to falls increased considerably between the years 1971 and 2009, from 162 to 627 (a 287% increase). The age-adjusted incidence also increased from 43.4 (per 100,000 persons) in 1971 to 57.9 in 2000, but stabilized thereafter (57.3 in 2009). Among elderly Finnish women, the number of fall-induced deaths increased till the beginning of the new millennium (from 279 in 1971 to 499 in 2000) but stabilized thereafter (506 in 2009), and, in sharp contrast to men, women's age-adjusted incidence of fall-induced deaths declined during the entire study period, the incidence being 77.2 in 1971 while only 35.3 in 2009. CONCLUSIONS Between 1971 and 2009 the number of fall-induced deaths increased among elderly Finns. The changes were sex-specific so that men surpassed women in both the number and age-adjusted incidence of these fatal falls. Welcome observations were that men's age-adjusted incidence of fall-induced deaths started to stabilize during the new millennium and that in women this incidence continuously declined between 1971 and 2009.
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Affiliation(s)
- Niina Korhonen
- Injury & Osteoporosis Research Center, UKK Institute for Health Promotion Research, Tampere, Finland.
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Guevara CR, Lugo LH. Validez y confiabilidad de la Escala de Tinetti para población colombiana. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/s0121-8123(12)70017-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Fatal falls in an ethnically diverse urban community: the link between demographic factors and the circumstances surrounding fatal falls. South Med J 2012; 105:405-10. [PMID: 22864096 DOI: 10.1097/smj.0b013e31825efc70] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Fatal falls cause more than 15,000 deaths per year in the United States. Despite this, the circumstances surrounding fatal falls in elderly adults are poorly understood. It is unknown whether these circumstances differ across ethnicities, although Hispanic American individuals are at reduced risk for fatal falls. This study sought to describe fatal falls in an urban, predominantly Hispanic, and white non-Hispanic community and to determine the association of demographics with the circumstances surrounding these falls (proximate factors). METHODS The death certificates and medical examiners' reports for all 328 elderly individuals experiencing a fatal fall in Miami-Dade County, FL, from 2005 to 2007 were reviewed for demographic and proximate factors such as the preceding activity and fall location. RESULTS Fatal falls in elderly adults were experienced mostly by individuals living in the community (80%) and affected all demographic subgroups, although 80% occurred in individuals older than 74 years. Most fatal falls occurred at home (74%), indoors (75%), and during nonvigorous activities such as walking (58%) and these tended to affect the oldest elderly. In addition, a significant number of fatal falls occurred in public locations, outdoors, and during vigorous activity, with these falls tending to affect younger individuals living without family. Hispanic ethnicity was not associated with proximate factors. CONCLUSIONS Fatal fall prevention is needed for elderly individuals living in the community and should target the oldest elderly adults living at home while helping to ensure that individuals who are living without family have the appropriate support. These data suggest that Hispanic individuals may benefit from prevention strategies developed in other populations.
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