Falling Indoors or Outdoors Makes a Difference in
Dealing with Risk Levels for Senior Citizens
Almost half of all falls occurred outdoors, and
people who fell outdoors had the same or better health than those who
did not fall at all
Sept. 8, 2010 Falls are well recognized as a
major danger for senior citizens nearly 40 percent of seniors living
outside of institutions fall every year, according to the Centers for
Disease Control and Prevention. Many of these suffer severe injuries,
including hip fractures and brain injuries. But, in the effort to better
understand these risks and reduce them, little attention has been paid
to where the falls happened - indoors or out.
Post-meal blood vessel expansion occurs in young,
not old; Muscles of young people look 50 years older by making muscle
blood vessels behave as they do in seniors
About half of these falls occur outdoors, says the
CDC. And this new study finds the risk factors for indoor and outdoor
falls for the elderly are different. The study was by the Institute for
Aging Research of Hebrew SeniorLife, an affiliate of Harvard Medical
School.
The differences are often missed when the two types
of falls are combined and this may affect how falls prevention programs
are structured.
"Indoor and outdoor falls are both important," says
senior author Marian T. Hannan, D.Sc., a senior scientist at the
Institute for Aging Research, "but people at high risk for indoor falls
are different in many ways from those at high risk of outdoor falls.
Failure to separate the two can mask important
information on risk factors and may hamper the effectiveness of falls
prevention programs."
Published online in the Journal of the American
Geriatrics Society, the study found that indoor falls are associated
with an inactive lifestyle, disability, and poor health, while outdoor
falls are associated with higher levels of activity and average or
better-than-average health.
Older adults who fell outdoors were -
● somewhat younger than those who fell indoors,
● more likely to be male,
● more likely to be better educated, and
● had lifestyle characteristics indicative of better health.
Those who fell indoors -
● had more physical disabilities,
● took more medications, and
● had lower cognitive function than those who fell outdoors.
The study examined 765 men and women, age 70 and
older, from randomly sampled households in the Boston area. Study
participants underwent a comprehensive baseline falls assessment,
including a home visit and clinic examination. Falls were reported on
monthly calendars submitted to the researchers.
Falls Severely Injure 37.3 Million a Year; Senior Citizens Most
Likely to Die: UN Health Agency
Falls are a
major public health problem across the world with an estimated
424,000 fatalities occurring each year, making it the second
leading cause of unintentional injury and death after road
traffic accidents, according to the United Nations health
agency.
More than 80
per cent of fall-related fatalities occur in low-and
middle-income countries, with regions of the Western Pacific and
South East Asia accounting for more than two thirds of these
deaths, the World Health Organization (WHO)
said in a
fact sheet issued today.
About 37.3
million falls severe enough to require medical attention occur
each year. The largest morbidity occurs in people aged 65 years
or older, young adults aged between 15 and 29 years and children
aged 15 years or younger.
People who
fall and suffer a disability, particularly older people, are at
a major risk for subsequent long-term care and
institutionalization, according to WHO. For people aged 65 years
or older, the average cost to the health system per fall injury
in Finland and Australia are $3,611 and $1,049 respectively.
Over a nearly two-year period, 598 indoor falls and
524 outdoor falls were reported. When a participant reported a fall, a
structured telephone interview was conducted to determine the
circumstances.
Dr. Hannan says the study has several implications.
First, a fall is not necessarily a marker of poor
health. In fact, almost half of all falls occurred outdoors, and people
who fell outdoors had the same or better health than those who did not
fall at all.
Second, epidemiological studies of risk factors for
falls in older people may be hampered when falls are combined, with
important associations between risk factors and indoor and outdoor falls
potentially being missed.
Third, intervention programs need to be tailored
differently for people more likely to fall outdoors than those who tend
to fall indoors.
"Most fall prevention programs emphasize the
prevention of indoor falls, particularly through strength, balance and
gait training; use of assistive devices; treatment of medical
conditions; reduction in the use of certain medications; improvement in
vision; and the elimination of home hazards," write Dr. Hannan and her
colleagues.
Many of these programs do not take into account the
causes of outdoor falls, she says. Falls interventions for
community-dwelling seniors, she adds, should consider their health
status, activity level, and other characteristics. Most seniors who fall
outdoors do so on sidewalks, streets or curbs, or in parking lots.
"Healthy, active older people should be aware of
their surroundings, especially when walking outdoors," says Dr. Hannan,
an associate professor of medicine at Harvard Medical School.
"More attention needs to be paid to the elimination
of outdoor environmental hazards involving sidewalks, curbs and streets,
such as repairing uneven surfaces, removing debris, installing ramps at
intersections, and painting curbs."
The study, which was funded by the National
Institutes of Health, was part of MOBILIZE Boston (Maintenance of
Balance, Independent Living, Intellect and Zest in the Elderly), a
long-term cohort study based at the Institute for Aging Research. The
study is determining the causes of falls in older adults in order to
develop new ways to prevent falls from occurring. MOBILIZE Boston is
directed by principal investigator Lewis A. Lipsitz, M.D., director of
the Institute for Aging Research, professor of medicine at Harvard
Medical School, and a leading authority on falls.
Scientists at the Institute for Aging Research of
Hebrew SeniorLife say they seek to transform the human experience of
aging by conducting research that will ensure a life of health, dignity
and productivity into advanced age. The Institute carries out medical
and social studies that discover the mechanisms of age-related disease
and disability; lead to the prevention, treatment and cure of disease;
advance the standard of care for older people; and inform public
decision-making.
Founded in 1903, Hebrew SeniorLife, an affiliate of
Harvard Medical School, is a nonprofit organization devoted to
innovative research, health care, education and housing that improves
the lives of seniors.
Links to More Archived Reports on
Senior Citizens and Risk of Falls
One-point decrease on social activity scale was
equivalent to being approximately five years older at the start of the
study - risk of death, disability jump
Sept. 8, 2010 Falls are well recognized as a
major danger for senior citizens nearly 40 percent of seniors living
outside of institutions fall every year, according to the Centers for
Disease Control and Prevention. Many of these suffer severe injuries,
including hip fractures and brain injuries. But, in the effort to better
understand these risks and reduce them, little attention has been paid
to where the falls happened - indoors or out.
Scientists at the Institute for Aging Research of
Hebrew SeniorLife say they seek to transform the human experience of
aging by conducting research that will ensure a life of health, dignity
and productivity into advanced age. The Institute carries out medical
and social studies that discover the mechanisms of age-related disease
and disability; lead to the prevention, treatment and cure of disease;
advance the standard of care for older people; and inform public
decision-making. 
