title: Factors predicting fractures during falling impacts among home-dwelling older adults.
abstract: OBJECTIVE
  To investigate the predictors of fractures during falling impacts among home-dwelling older adults.
  
  
  METHODS
  A case-control study within a prospective, population-based survey.
  
  
  METHODS
  Five rural municipalities in northern Finland.
  
  
  METHODS
  The study population consisted of all home-dwelling persons aged 70 or older living in these five municipalities (n = 790 (85%)). The cases for this study were those with fracture, using the first fracture (n = 82) in the analyses, during a follow-up period of 4 years. Controls (n = 82) were selected from among the persons who suffered soft tissue injuries; matching was by age, sex, and location of the first injury during the period.
  
  
  METHODS
  During a 4-year follow-up period, all falls in the population were recorded using fall diaries, telephone interviews, and information from medical records. Risk factors for fractures during the 4-year follow-up were determined according to the number and severity of previous falls, circumstances and place of falls, disease history, use of medicines, symptoms, clinical examinations and tests, nutritional status, functional abilities and social and health behavior. Cross-tabulations for categorial variables, paired t tests for the means of continuous variables, and conditional logistic regression analysis were performed.
  
  
  RESULTS
  According to the bivariate analyses, the risk factors for falls resulting in a fracture were frequent fear of falling, abnormal heel-shin test, reduced knee extension strength, reduced grip strength, poor distance visual acuity, low supine pulse rate, inability to carry a 5-kg load 100 meters, not doing heavy outdoor work, and no habitual exercise. A limited amount of social participation was associated negatively with fracturing. Conditional logistic regression analysis showed that the risk factors for fracture-causing falls were frequent fear of falling (OR 2.50; CI 1.11-5.65), reduced knee extension strength (OR 3.38; CI 1.00-11.4), and poor distance visual acuity (OR 3.45; CI 1.13-10.6), whereas limited social participation (OR 0.29; CI 0.11-0.79) protected against the occurrence of fractures.
  
  
  CONCLUSIONS
  Impaired perception, muscle strength, and psychological and social functioning may influence fracture risk during injurious fall impacts. Studies with larger sample sizes are needed to confirm this and to examine the circumstances and mechanisms contributing to the fracture risk during falls via these risk factors.
authors.affiliation: Department of Public Health Science and General Practice, University of Oulu, Finland.
authors.forename: H
authors.initials: H
authors.lastname: Luukinen
authors.forename: K
authors.initials: K
authors.lastname: Koski
authors.forename: P
authors.initials: P
authors.lastname: Laippala
authors.forename: S L
authors.initials: SL
authors.lastname: Kivelä
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000453:epidemiology* / Q000503:physiopathology; D015438:Health Behavior; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology; D008297:Male; D009068:Movement; D015999:Multivariate Analysis; D011159:Population Surveillance; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D012424:Rural Population; D012932:Social Facilitation; D014792:Visual Acuity