Why the elderly fall in residential care facilities, and suggested remedies.
OBJECTIVE
To study precipitating factors for falls among older people living in residential care facilities.


METHODS
Prospective cohort study.


METHODS
Five residential care facilities.


METHODS
140 women and 59 men, mean age +/- SD 82.4 +/- 6.8 (range, 65-97).


METHODS
After baseline assessments, falls in the population were tracked for 1 year. A physician, a nurse, and a physiotherapist investigated each event, and reached a consensus concerning the most probable precipitating factors for the fall.


RESULTS
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%) of the 482 registered falls. Acute disease or symptoms of disease were judged to be precipitating, alone or in combination in 186 (38.6%) of all falls; delirium was a factor in 48 falls (10.0%), and infection, most often urinary tract infection, was a factor in 38 falls (7.9%). Benzodiazepines or neuroleptics were involved in the majority of the 37 falls (7.7%) precipitated by drugs. External factors, such as material defects and obstacles, precipitated 38 (7.9%) of the falls. Other conditions both related to the individual and the environment, such as misinterpretation (eg, overestimation of capacity or forgetfulness), misuse of a roller walker, or mistakes made by the staff were precipitating factors in 83 (17.2%) of falls.


CONCLUSIONS
Among older people in residential care facilities, acute diseases and side effects of drugs are important precipitating factors for falls. Falls should therefore be regarded as a possible symptom of disease or a drug side effect until proven otherwise. Timely correction of precipitating and predisposing factors will help prevent further falls.
Kallin
Kristina
K
Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden. kristina.kallin@germed.umu.se
Jensen
Jane
J
Olsson
Lillemor Lundin
LL
Nyberg
Lars
L
Gustafson
Yngve
Y
D000058:Accidental Falls / Q000706:statistics & numerical data*; D000208:Acute Disease / Q000453:epidemiology; D000368:Aged; D000369:Aged, 80 and over; D000437:Alcoholism / Q000150:complications / Q000453:epidemiology; D002908:Chronic Disease / Q000453:epidemiology; D015331:Cohort Studies; D003693:Delirium / Q000150:complications / Q000453:epidemiology; D064420:Drug-Related Side Effects and Adverse Reactions; D004779:Environment Design; D005260:Female; D006620:Hip Fractures / Q000517:prevention & control; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011482:Protective Devices / Q000009:adverse effects; D012112:Residential Facilities; D020521:Stroke / Q000150:complications / Q000453:epidemiology; D013548:Sweden / Q000453:epidemiology; D013575:Syncope / Q000150:complications / Q000453:epidemiology; D014552:Urinary Tract Infections / Q000150:complications / Q000453:epidemiology