title: Prevalence, risk factors and disability associated with fall-related injury in older adults in low- and middle-incomecountries: results from the WHO Study on global AGEing and adult health (SAGE).
abstract: BACKGROUND
  In 2010 falls were responsible for approximately 80 % of disability stemming from unintentional injuries excluding traffic accidents in adults 50 years and over. Falls are becoming a major public health problem in low- and middle-income countries (LMICs) where populations are ageing rapidly.
  
  
  METHODS
  Nationally representative standardized data collected from adults aged 50 years and over participating in the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) Wave 1 in China, Ghana, India, Mexico, the Russian Federation and South Africa are analysed. The aims are to identify the prevalence of, and risk factors for, past-year fall-related injury and to assess associations between fall-related injury and disability. Regression methods are used to identify risk factors and association between fall-related injury and disability. Disability was measured using the WHO Disability Assessment Schedule Version 2.0 (WHODAS 2.0).
  
  
  RESULTS
  The prevalence of past-year fall-related injuries ranged from 6.6 % in India to 1.0 % in South Africa and was 4.0 % across the pooled countries. The proportion of all past-year injuries that were fall-related ranged from 73.3 % in the Russian Federation to 44.4 % in Ghana. Across the six countries this was 65.7 %. In the multivariable logistic regression, the odds of past-year fall-related injury were significantly higher for: women (OR: 1.27; 95 % CI: 0.99,1.62); respondents who lived in rural areas (OR: 1.36; 95 % CI: 1.06,1.75); those with depression (OR: 1.43; 95 % CI: 1.01,2.02); respondents who reported severe or extreme problems sleeping (OR: 1.54; 95 % CI: 1.15,2.08); and those who reported two or more (compared with no) chronic conditions (OR: 2.15; 95 % CI: 1.45,3.19). Poor cognition was also a significant risk factor for fall-related injury. The association between fall-related injury and the WHODAS measure of disability was highly significant (P<0.0001) with some attenuation after adjusting for confounders. Reporting two or more chronic conditions (compared with none) was significantly associated with disability (P<0.0001).
  
  
  CONCLUSIONS
  The findings provide a platform for improving understanding of risk factors for falls in older adults in this group of LMICs. Clinicians and public health professionals in these countries must be made aware of the extent of this problem and the need to implement policies to reduce the risk of falls in older adults.
authors.affiliation: Research Centre for Gender, Health and Ageing, Faculty of Health, University of Newcastle, Newcastle, Australia. jennifer.stewart.williams@epiph.umu.se.|Epidemiology and Global Health, Umeå University, Umeå, Sweden. jennifer.stewart.williams@epiph.umu.se.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Stewart Williams
authors.affiliation: Research Centre for Gender, Health and Ageing, Faculty of Health, University of Newcastle, Newcastle, Australia. kowalp@who.int.|Surveys, Measurement and Analysis Unit, World Health Organization, Geneva, Switzerland. kowalp@who.int.
authors.forename: Paul
authors.initials: P
authors.lastname: Kowal
authors.affiliation: University of Southern California, Los Angeles, USA. hhestekin@gmail.com.
authors.forename: Heather
authors.initials: H
authors.lastname: Hestekin
authors.affiliation: Midwestern University Chicago College of Pharmacy, Chicago, USA. todris@midwestern.edu.
authors.forename: Tristan
authors.initials: T
authors.lastname: O'Driscoll
authors.affiliation: Human Sciences Research Council, Pretoria, South Africa. kpeltzer@hsrc.ac.za.|University of Limpopo, Turfloop, Sovenga, South Africa. kpeltzer@hsrc.ac.za.|Mahidol University, Salaya, Phutthamonthon, Nakhonpathom, Thailand. kpeltzer@hsrc.ac.za.
authors.forename: Karl
authors.initials: K
authors.lastname: Peltzer
authors.affiliation: Department of Community Health, University of Ghana, Accra, Ghana. aeyawson@yahoo.com.
authors.forename: Alfred
authors.initials: A
authors.lastname: Yawson
authors.affiliation: Department of Community Health, University of Ghana, Accra, Ghana. biritwum@africaonline.com.gh.
authors.forename: Richard
authors.initials: R
authors.lastname: Biritwum
authors.affiliation: National Research Institute of Public Health (FSBI, RAMS), Moscow, Russian Federation. tmaximova@mail.ru.
authors.forename: Tamara
authors.initials: T
authors.lastname: Maximova
authors.affiliation: Center for Evaluation Research and Surveys, National Institute of Public Health, Cuernavaca, Morelos, Mexico. asalinas@insp.mx.
authors.forename: Aarón
authors.initials: A
authors.lastname: Salinas Rodríguez
authors.affiliation: Center for Evaluation Research and Surveys, National Institute of Public Health, Cuernavaca, Morelos, Mexico. bmanrique@insp.mx.
authors.forename: Betty
authors.initials: B
authors.lastname: Manrique Espinoza
authors.affiliation: Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China. wufan@scdc.sh.cn.
authors.forename: Fan
authors.initials: F
authors.lastname: Wu
authors.affiliation: International Institute of Population Sciences, Mumbai, India. parokiasamy@iips.net.
authors.forename: Perianayagam
authors.initials: P
authors.lastname: Arokiasamy
authors.affiliation: Surveys, Measurement and Analysis Unit, World Health Organization, Geneva, Switzerland. chatterjis@who.int.
authors.forename: Somnath
authors.initials: S
authors.lastname: Chatterji
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control / Q000706:statistics & numerical data; D000368:Aged; D002681:China / Q000453:epidemiology; D002908:Chronic Disease / Q000453:epidemiology*; D003863:Depression / Q000453:epidemiology*; D003906:Developing Countries / Q000706:statistics & numerical data; D004185:Disability Evaluation; D005260:Female; D005869:Ghana / Q000453:epidemiology; D006801:Humans; D007194:India / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data; D012426:Russia / Q000453:epidemiology; D013019:South Africa / Q000453:epidemiology; D014944:World Health Organization; D014947:Wounds and Injuries / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology