Health and lifestyle risk factors for falls in a large population-based sample of older people in Australia

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Abstract

Introduction

Fall-related injuries among older people is a significant public health issue.

Method

To identify medical, general health and lifestyle factors associated with falls and multiple falls in older persons, a representative sample of people aged 65 + years living in the community in New South Wales (NSW) Australia were surveyed regarding their falls experience, lifestyle and general health.

Results

One-quarter of respondents indicated they had fallen in the past 12 months. People who fell were more likely to be aged 85 + years, have cataracts, musculoskeletal system and connective tissue disorders, major diseases of the circulatory, respiratory and nervous systems, use four or more medications, use a mobility aid and be overweight than non-fallers. Individuals aged 85 + years and those who experienced circulatory diseases, used four or more medications and used mobility aids were more likely to experience multiple falls.

Discussion

This representative population-based survey reinforces the multi-factorial nature of falls and the complex interaction of risk factors that increase the likelihood of individuals having a fall or multiple falls. Agencies focused on community-based fall prevention strategies should adopt a systematic, integrated approach to reduce the burden of fall injury at the population-level and should have mechanisms in place at the population-level to monitor the success of fall reduction strategies.

Highlights

► Falls are an important cause of serious injury amongst older individuals. ► This study demonstrates the ability to achieve population-level baseline data to monitor the future impact of fall injury reduction strategies ► Reinforces the multi-factorial nature of falls and the complex interaction of fall risk factors and highlights the need for monitoring success of implementation strategies at the population-level. ► Different prevention strategies are needed to address the needs of sub-populations as fall risk factors can differ between single and multiple fallers.

Introduction

Fall-related injury morbidity and mortality among older people is a significant public health issue worldwide (Aschkenasy and Rothenhaus, 2006, Bradley and Pointer, 2009, Peden et al., 2002). It is estimated that approximately one-third of individuals aged 65 years and older living in the community fall each year with many older individuals falling more than once (Campbell and Robertson, 2010, Tinetti, 2003). Fall-related injuries among older people represent a significant cost in health care (Schuffham et al., 2003, Stevens et al., 2006), with the annual direct cost to the health system in 2006-07 estimated at $558.5 million in New South Wales (NSW), the most populous state in Australia, with an estimated 460,000 people aged 65 years and older (Watson, Clapperton, & Mitchell, 2011).

The causes of falls are multi-factorial, involving both intrinsic and extrinsic factors (Graafmans et al., 1996, Morris et al., 2004). In particular, fall injury risk has been associated with a number of physical and lifestyle-related factors, such as the presence of chronic health conditions, like stroke, being female, having mobility problems, using multiple medications, alcohol consumption, and a low body mass index (O'Loughlin et al., 1993, Tinetti et al., 1988, van Doorn et al., 2003). In addition to causing physical injuries, falls can have a detrimental effect on an individuals’ confidence. Following a fall, older people can develop a fear of falling, often decreasing their levels of activity in an attempt to prevent further falls (King & Tinetti, 1995).

With the ageing of the population and the growing costs to the health system of fall-related injuries, government policies have sought to reduce the fall injury morbidity burden by encouraging participation in activities that promote healthy ageing that are likely to prevent, or reduce, the number of fall injuries (Campbell et al., 1989, Scott et al., 2010). These strategies have included encouraging involvement in physical activities, particularly strength and balance exercises, medication reviews and cataract surgery (Gillespie et al., 2009).

In Australia, there have been few attempts at the population-level to monitor the success of fall reduction strategies by conducting representative population-based surveys to collect information across a range of factors pertinent to falls. In order to create a baseline for monitoring government strategies to reduce fall injury in NSW, information on lifestyle and health differences between fallers and non-fallers, and between single fallers and repeat fallers, need to be described. The aim of this paper is to use such baseline data to compare health and lifestyle factors between fallers and non-fallers and between single and multiple fallers in persons aged 65 years and over in a population-based sample.

Section snippets

Sampling design

The NSW Falls Prevention Baseline Survey was undertaken in 2009 by the NSW Ministry of Health (Centre for Health Advancement and Centre for Epidemiology and Research, 2010). A representative sample of 5,681 older people (aged 65 + years) living in the community, with a private telephone, were surveyed across NSW regarding their falls experience, knowledge and perception of falls, participation and awareness of physical activity and health status. The full details concerning the development of

Results

Around one-quarter (25.6%) of older individuals in 2009 indicated that they had fallen in the preceding 12 months and of these, 38.1% reported falling more than once. Of all those who fell, 65.9% of falls resulted in an injury. Of the injurious falls, 19.9% required a visit to hospital and 10.7% required hospital admission.

Discussion

The growth of the ageing population has resulted in an increase in the incidence of fall-related injury requiring hospitalisation in a number of countries (Bradley and Pointer, 2009, Scott et al., 2010). Fall-related injury morbidity and recurrent falls can leave older individuals with ongoing health concerns and impaired mobility which can adversely impact on their quality of life (Pinheiro, Ciconelli, Martini, & Ferraz, 2010). To ensure that older individuals have the best opportunity to

Acknowledgements

R Mitchell was supported by an ARC-linkage post-doctoral fellowship (LP0990057) and the NSW Ministry of Health. W Watson was supported by the NSW Ministry of Health.

The authors would like to thank the Centre for Population Health and the Centre for Epidemiology and Evidence at the NSW Ministry of Health for providing access to the NSW Falls Prevention Baseline Survey data analysed in this study.

Rebecca Mitchell is a Senior Research Fellow at the Falls and Injury Prevention Group at Neuroscience Research Australia, University of New South Wales. Her primary research interests include evaluative tool development, data linkage studies, trauma services research, injury policy, and epidemiological and evaluation studies, predominantly in the areas of occupational health, road trauma, patient safety, sport and water safety, and falls injury prevention. Previously, she worked as a Senior

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    Rebecca Mitchell is a Senior Research Fellow at the Falls and Injury Prevention Group at Neuroscience Research Australia, University of New South Wales. Her primary research interests include evaluative tool development, data linkage studies, trauma services research, injury policy, and epidemiological and evaluation studies, predominantly in the areas of occupational health, road trauma, patient safety, sport and water safety, and falls injury prevention. Previously, she worked as a Senior Policy Analyst in the Injury Prevention and Policy Branch of the NSW Ministry of Health and as a Senior Officer in the Epidemiology Unit at the National Occupational Health and Safety Commission.

    Wendy Watson was formerly a Senior Research Fellow at the NSW Injury Risk Management Research Centre at the University of New South Wales where her role includes the development and management of the evaluation of the NSW State Falls Prevention policy. She has 20 years experience in injury prevention research and her main areas of interest include epidemiologic analysis of injury surveillance data, monitoring and evaluation of injury prevention programs and policy and measuring the burden of injury at the population level. She previously worked at the Monash University Accident Research Centre across a wide variety of injury prevention research issues.

    Andrew Milat is a policy maker come intervention researcher with almost 20 years experience in the design, implementation and evaluation of innovative health policies and programs at national, state and local levels. His research interests are centred around implementation science in public health and he has published widely in the areas of tobacco control, obesity prevention and falls prevention. He is currently an Investigator on three National Health and Medical Research Council Grants focusing implementation science, translational research and research impact assessment. He has worked as a Regional Director of Health Promotion, Head of the Sax Institute's Knowledge Transfer Division and is currently the Manager of Evidence and Evaluation Branch in NSW Ministry of Health, Australia. His extensive experience across levels of government and wide ranging experience in intervention research provides him with unique appreciation of the interface between research, policy and practice

    Amy Chung is a Research Assistant at the School of Aviation at the University of New South Wales. She is a Registered Psychologist and has a Masters degree in Organisational Psychology. She is currently completing her PhD on the research-practice gap and barriers to research application in human factors and ergonomics.

    Stephen Lord is a Senior Principal Research Fellow at Neuroscience Research Australia, University of New South Wales. He trained in biology, physiology and psychology at the University of Sydney and undertook his PhD and DSc degrees at the University of New South Wales. His research interests include understanding balance, indentifying risk factors for falls, fall risk assessments, interventions to prevent falls and translational research including incorporation of validated fall risk assessments into routine practice and implementing evidence-based exercise findings into fall prevention Programs.

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