We All Fall Down, but Who Gets Hurt?: A Mixed Methods Study

Wednesday, 1 August 2012: 9:10 AM

Ginette A. Pepper, RN, PhD, FAAN1
Bob Wong, PhD2
Victoria Gnatyuk, BS, MS2
Paul LaStayo, PT, PhD, CHT3
(1)University of Utah College of Nursing, Salt Lake City, UT
(2)College of Nursing, University of Utah, Salt Lake City, UT
(3)Physical Therapy Department, University of Utah College of Health, Salt Lake City, UT

Learning Objective 1: Describe a non-traditional approach to fall prevention programs.

Learning Objective 2: List factors that distinguish injury falls and non-injury falls by older adults.

Purpose: Although one third of older adults fall each year, that rate is not substantially different than younger adults. However, older adults are more likely to suffer injury with 25% of hospital admissions and 40% of nursing home admissions associated with falls. Forty percent of community dwelling older adults hospitalized for a fall will not return to independent living and 25% die within one year. Therefore, fall prevention programs should emphasize avoidance of injury falls. The purpose of this mixed methods study was to ascertain if there are differences in risk factors for injury and non-injury falls.

Methods:  Subjects (N=75) in this secondary analysis of data from a larger clinical trial comparing eccentric exercise and traditional muscle strengthening exercise were over 65 years, had 2 or more  comorbidities, and had fallen at least once in the last year. Data collected at baseline included demographics (age, comorbidities, and gender), Timed Up and Go, 6 Minute Walk, Berg Functional Balance scale, and lower extremity strength. Using the postcard method, subjects were followed for one year for falls and were interviewed by telephone after each event to ascertain characteristics associated with the fall. Quantitative analysis included t-test and ANOVA.  Descriptive qualitative methods were used to derive themes.

Results: No demographic or functional characteristics differentiated injury and non-injury fallers. Number of comorbidities increased risk for serious injury risk (p=.038; one-tailed), but not for minor injury. Themes that emerged related to environment, prodromal symptoms, location, activities, and “catching” oneself. Patterns more likely to be associated with injury falls were being outdoors, ground elevation changes, moving fast, and distracted by concern for others.

Conclusion: Qualitative and quantitative features may distinguish those likely to suffer injury falls. Taking good fall history may allow detection of patterns of non-injury falls before an injury is sustained.