| Abstract |
Introduction: Low energy falls from standing height are a common occurrence with huge socio-economic implications. Elderly populations are particularly susceptible to such falls, often resulting in more severe complications. To properly identify the risk factors involved in such falls, it is useful to obtain a patient’s through medical history and complete medications list, to examine their lifestyle and activities of daily living, as well as to review the spatial arrangement of their residence. In our country, which ranks among the ‘eldest’ of the European Union, there is an urgent need to implement preventive measures against falls through safe-living and the preservation of the quality of life of the elderly population.
Purpose: This study is designed to identify and investigate the risk factors which contribute to falls in the elderly that lead to trauma and a subsequent deterioration in their quality of life. The goal of the study was to identify and record these risk factors which may ulteriorly be served by appropriately targeted measures and interventions that can lead to a reduction in the number of falls in this population.
Methodology: A cross-sectional study was performed from the months of January 2023 to April 2023 at the University Hospital of Heraklion. Participants in the study were aged 65 and older. The sample population consisted of around 76 patients that were hospitalized in the Orthopaedic Trauma and Spine Surgery Department having suffered a fracture after a fall. The inclusion criteria into the study were for the patient to be aged 65 years or older and to not present any serious communication impairment. However, there were 5 patients aged 60-64 that were not excluded from the study. Additionally, while researching the characteristics and treatments of certain fracture patients, a small number of 14 patients aged 61-90 years old having suffered a fall-related fracture, seen in the emergency department but not admitted to the Orthopaedic and Spine Surgery department were chosen for study. The resulting data obtained from these patients was not analyzed or compared to that obtained from the main sample of 76 patients that had been admitted to the ward. Data was collected through a questionnaire concerning socio-demographic information, patient activities, medical history and history of falls. In addition, the weighted scoring scale HOME FAST (The Home Falls and Accidents Screening Tool) was utilized, which refers to hazards within the home and relates to the performance of activities that are related to falls. The collected data was analyzed with the program IBM-SPSS 28.0 and hierarchical group analysis and estimation of complementary odds ratios were used to test for associations with risk factors of falls.
Results: Of the 76 patients that were admitted into the Orthopaedic and Spine Surgery departments, 69,7% were women and 48,7% were aged 80 years or older. 71,1% of the patients had an increased body mass index (BMI). Approximately half the patients had suffered the fall in their residence (56,6%), and nearly half reported a previous fall within the last year (44,7%). Hip fractures were the most common (53,9%), followed by femur fractures (11,8%), spine fractures and fractures of the humerus (6,6%). Regarding the patients’ medical history and physical condition, 88,2% of patients had problems with their vision, 71,1% had hypertension, and 60,5% reported chronic pain. Multimorbidity was observed in 84,2% of the patients. A majority of the patients required assistance for their activities of daily living (64,3%). An increased environmental risk for an in-residence fall was noted in 19,7% of patients and was more closely correlated with those patients who had suffered a hip fracture, those who required a walking aid, those who had suffered a previous recent fall, and those with diminished function. Combinations of ten different risk factors categorize the patients into two main groups, thus characterizing the fall profile of the patients: 1) Increased age, use of a walking aid, hip fracture, recent previous fall as well as increased in-residence fall risk characterize the first main group, whereas 2) female sex, comorbidities, in-residence fall, the need for assistance in activities of daily living and increased BMI characterize the second main group. Multimorbidity distinguishes itself by having the greatest frequency (84,2%), followed by increased BMI (71,1%) and the female sex (69,7%). Patients having suffered a hip fracture were at a much higher risk of a fall compared to the rest (29,3% vs 8,6%, p=0,024) or 4,4 higher odds (95% CI 1,1-17,2), having suffered a recent previous fall (32,4% vs 9,5%, p=0,013) or 4,5 higher odds (95% CI 1,3-15,9), those who need a walking aid (32,4% vs 7,7%, p=0,007) or 5,8 higher odds (95% CI 1,3-22,5), and those requiring assistance for activities of daily living (30,2% vs 6,1%, p=0,009) or 6,7 higher odds (95% CI 1,4-32,3). Conclusion: This study provides information concerning the frequency of particular risk factors for elderly patients who have suffered a fall resulting in a fracture. The most common among these factors that describe the profile of the participating patients are the female sex, increased age, vision problems, increased BMI, and presence of comobidities. Of interest is the resulting possible correlation of increased environmental in-residence hazards with certain intrinsic factors. Hence, we note a lack of knowledge and patient education of the elderly concerning fall prevention, as well as an absence of action and educational program implementation on behalf of the state concerning fall prevention and healthy ageing. The issue of fall-related fractures in the elderly is multifactorial and its resolution requires complex and multidisciplinary interventions on behalf of the health-care sector and its relative policies.
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