The Journals of Gerontology Series A: Biological Sciences and Medical Sciences Advance Access originally published online on March 5, 2009
The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 2009 64A(5):599-609; doi:10.1093/gerona/glp003
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Recurrent and Injurious Falls in the Year Following Hip Fracture: A Prospective Study of Incidence and Risk Factors From the Sarcopenia and Hip Fracture Study
1 Exercise, Health and Performance Faculty Research Group, Faculty of Health Sciences, University of Sydney, Lidcombe, New South Wales, Australia
2 Balmain Hospital, New South Wales, Australia
3 Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
4 Gastrointestinal Investigation Unit and Centre for In Vivo Body Composition, Royal North Shore Hospital, St. Leonards, New South Wales, Australia
5 St. George Hospital, Kogarah, New South Wales, Australia
6 Department of Aged Care & Rehabilitation Medicine, Royal North Shore Hospital, St. Leonards, New South Wales, Australia
7 Centre for Experimental Radiation Oncology, Cancer Care Centre, St. George Hospital, Kogarah, New South Wales, Australia
8 Present address: Australian Clinical Trials Registry, NHMRC Clinical Trials Centre Level 5, Camperdown, New South Wales, Australia
9 Faculty of Medicine, University of New South Wales, Sydney, Australia
10 Hebrew SeniorLife, Boston, Massachusetts
11 Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts
Address correspondence to Maria A. Fiatarone Singh, MD, Exercise, Health and Performance Faculty Research Group, Faculty of Health Sciences, University of Sydney, East Street, Lidcombe 2141, New South Wales, Australia. Email: m.singh{at}usyd.edu.au
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Abstract |
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Background: The incidence and etiology of falls in patients following hip fracture remains poorly understood.
Methods: We prospectively investigated the incidence of, and risk factors for, recurrent and injurious falls in community-dwelling persons admitted for surgical repair of minimal-trauma hip fracture. Fall surveillance methods included phone calls, medical records, and fall calendars. Potential predictors of falls included health status, quality of life, nutritional status, body composition, muscle strength, range of motion, gait velocity, balance, walking endurance, disability, cognition, depression, fear of falling, self-efficacy, social support, physical activity level, and vision.
Results: 193 participants enrolled in the study (81 ± 8 years, 72% women, gait velocity 0.3 ± 0.2 m/s). We identified 227 falls in the year after hip fracture for the 178 participants with fall surveillance data. Fifty-six percent of participants fell at least once, 28% had recurrent falls, 30% were injured, 12% sustained a new fracture, and 5% sustained a new hip fracture. Age-adjusted risk factors for recurrent and injurious falls included lower strength, balance, range of motion, physical activity level, quality of life, depth perception, vitamin D, and nutritional status, and greater polypharmacy, comorbidity, and disability. Multivariate analyses identified older age, congestive heart failure, poorer quality of life, and nutritional status as independent risk factors for recurrent and injurious falls.
Conclusions: Recurrent and injurious falls are common after hip fracture and are associated with multiple risk factors, many of which are treatable. Interventions should therefore be tailored to alleviating or reversing any nutritional, physiological, and psychosocial risk factors of individual patients.
Keywords Falls; Hip fracture; Osteoporosis; Aging
Received: August 8, 2007; Accepted: November 10, 2008