Knowledge and Perception of Fall-Related Risk Factors and Fall-Reduction Techniques Among Community-Dwelling Elderly Individuals.Research suggests that falls among community-dwelling elderly persons are prevalent[1] and are a major cause of death[2] and disability.[3] Approximately one third of people over 65 years of age[1] and 49% of community-dwelling persons aged 72 years and older[4] fall each year. Ten to fifteen percent of falls among older adults result in serious injury or death.[5,6] Management and treatment for fall-related injuries among older individuals,[7] including emergency department visits, hospitalizations, nursing home placement after hospitalization hospitalization /hos·pi·tal·iza·tion/ (hos?pi-t'l-i-za´shun) 1. the placing of a patient in a hospital for treatment. 2. the term of confinement in a hospital. , and home health care services,[8] are costly. Following a fall, many elderly people report experiencing difficulties with activities of daily living[9,10] and appear to reduce their activity levels due to fear of falling Fear Of Falling is the Season 2 final episode of the Nickelodeon show All Grown Up. Episode Notes
Risk factors for falls among elderly people include environmental hazards 'Environmental hazard' is a generic term for any situation or state of events which poses a threat to the surrounding environment. This term incorporates topics like pollution and Natural Hazards such as storms and earthquakes. and housing characteristics,[11-13] frailty frailty Vox populi A state of delicacy or weakness which, which encompasses age-related fragility, in particular osteoporosis. See FICSIT, Osteoporosis. ,[14] and deterioration de·te·ri·o·ra·tion n. The process or condition of becoming worse. of the neuromuscular system neuromuscular system n. The muscles of the body together with the nerves supplying them. .[15] Individual factors related to increased risk of falling include being female, older age, medication use (particularly sedative sedative, any of a variety of drugs that relieve anxiety. Most sedatives act as mild depressants of the nervous system, lessening general nervous activity or reducing the irritability or activity of a specific organ. or multiple drug use), comorbidities (eg, stroke or arthritis arthritis, painful inflammation of a joint or joints of the body, usually producing heat and redness. There are many kinds of arthritis. In its various forms, arthritis disables more people than any other chronic disorder. ), physical and mobility limitations, limited vision, dizziness dizziness: see vertigo. , and cognitive impairments.[3,16-22] Clinic-based or community-based information sessions and exercise prescription did not appear to reduce falls among participants of other studies.[23-26] Recently, however, interventions combining balance, strengthening and flexibility exercise flexibility exercise An exercise intended to elongate soft tissues to prepare for the rigors of sport protocols, medical management techniques, and in-home risk-factor reduction[27-29] have helped reduce falls among community-dwelling elderly people. Despite the potentially severe effects of falling, identification of fall-related risk factors, and discernment of successful fall-reduction strategies, the concern, knowledge level, and attitudes of community-dwelling older people toward falling and fall-related risk factors are unknown. The purposes of this study were to assess the perception of falls as a health problem, to determine the perceived importance of fall-related risk factors, and to identify personal characteristics and attitudes associated with perceived importance of fall-related risk factors among community-dwelling elderly people. Method Setting Duluth is the largest, most urban city in northeastern Minnesota, a primarily rural area of the state. Duluth residents are generally older than those in the rest of the state; approximately 17% are 65 years of age or older, as compared with the state population average of 12.5%.[30] The median annual income for men over 65 years of age living in nonfamilial households in Duluth (ie, about $13,000) is comparable to that of the rest of the state, whereas the median income for older women (ie, $8,000) is about 18% lower than for rest of the state.[30] Study Population Data were collected from a convenience sample of residents of 3 of the 17 government-subsidized apartment buildings for elderly people in the city of Duluth.[31] Buildings were randomly selected from the roster of apartment buildings for elderly people, and the building manager was contacted to determine the existence of a resident council at the building. The project description and survey were included on the agenda of the next meeting. All meetings were held in the apartment building and were accessible by elevator elevator, in machinery elevator, in machinery, device for transporting people or goods from one level to another. The term is applied to the enclosed structures as well as the open platforms used to provide vertical transportation in buildings, large ships, to all residents. Eligibility for residence in the buildings is income-based, with a maximum annual allowable income of $22,750 for an individual. The self-administered survey instrument was distributed to all attendees during the resident council meeting. A brief overview of the project and its purpose preceded distribution of the survey instrument. All meeting participants (N=120) completed the survey, yielding an overall building response rate of 44%. Resident attendance rates were 50% (68/137), 41% (28/69), and 40% (29/72) in buildings 1, 2, and 3, respectively. Instrument Focus-group methods were used to develop the survey form that assessed knowledge and perceptions of fall-related risk factors.[32] A structured series of questions were developed to guide a discussion of fall-related risk factors that was conducted with the residents of 2 buildings who were not surveyed for this report. Two facilitators used these open-ended questions A closed-ended question is a form of question, which normally can be answered with a simple "yes/no" dichotomous question, a specific simple piece of information, or a selection from multiple choices (multiple-choice question), if one excludes such non-answer responses as dodging a to solicit identification of known risk factors and continued the discussion until all the literature-based categories of fall-related risk factors were identified. Item selection reflected 4 literature-based areas of risk-factor identification: (1) indoor environmental factors such as rugs, furniture, and grab bars, (2) outdoor environmental factors such as pavement pavement, the wearing surface of a road, street, or sidewalk. Parts of Babylon and Troy are believed to have been paved; Roman roads were noted for their durable stone paving. Cobblestones were common from late medieval times into the 19th cent. maintenance, (3) physical factors such as weakness, balance, or visual changes, and (4) mental or judgment factors such as distraction Distraction Divination (See OMEN.) Porlock a “person from Porlock” interrupted Coleridge while he was recollecting the dream on which he based “Kubla Khan”. [Br. Lit.: Poems of Coleridge in Magill IV, 756] and confusion. The facilitators recorded the wording and format offered by the attendees and repeated the items back to the audience for consensus. The discussion concluded with a general ranking of importance by the attendees. From our meetings, 2 sets of questions were developed to assess (1) factors considered most likely to contribute to a fall (ie, by the respondent In Equity practice, the party who answers a bill or other proceeding in equity. The party against whom an appeal or motion, an application for a court order, is instituted and who is required to answer in order to protect his or her interests. ) (fall prevention survey form A) and (2) the perception of factors most likely to contribute to a fall among the general elderly population (fall prevention survey form B) (Appendix). Participants were asked to rate the probability of a fall given the presence of the specified condition on a scale from 0 (not at all likely) to 10 (most likely). A scale of 0 to 10 was chosen to allow a greater range of responses. Identical items were included in both forms of the survey instrument, except for the mental impairment Impairment 1. A reduction in a company's stated capital. 2. The total capital that is less than the par value of the company's capital stock. Notes: 1. This is usually reduced because of poorly estimated losses or gains. 2. question. In the general elderly population assessment, questions were asked about confusion or mental impairment, whereas the questions in the personal assessment dealt with forgetfulness Forgetfulness See also Carelessness. Absent-Minded Beggar, The ballad of forgetful soldiers who fought in the Boer War. [Br. Lit.: “The Absent-Minded Beg-gars” in Payton, 3] absent-minded professor . Sessions in the elderly community dwellers' residence buildings included a brief introduction to the survey form and the study rationale rationale (rash´  nal´),n the fundamental reasons used as the basis for a decision or action. . The 2 forms were distributed in a random fashion to meeting attendees. Due to the brief time allotted al·lot tr.v. al·lot·ted, al·lot·ting, al·lots 1. To parcel out; distribute or apportion: allotting land to homesteaders; allot blame. 2. for the resident council meeting, each participant completed 1 of the 2 forms. After the forms were completed, a brief presentation and discussion of fall-related risk factors was conducted. These sessions yielded 68 responses to the general expectation form and 52 responses to the personal expectation form. Falling as a Health Concern Participants were asked whether they believed thin could be prevented and whether falling was a concern for people in their age group. They were also asked to rate the likelihood of returning to their current living situation if a fall produced serious injury on a scale of 0 (not at all likely) to 10 (most likely) and to rate the importance of falling compared with other health concerns on a scale of 0 (not at all important) to 10 (most important). Personal Characteristics The survey forms included questions regarding socio-demographic characteristics, recent falls, and general health. The participants' sex, marital status marital status, n the legal standing of a person in regard to his or her marriage state. , and educational attainment Educational attainment is a term commonly used by statisticans to refer to the highest degree of education an individual has completed.[1] The US Census Bureau Glossary defines educational attainment as "the highest level of education completed in terms of the were ascertained as·cer·tain tr.v. as·cer·tained, as·cer·tain·ing, as·cer·tains 1. To discover with certainty, as through examination or experimentation. See Synonyms at discover. 2. . Fall prevalence was determined, including falls within the previous month, injurious in·ju·ri·ous adj. 1. Causing or tending to cause injury; harmful: eating habits that are injurious to one's health. 2. falls, and falls requiring medical attention, as was any history of hip fracture hip fracture Orthopedic surgery A femoral fracture which affects 1/6 white ♀–US during life Epidemiology 250,000/yr–US Specifics Proximal femur; 90+% femoral neck, intertrochanteric; 5-10% are subtrochanteric Risk factors Tall, thin ♀, . Prior to administering the survey, a definition of falling as an unintentional descent descent, in anthropology, method of classifying individuals in terms of their various kinship connections. Matrilineal and patrilineal descent refer to the mother's or father's sib (or other group), respectively. to a lower elevation elevation, vertical distance from a datum plane, usually mean sea level to a point above the earth. Often used synonymously with altitude, elevation is the height on the earth's surface and altitude, the height in space above the surface. was explained to the participants by the facilitator. Physical function was assessed by 3 questions about mobility (ie, the distance they walked outdoors, use of an assistive device assistive device Public health Any device designed or adapted to help people with physical or emotional disorders to perform actions, tasks, and activities. See Americans with Disabilities Act, Architectural barriers, Assistive technology. for ambulation am·bu·late intr.v. am·bu·lat·ed, am·bu·lat·ing, am·bu·lates To walk from place to place; move about. [Latin ambul , and stair-climbing ability). Data Analysis Survey results were tabulated, and frequencies were reported. Forms were excluded from the data set if there was no response to more than 2 of the fall-related risk-factor questions. Data were analyzed an·a·lyze tr.v. an·a·lyzed, an·a·lyz·ing, an·a·lyz·es 1. To examine methodically by separating into parts and studying their interrelations. 2. Chemistry To make a chemical analysis of. 3. to detect any differences in sociodemographics, health status, perceptions of falls as a health concern, and perceived fall-related effects by building and by form type. The fall-related risk factors on each of the 2 forms were grouped into 4 categories: interior environmental factors (2 questions), exterior environmental factors (3 questions), physical factors (4 questions), and psychological factors (4 questions). A summed total of the items in each category yielded a subscale score for each risk-factor category. All scales, except for the interior environmental factor scale, reflected the variability in patient response better than the individual items (Cronbach alpha [is greater than] .70, range=.72-.89) and were retained as dependent variables. Possible scale scores ranged from 30 when 3 questions constituted the scale to 40 when 4 questions constituted the scale. Individual items from the interior environmental factor scale were used as dependent variables; the maximum value of these items was 10. The relationships between the perceived importance of fall-related risk factors and participant characteristics such as health status, attitude toward falling as a health problem, and the perceived consequences of falling were determined by analysis of variance The discrepancy between what a party to a lawsuit alleges will be proved in pleadings and what the party actually proves at trial. In Zoning law, an official permit to use property in a manner that departs from the way in which other property in the same locality or linear regression Linear regression A statistical technique for fitting a straight line to a set of data points. . Separate analyses were done for perceptions of fall-related risk factors in the general elderly population and for personal likelihood of falling. More extensive analyses were precluded by the relatively small sample size. Results Sociodemographic characteristics of the sample are reported in Table 1. The majority of the participants were widowed women. The mean age was 78.8 years (SD=7.4, range=62-99). Two thirds of the sample were at least high-school graduates, although only 5.3% were college graduates. No differences were detected between participants who answered questions regarding risk factors among the general elderly population and participants who evaluated their own risk of falling (Tabs. 1-3).
Table 1.
Participant Characteristics(a)
Form A(b) (n = 68) Form B(c) (n = 52)
Age (y)
[bar] X 78.8 78.5
SD 7.3 7.8
Range 63-97 62-99
Sex
Female 84.1 90.2
Male 15.9 9.8
Educational attainment
Less than high school 29.4 29.6
High-school graduate 38.2 36.4
More than high school 32.4 34.1
Marital status
Married 20.3 16.7
Widowed 62.3 75.0
Divorced 8.7 6.3
Never married 8.7 2.1
Total (N = 120)
Age (y)
[bar] X 78.8
SD 7.4
Range 62-99
Sex
Female 86.0
Male 14.0
Educational attainment
Less than high school 30.7
High-school graduate 36.8
More than high school 32.5
Marital status
Married 18.3
Widowed 67.5
Divorced 7.5
Never married 6.7
(a) P < .05; all values are percentages, unless otherwise indicated. Chi-square analysis of categorical That which is unqualified or unconditional. A categorical imperative is a rule, command, or moral obligation that is absolutely and universally binding. Categorical is also used to describe programs limited to or designed for certain classes of people. variables and Student t test for continuous variables (eg, age) revealed no differences between respondents In the context of marketing research, a representative sample drawn from a larger population of people from whom information is collected and used to develop or confirm marketing strategy. using form A and respondents using form B of the fall prevention survey. (b) Assessed risk factors for falls in the general elderly population. (c) Assessed risk factors for a fall by a respondent. Table 2. Self-reported Health Status of Elderly People Living in Subsidized sub·si·dize tr.v. sub·si·dized, sub·si·diz·ing, sub·si·diz·es 1. To assist or support with a subsidy. 2. To secure the assistance of by granting a subsidy. Apartment Buildings (Expressed as a Percentage)(a)
Form A(b) Form B(c)
(n = 68) (n = 52)
Presence of a medical condition
predisposing participant to a
fall versus other elderly people 30.4 31.1
Current health status
Poor 4.4 2.1
Fair 26.1 36.2
Good 44.9 31.9
Very good 17.4 29.8
Excellent 7.3 0
Ambulation ability
Unable to walk outside the
apartment 4.4 2.2
Less than a block 17.7 24.4
Several blocks 36.8 48.9
A mile or more 41.2 24.4
Requires an assistive device to
walk outdoors 24.7 20.5
Ability on stairs
Unable to climb stairs 4.6 6.7
One flight with an assistive
device or handrail 39.4 33.3
One flight without an
assistive device or handrail 15.2 17.8
More than one flight without
an assistive device or handrail 40.9 42.2
Avoids activities due to fear
of falling 22.7 22.7
Total
(n = 120)
Presence of a medical condition
predisposing participant to a
fall versus other elderly people 30.7
Current health status
Poor 3.5
Fair 30.2
Good 39.7
Very good 22.4
Excellent 4.3
Ambulation ability
Unable to walk outside the
apartment 3.5
Less than a block 20.4
Several blocks 41.6
A mile or more 34.5
Requires an assistive device to
walk outdoors 23.0
Ability on stairs
Unable to climb stairs 5.3
One flight with an assistive
device or handrail 36.3
One flight without an
assistive device or handrail 16.8
More than one flight without
an assistive device or handrail 41.6
Avoids activities due to fear
of falling 22.7
(a) P < .05, chi-square analysis. (b) Assessed risk factors for falls in the general elderly population. (c) Assessed risk factors for a fall by a respondent. Table 3. Falling as a Health Problem Among Elderly People Living in Subsidized Housing Subsidized housing (aka social housing) is government supported accommodation for people with low to moderate incomes. To meet these goals many governments promote the construction of affordable housing. (a)
Form A(b) Form B(c)
(n = 68) (n = 52)
Perception of falling
Falls can be prevented (% yes) 82.0 80.0
Falls are a major concern for
elderly people (% yes) 89.7 84.4
Importance of falling compared
with other health concerns(d)
[bar] X 6.4 6.0
SD 2.9 3.2
Perceived effect of a serious fall
Probability of serious injury
due to a fall(e)
[bar] X 6.2 5.7
SD 2.8 3.0
Probability of returning to your
current living situation
after a serious fall(e)
[bar] X 6.4 6.9
SD 3.1 2.8
Total
(N = 120)
Perception of falling
Falls can be prevented (% yes) 81.0
Falls are a major concern for
elderly people (% yes) 87.0
Importance of falling compared
with other health concerns(d)
[bar] X 6.2
SD 3.1
Perceived effect of a serious fall
Probability of serious injury
due to a fall(e)
[bar] X 6.0
SD 2.9
Probability of returning to your
current living situation
after a serious fall(e)
[bar] X 6.6
SD 3.0
(a) P < .05; chi-square analysis for continuous variables (ie, "falls can be prevented," "falls are a major concern for elderly people"); Student t test for continuous variables (ie, importance of falling versus other health effects of a serious fall). (b) Assessed risk factors for falls in the general elderly population. (c) Assessed risk factors for a fall by a respondent. (d) Range: 0 (not at all important) to 10 (most important). (e) Range: 0 (not at all likely) to 10 (most likely). Falling within the month before the study was conducted was reported by 10.1% of the participants; 4.2% of the respondents reported injurious falls. No falls requiring medical attention were reported. Histories of hip fractures were reported by 4.2% of the respondents. Self-reported health status was generally good to excellent (Tab. 2). One third of the participants reported poor to fair general health. A self-reported medical condition likely to increase personal risk of falling compared with other elderly persons their age was noted in 30.2% of the subjects. The majority of the respondents reported that they could walk several blocks or farther, 23.5% of the respondents were unable to walk one block outside their apartment, and 5.3% of the respondents were unable to climb a flight of stairs Noun 1. flight of stairs - a stairway (set of steps) between one floor or landing and the next flight of steps, flight staircase, stairway - a way of access (upward and downward) consisting of a set of steps . Fear of falling restricted activity participation by 22.3%. Low self-reported health status was strongly associated with reduced mobility and considering oneself more likely to fall, but it was not associated with falling during the month preceding the study or with viewing falls as a health problem (chi-square test chi-square test: see statistics. , df=2, P [is greater than] .05; data not shown). The vast majority of the respondents considered falling a major preventable health problem for elderly people (Tab. 3). Compared with other health concerns, however, falling was considered moderately important. Although the self-reported perception of the probability of sustaining a serious injury during a hard fall was high, most of the respondents were confident that they would be able to return to their current living situation after a hard fall. Environmental factors, particularly sidewalk A Microsoft service that was launched in 1997 to provide online arts and entertainment guides on the Web for major cities worldwide. In 1999, Microsoft sold Sidewalk to Ticketmaster, which continued to provide guides, ticketing and other information to the MSN network. and pavement maintenance, were perceived as most likely to cause falls among both the participants who answered questions regarding risk factors among the general elderly population and the participants who evaluated their own risk of falling (Tab. 4). Poor judgment, distraction, and mental impairment were least likely to be cited as increasing the likelihood of falling in an individual, but these factors were generally equal in importance to other listed risk factors for falls among the general elderly population. Personal expectations of experiencing a fall due to the risk factors listed were universally and markedly lower than the expectation for falls among the general elderly population. Table 4. Perceived Importance of Factors Associated With Increased Risk of Falling Among Community-Dwelling Elderly People(a)
Importance Importance
for a Fall for a
in the Personal
General Fall
Elderly (n=52)
Population ("I am
(n=68) likely to
("They fall fall...")
...")
Risk Factor [bar]X SD [bar]X SD
Interior environmental factors
Because things like rugs, furniture,
and stairs get in the way 7.5 2.3 3.8 3.4
Because grab bars in their house or
apartment are not present or are not
in a helpful position 7.7 2.4 2.7 3.3
Exterior environmental factors
Because sidewalks, streets, and
pavement are not clear of ice and
snow 9.0 1.8 7.4 3.0
Because sidewalks, streets, and
pavement are poorly maintained
(eg, cracked or irregular pavement,
inadequate street markings) 8.7 1.8 7.2 2.8
Because handrails are not present or
are poorly positioned in public
places 7.7 2.7 4.6 3.4
Physical factors
Because of a coordination or balance
problem 8.2 2.1 2.7 3.3
Because of inadequate muscle strength
or endurance 8.0 2.2 2.5 3.2
Because of weakened bones due to age
(osteoporosis) 8.3 2.1 2.9 3.6
Because of poor vision 7.9 2.5 2.9 3.3
Psychological factors
Because of doing unsafe or risky
things 8.0 2.7 1.9 2.5
Because of not paying attention 7.7 2.5 2.2 3.0
Because of confusion or mental
impairment 7.2 2.7
Because of forgetfulness 1.4 2.2
(a) Range 0-10, with 10 being most likely to increase the risk of falling. Participant characteristics and attitudes were related to the perceived importance of certain risk factors, particularly physical factors, in increasing the likelihood of falling in an individual. Participants who considered falls to be an important health concern attributed higher levels of importance to virtually all personal fall-related risk factors, particularly exterior environmental factors and physical factors, compared with participants who did not consider falls to be an important health concern for elderly people (Tab. 5). The perceived importance of physical factors was higher among participants reporting poor to fair health status and among participants who reported that fear of falling limits activities (Tab. 6). In addition, the perceived importance of physical factors in increasing the likelihood of falling was higher among those respondents who considered falling as relatively important compared with other health concerns, those respondents who reported a high probability of serious injury as a result of a fall, and those respondents who reported being unlikely to return to their current living situation after a serious fall (Tab. 7). Table 5. Differences in Perceived Risk-Factor Scab Scores for Increasing the Likelihood of Falling in an Individual by the Belief That Falls Are an Important Concern for Elderly People
Falls Are an Falls Are
Important Not an
Concern Important
Concern
Interior environmental risk factors
Rugs, furniture, and stairs
(range: 0-10)(a) 4.1 1.1(b)
Grab bars (range: 0-10)(a) 3.1 1.1
Exterior environmental risk-factor
scale (range: 0-30)(a) 20.9 12.3(b)
Physical risk-factor scale
(range: 0-40)(a) 11.0 2.9(b)
Psychological risk-factor scale
(range: 0-30)(a) 6.0 1.4(b)
(a) High score indicates greater importance for increasing the likelihood of a fall by a respondent (0 = not at all likely, 10 = most likely). (b) p <. 05; Student t test. Table 6. Perceived importance of Physical Factors Associated With Increased Risk of Falling in an Individual by Health Status and Fear of Falling
Physical Factor Scale
Score(a) (Range: 0-40)
Health status
Poor-fair 15.0(b)
Good 6.8
Very good-excellent 4.3
Fear of falling limits activities
Yes 19.0(b)
No 6.8
(a) High score indicates greater importance for increasing the likelihood of a fall by a respondent (0 = not at all likely, 10 = most likely). (b) P <. 05; analysis of variance. Table 7. Perceived Importance of Physical Factors by Perception of Falling as a Health Concern and Perceived Effect of a Serious Fall
Regression
Perception Intercept Coefficient [Beta]
Importance of falling compared with 1.65 1.34
other health concerns
(range: 0-10)(a)
Probability of a serious injury as 2.68 1.27
a result of a fall
(range: 0-10)(a)
Probability of returning to your 20.0 -1.45
current living situation after a
fall (range: 0-10)(a)
Formula
Intercept +
Perception [([Beta])x
Score Perception
Example Score
Importance of falling compared with 3 1.65+3 (1.34)
other health concerns 8 1.65+8 (1.34)
(range: 0-10)(a)
Probability of a serious injury as 3 2.68+3 (1.27)
a result of a fall 8 2.68+8 (1.27)
(range: 0-10)(a)
Probability of returning to your 3 20.0+3 (-1.45)
current living situation after a 8 20.0+8 (-1.45)
fall (range: 0-10)(a)
Physical Factor
Scale Score(a)
(Range 0-40)
Importance of falling compared with 5.7
other health concerns 12.4
(range: 0-10)(a)
Probability of a serious injury as 6.5
a result of a fall 12.8
(range: 0-10)(a)
Probability of returning to your 15.7
current living situation after a 8.4
fall (range: 0-10)(a)
(a) High score indicates greater importance or higher probability for increasing the likelihood of a fall by a respondent (0 = not at all likely, 10 = most likely). The perceived importance of the listed risk factors in causing falls among the general elderly population was not strongly associated with participant characteristics such as health status, perception of falls as a health problem, or perception of fall consequences. Factors not associated with perceptions of fall-related risk factors included education, sex, history of falling, considering oneself more prone to falling, believing falls are preventable, and functional mobility. Discussion The results of my study suggest that community-dwelling elderly people consider falling to be an important, preventable health problem, although falling was only moderately important compared with other health concerns among the majority of the survey participants. Although many respondents considered themselves to be at risk of serious injury as a result of a hard fall, most respondents were confident that they would return to their current living situation after a serious fall. These data suggest an adequate understanding of the magnitude and importance of falls as a health problem, although the personal consequences of falling may be underestimated. Fall-related risk factors were considered important overall in increasing the likelihood of falling among elderly people. Exterior environmental factors and, secondarily, physical factors were perceived as most important. Psychological factors were perceived as least important. Neither an individual's health status nor a perception of falling as a serious health problem with important consequences was strongly and consistently associated with the perceived importance of risk factors in contributing to falls within the broad group of elderly people. These data indicate a reasonably high understanding of general fall-related risk factors, although psychological factors and interior environmental factors tended to be underestimated. With the exception of exterior environmental factors, the elderly participants in this study generally considered the documented risk factors to be unimportant un·im·por·tant adj. Not important; petty. un  im·por tance n. as contributors to the likelihood of their own
falls, suggesting less application of risk-factor knowledge to
themselves as individuals. Although individual characteristics and
circumstances CIRCUMSTANCES, evidence. The particulars which accompany a fact.2. The facts proved are either possible or impossible, ordinary and probable, or extraordinary and improbable, recent or ancient; they may have happened near us, or afar off; they are public or are likely to differ among elderly individuals, most of the risk factors listed are universally applicable to a majority of elderly people. The attributed importance for a fall by the respondent, therefore, was expected to be at least moderate across all fall-related risk factors. An increased perception of falling as a serious health problem with important consequences was associated with higher levels of importance assigned as·sign tr.v. as·signed, as·sign·ing, as·signs 1. To set apart for a particular purpose; designate: assigned a day for the inspection. 2. to most risk factors. This perception of falls as a health problem may promote increased awareness of the personal applicability of established fall-related risk factors. The results of this study should be interpreted with the following considerations. First, the participants were residents of subsidized apartment buildings for elderly people. These individuals represent a segment of the elderly population with unique socioeconomic so·ci·o·ec·o·nom·ic adj. Of or involving both social and economic factors. socioeconomic Adjective of or involving economic and social factors Adj. 1. characteristics, and they may not reflect the physical health, emotional health, knowledge level, and attitudes or perceptions of older people living in other housing environments such as private homes, assisted-living situations, or nursing homes. Generalization gen·er·al·i·za·tion n. 1. The act or an instance of generalizing. 2. A principle, a statement, or an idea having general application. of these study results to all elderly people may be misleading and inaccurate. Second, elderly individuals attending a resident council meeting may differ from nonattendees. There may be differences in physical health or in knowledge and perceptions of falls that affect the relationship among attitudes, perceptions, and fall-related risk-factor importance. The response rate of 44% suggests moderate representation of the residents of apartment buildings for elderly people, thus cautious generalizability of the study results beyond elderly people who are vigorous and interested enough to attend a meeting. Third, the elderly participants in this study were surveyed during winter in an area characterized char·ac·ter·ize tr.v. character·ized, character·iz·ing, character·iz·es 1. To describe the qualities or peculiarities of: characterized the warden as ruthless. 2. by severe winter weather conditions, including subzero temperatures and extensive snowfall. Results may differ if elderly individuals are surveyed in geographical areas with milder climates or during other times of the year. Finally, the sample was insufficient for multivariate analysis multivariate analysis, n a statistical approach used to evaluate multiple variables. multivariate analysis, n a set of techniques used when variation in several variables has to be studied simultaneously. and potentially insufficient to detect some important relationships. Relationships identified in these analyses are not likely to be spurious spu·ri·ous adj. Similar in appearance or symptoms but unrelated in morphology or pathology; false. spurious simulated; not genuine; false. due the small sample size. They should, however, be viewed as a first attempt at identifying relevant predictors. Conclusion The results of this preliminary study suggest that community-dwelling elderly people consider falls to be an important, preventable health problem and understand the importance of fall-related risk factors as applied to the general elderly population, but that they minimize personal susceptibility susceptibility the state of being susceptible. Refers usually to infectious disease but may be to physical factors such as wetting or to psychological factors such as harassment. to established risk factors. The participants who considered falls to be an important health concern, however, recognized the importance of exterior environmental factors--and, to a lesser extent, physical factors--leading to falls. Physical therapists who treat elderly people could easily promote improved understanding of the full scope of fall-related risk factors by incorporating a brief educational intervention A procedure used in a lawsuit by which the court allows a third person who was not originally a party to the suit to become a party, by joining with either the plaintiff or the defendant. into a treatment visit. Existing fall prevention programs may benefit from inclusion of methods to enhance understanding of personal susceptibility to fall-related risk factors. Further studies are needed to assess the interrelationship in·ter·re·late tr. & intr.v. in·ter·re·lat·ed, in·ter·re·lat·ing, in·ter·re·lates To place in or come into mutual relationship. in among perceptions and attitudes toward falls as a health problem, the presence of fall-related risk factors, and the risk of falling. The effect of changing knowledge, perceptions, and attitudes on the presence of modifiable fall-related risk factors merits consideration. Furthermore, expanding this study to include other segments of the elderly population such as older individuals living in rural areas, assisted-living environments, and private homes may indicate other educational needs regarding falls among elderly people. Acknowledgments I gratefully acknowledge Patricia Jensen, RN, for assistance in data collection and Jean F Wyman, PhD, RN, CS, FAAN FAAN abbr. Fellow of the American Academy of Nursing , for her comments on the manuscript manuscript, a handwritten work as distinguished from printing. The oldest manuscripts, those found in Egyptian tombs, were written on papyrus; the earliest dates from c.3500 B.C. . References [1] Cummings SR, Nevitt MC. Falls. N Engl J Med. 1994;331:872-873. [2] Sattin RW. Falls among older persons: a public health perspective. Annu Rev Public Health. 1992; 13:489-508. [3] Tinetti ME. Prevention of falls and fall injuries in elderly persons: a research agenda. Prev Med. 1994;23:756-762. [4] Tinetti ME, Doucette J, Claus E, Marottoli R. Risk factors for serious injury during falls by older persons in the community. J Am Geriatr Soc. 1995;43:1214-1221. [5] Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med. 1988;319: 1701-1707. [6] Nevitt MC, Cummings SR, Hudes ES. Risk factors for injurious falls: a prospective study. J Gerontol. 1991;46:M164-M170. [7] Bernstein AB. Expenditures for unintentional injuries unintentional injury Accidental injury Public health Any injury caused by an accident. See Injury. among the elderly. Journal of Aging and Health. May 1990:157-178. [8] Sattin RW, Lambert Lambert may refer to
[9] Kiel DP, O'Sullivan P, Teno JM, Mor V. Health care utilization and functional status in the aged following a fall. Med Care. 1991;29: 221-228. [10] Wolinsky FD, Johnson RJ, Fitzgerald JF. Falling, health status, and the use of health services health services Managed care The benefits covered under a health contract by older adults: a prospective study. Med Care. 1992;30:587-597. [11] Tinetti ME, Speechley M. Prevention of falls among the elderly. N Engl J Med. 1989;320:1055-1059. [12] Urton MM. A community home inspection approach to preventing falls among the elderly. Public Health Rep (programming) REP - A directive used in IBM object code card decks (and later PTF Tapes) to REPlace fragments of already assembled or compiled object code prior to link edit. . 1991;106:192-195. [13] Wickham C, Cooper C, Margetts BM, Barker barker a term for an animal that does not usually bark which makes a violent respiratory effort, often during a convulsion, accompanied by a sound which roughly resembles a dog's bark. DJP DJP DJ Premier DJP Department of Justice and Police DJP D'Jungle People Sdn Bhd DJP Doctor of Jurisprudence DJP Desk Jet Printer DJP Digital Jet Printer . Muscle strength, activity, housing, and the risk of falls in elderly people. Age Ageing. 1989; 18:47-51. [14] Riggs JE. Mortality from accidental accidental /ac·ci·den·tal/ (ak?si-den´t'l) 1. occurring by chance, unexpectedly, or unintentionally. 2. nonessential; not innate or intrinsic. falls among the elderly in the United States United States, officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area. , 1962-1988: demonstrating the impact of improved trauma management. J Trauma. 1993;35:212-219. [15] Wolfson LI, Whipple R, Amerman P, et al. Gait gait (gat) the manner or style of walking. antalgic gait a limp adopted so as to avoid pain on weight-bearing structures, characterized by a very short stance phase. and balance in the elderly: two functional capacities that link sensory sensory /sen·so·ry/ (sen´sor-e) pertaining to sensation. sen·so·ry adj. 1. Of or relating to the senses or sensation. 2. and motor ability to falls. Clin Geriatr Med. 1985;1:649-659. [16] Graafmans WC, Ooms ME, Hofstee HMA (High Memory Area) In PCs, the first 64K of extended memory from 1024K to 1088K, which can be accessed by DOS. It is managed by the HIMEM.SYS driver. It was discovered by accident that this area could be used by DOS, even though it was beyond the traditional , et al. Falls in the elderly: a prospective study of risk factors and risk profiles. Am J Epidemiol. 1996; 143:1129-1136. [17] Lord SR, Ward JA, Williams P, Anstey KJ. Physiological physiological /phys·i·o·log·i·cal/ (-loj´i-kal) pertaining to physiology; normal; not pathologic. phys·i·o·log·i·cal or phys·i·o·log·ic adj. Abbr. phys. 1. factors associated with falls in older community-dwelling women. J Am Geriatr Soc. 1994;42:1110-1117. [18] O'Loughlin JL, Robitaille Y, Boivin J-F, Suissa S. Incidence of and risk factors for falls and injurious falls among the community-dwelling elderly. Am J Epidemiol. 1993;137:342-354. [19] Clark RD, Lord SR, Webster Webster, town (1990 pop. 16,196), Worcester co., S Mass., near the Conn. line; settled c.1713, set off from Dudley and Oxford and inc. 1832. The chief manufactures are footwear, fabrics, and textiles. IW. Clinical parameters associated with falls in an elderly population. Gerontology gerontology: see geriatrics. . 1993;39:117-123. [20] Cumming RG, Miller JP, Kelsey JL, et al. Medications and multiple falls in elderly people: the St Louis OASIS Study. Age Ageing. 1991;20: 455-461. [21] Campbell AJ, Spears GF, Borrie MJ. Examination by logistic regression In statistics, logistic regression is a regression model for binomially distributed response/dependent variables. It is useful for modeling the probability of an event occurring as a function of other factors. modeling of the variables which increase the relative risk of elderly women falling compared to elderly men. J Clin Epidemiol. 1990;43: 1415-1420. [22] Campbell AJ, Borrie MJ, Spears GF. Risk factors for falls in a community-based prospective study of people 70 years and older. J Gerontol. 1989;44:M112-M117. [23] Vetter NJ, Lewis PA, Ford D. Can health visitors prevent fractures Fractures Definition A fracture is a complete or incomplete break in a bone resulting from the application of excessive force. Description in elderly people? BMJ BMJ n abbr (= British Medical Journal) → vom BMA herausgegebene Zeitschrift . 1992;304:888-890. [24] Reinsch S, MacRae P, Lachenbruch PA, Tobis JS. Attempts to prevent falls and injury: a prospective community study. Gerontologist ger·on·tol·o·gy n. The scientific study of the biological, psychological, and sociological phenomena associated with old age and aging. ge·ron . 1992;32:450-456. [25] Hornbrook MC, Stevens VJ, Wingfield DJ, et al. Preventing falls among community-dwelling older persons: results from a randomized ran·dom·ize tr.v. ran·dom·ized, ran·dom·iz·ing, ran·dom·iz·es To make random in arrangement, especially in order to control the variables in an experiment. trial. Gerontologist. 1994;34:16-23. [26] Lord SR, Ward JA, Williams P, Strudwick M. The effect of a 12-month exercise trial on balance, strength, and falls in older women: a randomized controlled trial A randomized controlled trial (RCT) is a scientific procedure most commonly used in testing medicines or medical procedures. RCTs are considered the most reliable form of scientific evidence because it eliminates all forms of spurious causality. . JAm Geriatr Soc. 1995;43:1198-1206. [27] Province MA, Hadley EC, Hornbrook MC, et al. The effects of exercise on falls in elderly patients. JAMA JAMA abbr. Journal of the American Medical Association . 1995;273:1341-1347. [28] Wolfson L, Whipple R, Derby C, et al. Balance and strength training in older adults: intervention gains and Tai Chi Tai Chi Definition T'ai chi is a Chinese exercise system that uses slow, smooth body movements to achieve a state of relaxation of both body and mind. maintenance. J Am Geriatr Soc. 1996;44:498-506. [29] Wolf SL, Barnhart HX, Kutner NG, et al. Reducing frailty and falls in older persons: an investigation of Tai Chi and computerized computerized adapted for analysis, storage and retrieval on a computer. computerized axial tomography see computed tomography. balance training. J Am Geriatr Soc. 1996;44:489-497. [30] 1990 Census Population: Social and Environmental Characteristics of Minnesota. US Department of Commerce, Environment and Statistical Administration, Bureau of the Census Noun 1. Bureau of the Census - the bureau of the Commerce Department responsible for taking the census; provides demographic information and analyses about the population of the United States Census Bureau . CP-2-25, September 1993. [31] Senior Housing in the Arrowhead arrowhead, any plant of the genus Sagittaria, widely distributed marsh or aquatic herbs of the primitive family Alismataceae (water-plantain family). The name derives from the arrowhead-shaped leaves of many species. : The Choice Is Yours. 2nd ed. Duluth, Minn: Arrowhead Area Agency on Aging; 1996. [32] Berry Berry, former province, France Berry (bĕrē`), former province, central France. Bourges, the capital, and Châteauroux are the chief towns. SH, Cleary PD, Kerr EA. Focus group methods and applications. Paper presented at: Annual Meeting of the Association for Health Services Research Health services research is the multidisciplinary field of scientific investigation that studies how social factors, financing systems, organizational structures and processes, health technologies, and personal behaviors affect access to health care, the quality and cost of health care, ; June 1996; Atlanta, Ga. BL Braun, PhD, PT, is Health Services Researcher, Health Research (;enter, Institute for Research and Education, HealthSystem Minnesota, 3800 Park Nicollet Blvd, Minneapolis, MN 55805 (USA) (braun.b@hsmnet.com). She was Clinical Epidemiologist epidemiologist an expert in epidemiology. , St Mary's/Duluth Clinic Health System, Division of Education and Research, Duluth, Minn, and Clinical Lecturer lecturer A person who is primarily–if not entirely—involved in the teaching activities of an academic center, who is not expected to perform research or Pt management; in general, lectureships are non-tenured positions , Department of Family Medicine, School of Medicine, University of Minnesota (body, education) University of Minnesota - The home of Gopher. http://umn.edu/. Address: Minneapolis, Minnesota, USA. , Duluth, Minn, at the time this research was conducted. Support for this project was provided by St Mary's/Duluth Clinic Health System. This research, in part, was presented at the annual meeting of the American Public Health Association The American Public Health Association (APHA) is Washington, D.C.-based professional organization for public health professionals in the United States. Founded in 1872 by Dr. Stephen Smith, APHA has more than 30,000 members worldwide. , November 11, 1997, Indianapolis. Ind. This study was approved by the Institutional Review Board of St Mary's/Duluth Clinic Health System. This article was submitted September 4, 1997, and was accepted May 22, 1998. |
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