Epidemiology of falls in elderly semi-independent residents in residential care

Objectives: To determine the incidence and consequences of falls in elderly people living in hostels, and the role of comorbidity, orthostatic hypotension and medications as risk factors for falls. Methods: Cross-sectional prevalence and event association was studied in eight aged-care hostels (Canberra, ACT, 1999) of 179 residents aged 65 years and older (83 +/- 7 years (mean +/- standard deviation), 80% women) independent in activities of daily living. History of falls and injuries on falling, comorbidity, medications and mobility data were obtained. Measurements of blood pressure and heart rate were made supine after waking from overnight sleep and after standing for 1 and 3 min. Results: Forty-three per cent of subjects had fallen in the last year (1.3 +/- 2.6 falls per person per year) and 29% of these had sustained a fracture, 53% of fallers had recurrent falls. In multivariate analysis, four factors were associated independently with falling within a year: using a walking device, history of cancer, taking selective serotonin reuptake inhibitors (SSRI) and cigarette smoking. For recurrent falls, cerebrovascular disease and using nitrates were also independent risk factors. In univariate analysis, reversible inhibitors of monoamine oxidase and potassium-sparing diuretics were negatively associated with falls. There were no differences between fallers and non-fallers in blood pressure in supine and standing positions, although one-third of residents had orthostatic hypotension. Conclusions: Falls in elderly hostel residents are common and often have serious consequences. Living in an institution is associated with an increased risk of fractures. The study identified several novel potential risk factors for falls in this population: using a walking device, history of falls, presence of cancer, presence of cerebrovascular disease, taking SSRIs, taking nitrates and cigarette smoking. These can be used to identify hostel residents at high risk of falling who can then be targeted for monitoring, specific treatment and prevention strategies.