Circumstances of fall-related injuries by age and gender among community-dwelling adults in the United States

Lava R Timsina, Joanna L Willetts, Melanye J Brennan, Helen Marucci-Wellman, David A Lombardi, Theodore K Courtney, Santosh K Verma, Lava R Timsina, Joanna L Willetts, Melanye J Brennan, Helen Marucci-Wellman, David A Lombardi, Theodore K Courtney, Santosh K Verma

Abstract

Introduction: Falls are the leading cause of injury in almost all age-strata in the U.S. However, fall-related injuries (FI) and their circumstances are under-studied at the population level, particularly among young and middle-aged adults. This study examined the circumstances of FI among community-dwelling U.S. adults, by age and gender.

Methods: Narrative texts of FI from the National Health Interview Survey (1997-2010) were coded using a customized taxonomy to assess place, activity, initiating event, hazards, contributing factors, fall height, and work-relatedness of FI. Weighted proportions and incidence rates of FI were calculated across six age-gender groups (18-44, 45-64, 65+ years; women, men).

Results: The proportion of FI occurring indoors increased with age in both genders (22%, 30%, and 48% among men, and 40%, 49% and 62% among women for 18-44, 45-64, 65+ age-groups, respectively). In each age group the proportion of indoor FI was higher among women as compared to men. Among women, using the stairs was the second leading activity (after walking) at the time of FI (19%, 14% and 10% for women in 18-44, 45-64, 65+ age groups, respectively). FI associated with tripping increased with age among both genders, and women were more likely to trip than men in every age group. Of all age-gender groups, the rate of FI while using ladders was the highest among middle-aged men (3.3 per 1000 person-year, 95% CI 2.0, 4.5). Large objects, stairs and steps, and surface contamination were the three most common hazards noted for 15%, 14% and 13% of fall-related injuries, respectively.

Conclusions: The rate and the circumstances of FI differ by age and gender. Understanding these differences and obtaining information about circumstances could be vital for developing effective interventions to prevent falls and FI.

Conflict of interest statement

Competing Interests: This research study was funded by the Liberty Mutual Research Institute for Safety which is a wholly owned subsidiary of the Liberty Mutual Insurance Company. However, this does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1. Place of fall injuries (%).
Fig 1. Place of fall injuries (%).
Outdoor pavement included parking lots, sidewalks, curbs and streets.
Fig 2. Activity preceding fall injuries (%).
Fig 2. Activity preceding fall injuries (%).
The proportion of FI while using stairs was the highest among young women (18.9%, 95% CI 15.1, 22.6), followed by middle-aged women (13.8%, 95% CI 11.2, 16.4) and older women (10.2%, 95% CI 8.1, 12.4). The proportion was less than 10% for men in all three age groups. The rate of FI while working on ladders was higher among young and middle-aged men as compared to women of the same age groups. An estimated 258 thousand FI occurred annually while on ladders among community-dwelling adults in the U.S.
Fig 3. Initiating events leading to fall…
Fig 3. Initiating events leading to fall injuries (%).

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