Inability to get up after falling, subsequent time on floor, and summoning help: prospective cohort study in people over 90

Jane Fleming, Carol Brayne, Cambridge City over-75s Cohort (CC75C) study collaboration, Rosemary Abbott, Stephen Barclay, Tom Dening, Morag Farquhar, Felicia Huppert, Ann-Louise Kinmonth, Fiona Matthews, Elizabeta Mukaetova-Ladinska, Graciela Muniz, Angela O'Sullivan, Eugene Paykel, Kathryn Richardson, Emily Zhao, Jane Fleming, Carol Brayne, Cambridge City over-75s Cohort (CC75C) study collaboration, Rosemary Abbott, Stephen Barclay, Tom Dening, Morag Farquhar, Felicia Huppert, Ann-Louise Kinmonth, Fiona Matthews, Elizabeta Mukaetova-Ladinska, Graciela Muniz, Angela O'Sullivan, Eugene Paykel, Kathryn Richardson, Emily Zhao

Abstract

Objectives: To describe the incidence and extent of lying on the floor for a long time after being unable to get up from a fall among people aged over 90; to explore their use of call alarm systems in these circumstances.

Design: 1 year follow-up of participants in a prospective cohort study of ageing, using fall calendars, phone calls, and visits.

Setting: Participants' usual place of residence (own homes or care homes), mostly in Cambridge.

Participants: 90 women and 20 men aged over 90 (n=110), surviving participants of the Cambridge City over-75s Cohort, a population based sample.

Main outcome measures: Inability to get up without help, lying on floor for a long time after falling, associated factors; availability and use of call alarm systems; participants' views on using call alarms to summon help if needed after falling.

Results: In one year's intensive follow-up, 54% (144/265) of fall reports described the participant as being found on the floor and 82% (217/265) of falls occurred when the person was alone. Of the 60% who fell, 80% (53/66) were unable to get up after at least one fall and 30% (20/66) had lain on the floor for an hour or more. Difficulty in getting up was consistently associated with age, reported mobility, and severe cognitive impairment. Cognition was the only characteristic that predicted lying on the floor for a long time. Lying on the floor for a long time was strongly associated with serious injuries, admission to hospital, and subsequent moves into long term care. Call alarms were widely available but were not used in most cases of falls that led to lying on the floor for a long time. Comments from older people and carers showed the complexity of issues around the use of call alarms, including perceptions of irrelevance, concerns about independence, and practical difficulties.

Conclusions: Lying on the floor for a long time after falling is more common among the "oldest old" than previously thought and is associated with serious consequences. Factors indicating higher risk and comments from participants suggest practical implications. People need training in strategies to get up from the floor. Work is needed on access and activation issues for design of call alarms and information for their effective use. Care providers need better understanding of the perceptions of older people to provide acceptable support services.

Conflict of interest statement

Competing interests: None declared.

Figures

https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4787195/bin/flej568329.f1.jpg
Fig 1 Lying on the floor for over an hour after falling (143 falls in people aged >90 who were alone and unable to get up). Proportions with 95% confidence intervals
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4787195/bin/flej568329.f2.jpg
Fig 2 Time on floor according to use of call alarm (143 falls in people aged >90 who were alone and unable to get up). Proportions with 95% confidence intervals

References

    1. Tinetti ME, Liu WL, Claus EB. Predictors and prognosis of inability to get up after falls among elderly persons. JAMA 1993;269:65-70.
    1. Halter M, Close J, Elrick A, Brain G, Swift C. Falls in the older population: a pilot study to assess those individuals who are attended to by the London ambulance service as a result of a fall but are not conveyed to hospital. London: London Ambulance Service NHS Trust Report, 2000.
    1. Bergland A, Laake K. Concurrent and predictive validity of “getting up from lying on the floor”. Aging Clin Exp Res 2005;17:181-5.
    1. Wild D, Nayak US, Isaacs B. How dangerous are falls in old people at home? BMJ 1981;282:266-8.
    1. Miskelly FG. Assistive technology in elderly care. Age Ageing 2001;30:455-8.
    1. Demiris G, Rantz M, Aud M, Marek K, Tyrer H, Skubic M, et al. Older adults’ attitudes towards and perceptions of “smart home” technologies: a pilot study. Med Inform Internet Med 2004;29:87-94.
    1. Brownsell S, Hawley MS. Automatic fall detectors and the fear of falling. J Telemed Telecare 2004;10:262-6.
    1. Lindemann U, Hock A, Stuber M, Keck W, Becker C. Evaluation of a fall detector based on accelerometers: a pilot study. Med Biol Eng Comput 2005;43:548-51.
    1. Roush RE, Teasdale TA, Murphy JN, Kirk MS. Impact of a personal emergency response system on hospital utilization by community-residing elders. South Med J 1995;88:917-22.
    1. Bernstein M. “Low-tech” personal emergency response systems reduce costs and improve outcomes. Manag Care Q 2000;8:38-43.
    1. Levine DA, Tideiksaar R. Personal emergency response systems: factors associated with use among older persons. Mt Sinai J Med 1995;62:293-7.
    1. Mann WC, Belchior P, Tomita MR, Kemp BJ. Use of personal emergency response systems by older individuals with disabilities. Assist Technol 2005;17:82-8.
    1. Fleming J, Zhao E, O’Connor DW, Pollitt PA, Brayne C, CC75C study collaboration. Cohort profile: the Cambridge city over-75s cohort (CC75C). Int J Epidemiol 2007;36:40-6.
    1. Fleming J. Patterns and predictors of falls and their consequences in extreme old age. [PhD thesis.] Cambridge: University of Cambridge, 2006.
    1. Fleming J, Brayne C, CC75C collaborative. Falls in advanced old age: recalled falls and prospective follow-up of over-90-year-olds in the CC75C study. BMC Geriatrics 2008;8:6.
    1. Huppert FA, Brayne C, Gill C, Paykel ES, Beardsall L. CAMCOG—a concise neuropsychological test to assist dementia diagnosis: socio-demographic determinants in an elderly population sample. Br J Clin Psychol 1995;34:529-41.
    1. Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-98.
    1. Nevitt MC, Cummings SR, Kidd S, Black D. Risk factors for recurrent nonsyncopal falls. A prospective study. JAMA 1989;261:2663-8.
    1. Luukinen H, Koski K, Honkanen R, Kivela SL. Incidence of injury-causing falls among older adults by place of residence: a population-based study. J Am Geriatr Soc 1995;43:871-6.
    1. Koski K, Luukinen H, Laippala P, Kivela SL. Risk factors for major injurious falls among the home-dwelling elderly by functional abilities. A prospective population-based study. Gerontology 1998;44:232-8.
    1. Lord SR, Ward JA, Williams P, Anstey KJ. An epidemiological study of falls in older community-dwelling women: the Randwick falls and fractures study. Aust J Public Health 1993;17:240-5.
    1. Alexander NB, Ulbrich J, Raheja A, Channer D. Rising from the floor in older adults. J Am Geriatr Soc 1997;45:564-9.
    1. Asbjornsen G, Braathen L, Mellemstuen H. [Are old patients able to get up from the floor?]. Tidsskr Nor Laegeforen 2000;120:3119-20.
    1. Nevitt MC, Cummings SR, Hudes ES. Risk factors for injurious falls: a prospective study. J Gerontol 1991;46:M164-70.
    1. King MB, Tinetti ME. Falls in community-dwelling older persons. J Am Geriatr Soc 1995;43:1146-54.
    1. Reece A, Simpson JM. Teaching elderly people how to cope after a fall. Physiotherapy 1996;82:27-35.
    1. Simpson JM, Salkin S. Are elderly people at risk of falling taught how to get up again? Age Ageing 1993;22:294-6.
    1. Hofmeyer MR, Alexander NB, Nyquist LV, Medell JL, Koreishi A. Floor-rise strategy training in older adults. J Am Geriatr Soc 2002;50:1702-6.
    1. Skelton D, Dinan S, Campbell M, Rutherford O. Tailored group exercise (falls management exercise—FaME) reduces falls in community-dwelling older frequent fallers (an RCT). Age Ageing 2005;34:636-9.
    1. Shaw FE, Kenny RA. Can falls in patients with dementia be prevented? Age Ageing 1998;27:7-9.
    1. Howse K, Ebrahim S, Goober-man Hill R. Help-avoidance: why older people do not always seek help. Rev Clin Gerontol 2004;14:63-70.
    1. Yardley L, Donovan-Hall M, Francis K, Todd C. Older people’s views of advice about falls prevention: a qualitative study. Health Educ Res 2006;21:508-17.
    1. Yardley L, Bishop FL, Beyer N, Hauer K, Kempen GI, Piot-Ziegler C, et al. Older people’s views of falls-prevention interventions in six European countries. Gerontologist 2006;46:650-60.
    1. Gill T, Taylor AW, Pengelly A. A population-based survey of factors relating to the prevalence of falls in older people. Gerontology 2005;51:340-5.
    1. Berg WP, Alessio HM, Mills EM, Tong C. Circumstances and consequences of falls in independent community-dwelling older adults. Age Ageing 1997;26:261-8.
    1. Cameron ID, Quine S. External hip protectors: likely non-compliance among high risk elderly people living in the community. Arch Gerontol Geriatr 1994;19:273-81.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel