Original Article

Fatal Falls in an Ethnically Diverse Urban Community: The Link between Demographic Factors and the Circumstances Surrounding Fatal Falls

Authors: David C. Landy, PhD, MPH, Michael J. Mintzer, MD, Stephen R. Dearwater, MS, Jill A. Graygo, MA, MPH, Carl I. Schulman, MD, PhD

Abstract

Objectives: Fatal falls cause more than 15,000 deaths per year in the United States. Despite this, the circumstances surrounding fatal falls in elderly adults are poorly understood. It is unknown whether these circumstances differ across ethnicities, although Hispanic American individuals are at reduced risk for fatal falls. This study sought to describe fatal falls in an urban, predominantly Hispanic, and white non-Hispanic community and to determine the association of demographics with the circumstances surrounding these falls (proximate factors).


Methods: The death certificates and medical examiners’ reports for all 328 elderly individuals experiencing a fatal fall in Miami-Dade County, FL, from 2005 to 2007 were reviewed for demographic and proximate factors such as the preceding activity and fall location.


Results: Fatal falls in elderly adults were experienced mostly by individuals living in the community (80%) and affected all demographic subgroups, although 80% occurred in individuals older than 74 years. Most fatal falls occurred at home (74%), indoors (75%), and during nonvigorous activities such as walking (58%) and these tended to affect the oldest elderly. In addition, a significant number of fatal falls occurred in public locations, outdoors, and during vigorous activity, with these falls tending to affect younger individuals living without family. Hispanic ethnicity was not associated with proximate factors.


Conclusions: Fatal fall prevention is needed for elderly individuals living in the community and should target the oldest elderly adults living at home while helping to ensure that individuals who are living without family have the appropriate support. These data suggest that Hispanic individuals may benefit from prevention strategies developed in other populations.

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References

1. 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.
 
2. Rubenstein LZ, Josephson KR. The epidemiology of falls and syncope. Clin Geriatr Med 2002; 18: 141–158.
 
3. Tinetti ME, Kumar C. The patient who falls: “it’s always a trade-off.” JAMA 2010; 303: 258–266.
 
4. Chang JT, Morton SC, Rubenstein LZ, et al. Interventions for the prevention of falls in older adults: systematic review and meta-analysis of randomised clinical trials. Br Med J 2004; 328: 680–686.
 
5. Milisen K, Geeraerts A, Dejaeger E. Use of a fall prevention practice guideline for community-dwelling older persons at risk for falling: a feasibility study. Gerontology 2009; 55: 169–178.
 
6. Carpenter CR. Evidence-based emergency medicine/systematic review abstract. Preventing falls in community-dwelling older adults. Ann Emerg Med 2010; 55: 296–298.
 
7. Hendriks MR, Bleijlevens MH, van Haastregt JC, et al. Lack of effectiveness of a multidisciplinary fall-prevention program in elderly people at risk: a randomized, controlled trial. J Am Geriatr Soc 2008; 56: 1390–1397.
 
8. Tinetti ME, Baker DI, King M, et al. Effect of dissemination of evidence in reducing injuries from falls. N Engl J Med 2008; 359: 252–261.
 
9. Deprey SM. Descriptive analysis of fatal falls of older adults in a Midwestern county in the year 2005. J Geriatr Phys Ther 2009; 32: 23–28.
 
10. Thierauf A, Preuss J, Lignitz E, et al. Retrospective analysis of fatal falls. Forensic Sci Int 2010; 198: 92–96.
 
11. Stevens JA, Dellinger AM. Motor vehicle and fall related deaths among older Americans 1990–98: sex, race, and ethnic disparities. Inj Prev 2002; 8: 272–275.
 
12. Landy DC, Mintzer MJ, Silva AK, et al. Hispanic ethnicity and unintentional injury mortality in the elderly. J Surg Res 2011; 166: 28–31.
 
13. Landy DC, Mintzer MJ, Silva AK, et al. Hispanic ethnicity and fatal fall risk: do age, gender, and community modify the relationship? J Surg Res 2012; 175: 113–117.
 
14. Kannus P, Parkkari J, Niemi S, et al. Fall-induced deaths among elderly people. Am J Public Health 2005; 95: 422–424.
 
15. Faulkner KA, Cauley JA, Zmuda JM, et al. Ethnic differences in the frequency and circumstances of falling in older community-dwelling women. J Am Geriatr Soc 2005; 53: 1774–1779.
 
16. Reyes-Ortiz CA, Snih SA, Markides KS. Falls among elderly persons in Latin America and the Caribbean and among elderly Mexican-Americans. Rev Panam Salud Publica 2005; 17: 362–369.
 
17. Warriner AH, Outman RC, Saag KG, et al. Management of osteoporosis among home health and long-term care patients with a prior fracture. South Med J 2009; 102: 397–404.
 
18. Li W, Keegan THM, Sternfeld B, et al. Outdoor falls among middle-aged and older adults: a neglected public health problem. Am J Public Health 2006; 96: 1192–1200.
 
19. Bux R, Parzeller M, Bratzke H. Causes and circumstances of fatal falls downstairs. Forensic Sci Int 2007; 171: 122–126.
 
20. Schwartz AV, Villa ML, Prill M, et al. Falls in older Mexican-American women. J Am Geriatr Soc 1999; 47: 1371–1378.
 
21. Ellis AA, Trent RB. Hospitalized fall injuries and race in California. Inj Prev 2001; 7: 316–320.
 
22. Reyes-Ortiz CA, Al Snih S, Loera J, et al. Risk factors for falling in older Mexican Americans. Ethn Dis 2004; 14: 417–422.
 
23. Orces CH, Alamgir AH. Trends in hip fracture-related mortality in Texas, 1990–2007. South Med J 2011; 104: 482–487.
 
24. Hill KD, LoGiudice D, Lautenschlager NT, et al. Effectiveness of balance training exercise in people with mild to moderate severity Alzheimer’s disease: protocol for a randomised trial. BMC Geriatr 2009; 9: 29.
 
25. Flores EK, Henry R, Stewart DW. Pharmacist’s role in an interdisciplinary falls clinic. South Med J 2011; 104: 143–146.
 
26. Tinetti ME, McAvay GJ, Fried TR, et al. Health outcome priorities among competing cardiovascular, fall injury, and medication-related symptom outcomes. J Am Geriatr Soc 2008; 56: 1409–1416.
 
27. Sherrington C, Whitney JC, Lord SR, et al. Effective exercise for the prevention of falls: a systematic review and meta-analysis. J Am Geriatr Soc 2008; 56: 2234–2243.
 
28. Martin-Matthews A, Sims-Gould J. Employers, home support workers and elderly clients: identifying key issues in delivery and receipt of home support. Healthc Q 2008; 11: 69–75.
 
29. Kirby JB, Lau DT. Community and individual race/ethnicity and home health care use among elderly persons in the United States. Health Serv Res 2010; 45: 1251–1267.
 
30. Ashley A, Butler SS, Fishwick N. Home care aides’ voices from the field: job experiences of personal support specialists. Home Healthc Nurse 2010; 28: 399–405.
 
31. Alisky JM. Do not overlook polymyalgia rheumatica as a cause for immobility in poorly communicating dementia patients. South Med J 2008; 101: 1277–1278.
 
32. van Zuilen MH, Rodriguez OL, Mintzer MJ. Eliminate hazards in your home: a safety checklist with recommendations. https://www.mededportal.org/publication/1063. Accessed September 8, 2011.
 
33. Koepsell T, McCloskey L, Wolf M, et al. Crosswalk markings and the risk of pedestrian-motor vehicle collisions in older pedestrians. JAMA 2002; 288: 2136–2143.
 
34. Cayless SM. Slip, trip and fall accidents: relationship to building features and use of coroners’ reports in ascribing cause. Appl Ergon 2001; 32: 155–162.
 
35. Buki LP, Salazar SI, Pitton VO. Design elements for the development of cancer education print materials for a Latina/o audience. Health Promot Pract 2009; 10: 564–572.
 
36. Tu SP, Jackson JC, Teh C, et al. Translation challenges of cross-cultural research and program development. Asian Am Pac Isl J Health 2003; 10: 58–66.
 
37. Keyes KM, Liu XC, Cerda M. The role of race/ethnicity in alcohol-attributable injury in the United States. Epidemiol Rev 2012; 34: 89–102.
 
38. Sorock GS, Chen L, Gonzalgo SR, et al. Alcohol-drinking history and fatal injury in older adults. Alcohol 2006; 40: 193–199.
 
39. Jansson B. Coding errors and underestimation of fall injury mortality. Am J Public Health 2005; 95: 1305.
 
40. Koehler SA, Weiss HB, Shakir A, et al. Accurately assessing elderly fall deaths using hospital discharge and vital statistics data. Am J Forensic Med Pathol 2006; 27: 30–35.