Falls

• Deaths and hospitalisations
• Emergency department attendances

Deaths and hospitalisations

Table 1 shows similar overall female and male rates of fall related death. This contrasts with the usual pattern of higher male rates for most causes of injury. When age specific data are considered, it can be seen that highest rates of fall-related deaths occur in the older age groups (Figure 3). Females have lower fall-related death rates than males until the older age groups. Male and female rates tend to converge from middle age, driven by an increasing rate of fall-related deaths among older women. Falls are the leading cause of injury related death for females aged 65 years and over, accounting for 52% of all female injury related deaths.

Further evidence for the importance of falls is shown by the overall rate of female hospitalisation due to fall-related injuries which is the highest of any specific cause group and exceeds that for males (Table 1). Victorian figures also suggest that falls are the leading cause of injury related hospitalisation for females aged 65 years and over. In that State, the annual average fall-related hospital admission for that group was 52% in the period July 1987 to July 1993 [14].

For hospitalisation, the upward trend in the rate ratio commences at an earlier age than for deaths, and by around 55 years of age, the female rate exceeds the male rate (Figure 4). The reason why older women have a higher rate of fall-related hospital admission than older men is not known. One possible explanation is that, as women grow older, they are more likely than men to sustain a serious injury when they do fall. More research is needed to understand if these women have a greater risk of falling than men, and to determine if the risk of injury or death following a fall is different for women. Emergency department attendance data allow us to begin examining the nature of the falls experience of older women.

Emergency department attendances

An examination of the fall locations recorded in the ISIS data shows that as women get older, there is a decline in falling on a road or footpath and an increase in falling in residential indoor settings (Table 3). This probably reflects a change in exposure patterns as the more frail, higher risk women spend more time indoors. Knowledge of such changes in women's exposure patterns can assist in better targeting of falls prevention activities.

Table 3: Location of falls leading to injuries in females seen at ISIS hospital emergency departments

Location of fall	Age 45-59	Age 60-74	Age 75+
	%	%	%
Road or footpath	15.0	16.7	9.3
Home-indoor	25.0	31.5	39.2
Home-outdoor	24.0	24.8	16.5
Other	36.1	27.0	34.9
Total	100.0	100.0	100.0

Prevention strategies suggested in the literature [15] include:

• improving the management of medication for older people to reduce their risk of falling;
• encouraging participation in exercise programs that incorporate facets such as balance and gait assessment, and physiotherapy, to increase muscle strength and improve fitness and mobility;
• modifying the environments of older people through measures such as improving indoor lighting and installing grab rails in private houses and nursing homes;
• further developing the utility and effectiveness of devices such as protective hip pads designed to be added to clothing to reduce the impact of falls;
• treatment and prevention of osteoporosis to minimise the risk of fractures resulting from falls.

15. Fildes B (ed). Injuries among older people: falls at home and pedestrian accidents. Melbourne: Collins Dove, 1994; Vic Health Foundation Monograph Series, pp. 219-222.

16. Tinetti ME, Baker DI, McAvay G, Claus EB, Garrett P, Gottschalk M, Koch ML, Trainor MS, Horwitz RI. A multifactorial intervention to reduce the risk of falling among elderly people living in the community. New England J Medicine 1994; 331: 821-827.