Presenting to health services after falls and fall injuries in very old age: a population-based study of over-90-year-olds

Introduction

Older people who fall often do not present to health services, even if injured, but this is difficult to quantify.

Methods

When all participants in the Cambridge City over-75s Cohort, a representative population-based study of ageing, were aged over 90 prospective falls data collection successfully followed-up 96% of survivors for one year (20 men and 90 women aged 91-105, 18% in care). Participants or proxy informants returned weekly falls calendars and were re-interviewed after all reported falls regarding circumstances, consequences and whether they told anyone about that fall. 

Results

Over a third of falls recorded led to some form of injury (102/265, 38%), but over two-thirds of the people who fell (45/66, 68%) reported hurting themselves falling at least once.  Only 3% of falls resulted in ‘major’ injury (7 fractures, 1 head injury), but these affected 11% of those who fell.  For 7/38 people who sustained ‘minor’ injuries these remained painful >2 weeks (18%). Treatment was required for 22% of falls, but this affected 55% of the people who fell.  40% of falls and 64% of injurious falls presented to health service attention; a further 6% took place in hospital. However, family, friends, neighbours, carers and wardens had been told about the vast majority of the falls (87%, 92% of injurious falls).  Only 9% of falls and 4% of injurious falls were not reported to anyone. 

Conclusions

Rates of falls and resultant injuries from prospective falls data collection in this ‘older old’ population study are higher than reported in studies of older people who are not so old. Whilst these high rates clearly have implications for service providers, findings also show that health services were unaware of more than half the falls amongst this study’s over-90-year-olds, and unaware of almost three in every ten falls that resulted in injuries.