The Iowa record-linkage study. I. Suicides and accidental deaths among psychiatric patients. Prevention of fall incidents in patients with a high risk of falling: design of a randomised controlled trial with an economic evaluation of the effect of multidisciplinary transmural care Carotid sinus syndrome: a modifiable risk factor for nonaccidental falls in older adults (SAFE PACE). Ankle force and rate of force production increase following high intensity strength training in frail older adults Rate of accidental falls in institutionalised older people with and without cognitive impairment halved as a result of a staff-oriented intervention. Guidelines for the prevention of falls in people over 65 Geriatric comorbidities, such as falls, confer an independent mortality risk to elderly dialysis patients. Community-based intervention to optimise falls risk management: a randomised controlled trial. Incidence of injury-causing falls among older adults by place of residence: a population-based study. Circumstances and consequences of falls in independent community-dwelling older adults. Dizziness in an older community dwelling population: A multifactorial syndrome Effect of Aspirin on All‐Cause Mortality in the Healthy Elderly A water-based training program that include perturbation exercises to improve stepping responses in older adults: study protocol for a randomized controlled cross-over trial Factors related to functional prognosis in elderly patients after accidental hip fractures: a prospective cohort study Home environmental hazards and the risk of fall injury events among community-dwelling older persons. Study to Assess Falls Among the Elderly (SAFE) Group. The effect of a 12-month exercise trial on balance, strength, and falls in older women: a randomized controlled trial. Does mortality of the aged increase with the number of falls? Results from a nine-year follow-up study Multifactorial intervention to reduce falls in older people at high risk of recurrent falls: a randomized controlled trial. Predictors of suicide, accidental death, and premature natural death in a general-population birth cohort Preventing falls among community-dwelling older persons: results from a randomized trial. A cost-benefit analysis of three older adult fall prevention interventions. Falls and fall-related injuries in older dialysis patients. The differential influence of distinct clusters of psychiatric symptoms, as assessed by the general health questionnaire, on cause of death in older persons living in a rural community of Japan. Causes of death following spinal cord injury during inpatient rehabilitation and the first five years after discharge. A Dutch cohort study Increased Risk for Falling Associated with Subtle Cognitive Impairment: Secondary Analysis of a Randomized Clinical Trial A Population-Based Survey of Factors Relating to the Prevalence of Falls in Older People Antioxidant vitamins and mortality in older persons: findings from the nutrition add-on study to the Medical Research Council Trial of Assessment and Management of Older People in the Community. Posturography and Risk of Recurrent Falls in Healthy Non-Institutionalized Persons Aged Over 65 Incidence and Prediction of Falls in Dementia: A Prospective Study in Older People Promoting physical activity in older people in general practice: ProAct65+ cluster randomised controlled trial. Slow walking speed and cardiovascular death in well functioning older adults: prospective cohort study The Diagnostic Accuracy of Static Posturography in Predicting Accidental Falls in People With Multiple Sclerosis Physical Activity and Different Concepts of Fall Risk Estimation in Older People–Results of the ActiFE-Ulm Study Childhood accidents at home. Seasonal variations in incidence of fractures among elderly people Association of Opioids with Falls, Fractures, and Physical Performance among Older Men with Persistent Musculoskeletal Pain Vitamin D status in relation to one-year risk of recurrent falling in older men and women. Fall prevention in acute care hospitals: a randomized trial. Causes of death associated with psychiatric illness. A classification tree for predicting recurrent falling in community-dwelling older persons. Internet provision of tailored advice on falls prevention activities for older people: a randomized controlled evaluation. An algorithm to screen long-term care residents at risk for accidental falls Falls in the healthy elderly: predisposing causes. Evaluation of Falls Risk in Community-Dwelling Older Adults Using Body-Worn Sensors Predictors for occasional and recurrent falls in community-dwelling older people Intensive vs Standard Blood Pressure Control and Cardiovascular Disease Outcomes in Adults Aged ≥75 Years: A Randomized Clinical Trial. Home hazards and falls in the elderly: the role of health and functional status. Polypharmacy including falls risk-increasing medications and subsequent falls in community-dwelling middle-aged and older adults.
In a prospect i ve investigation of 5,412 formerly hospitalized psychiatric patients , 68 committed suicide and 38 died from accidental causes . Both figures are significantly in excess of expectations based on a relevant control population . Those at significant risk included men and women of all ages , except those older than 69 years . Comparison of st and ardized mortality ratios suggests relatively greater risk for women and young persons .  Risk for suicide was significant for patients of both sexes with acute schizophrenia , schizophrenia , affective disorders , and alcohol and other drug abuse , for men with neuroses , and for women with depressive neuroses .  Risk for accidental death was greatest for those aged from 30 to 49 years and for those with personality disorders Background Annually , about 30 % of the persons of 65 years and older falls at least once and 15 % falls at least twice . Falls often result in serious injuries , such as fractures . Therefore , the prevention of accidental falls is necessary . The aim is to describe the design of a study that evaluates the efficacy and cost-effectiveness of a multidisciplinary assessment and treatment of multiple fall risk factors in independently living older persons with a high risk of falling . Methods / Design The study is design ed as a r and omised controlled trial ( RCT ) with an economic evaluation . Independently living persons of 65 years and older who recently experienced a fall are interviewed in their homes and screened for risk of recurrent falling using a vali date d fall risk profile . Persons at low risk of recurrent falling are excluded from the RCT . Persons who have a high risk of recurrent falling are blindly r and omised into an intervention ( n = 100 ) or usual care ( n = 100 ) group . The intervention consists of a multidisciplinary assessment and treatment of multifactorial fall risk factors . The transmural multidisciplinary appraoch entails close cooperation between geriatrician , primary care physician , physical therapist and occupational therapist and can be extended with other specialists if relevant . A fall calendar is used to record falls during one year of follow-up . Primary outcomes are time to first and second falls . Three , six and twelve months after the home visit , question naires for economic evaluation are completed . After one year , during a second home visit , the secondary outcome measures are reassessed and the adherence to the interventions is evaluated . Data will be analysed according to the intention-to-treat principle and also an on-treatment analysis will be performed . Discussion Strengths of this study are the selection of persons at high risk of recurrent falling followed by a multidisciplinary intervention , its transmural character and the evaluation of adherence . If proven effective , implementation of our multidisciplinary assessment followed by treatment of fall risk factors will reduce the incidence of falls . Trial registration Current Controlled Trials IS RCT N11546541 OBJECTIVES The aim of the study was to determine whether cardiac pacing reduces falls in older adults with cardioinhibitory carotid sinus hypersensitivity ( CSH ) . BACKGROUND Cardioinhibitory carotid sinus syndrome causes syncope , and symptoms respond to cardiac pacing . There is circumstantial evidence for an association between falls and the syndrome . METHODS A r and omized controlled trial was done of consecutive older patients ( > 50 years ) attending an accident and emergency facility because of a non-accidental fall . Patients were r and omized to dual-chamber pacemaker implant ( paced patients )  or st and ard treatment ( controls ) . The primary outcome was the number of falls during one year of follow-up . RESULTS One hundred seventy-five eligible patients ( mean age 73 + /- 10 years ; 60 % women ) were r and omized to the trial : pacemaker 87 ; controls 88 .  Falls ( without loss of consciousness ) were reduced by two-thirds : controls reported 669 falls ( mean 9.3 ; range 0 to 89 ) , and paced patients 216 falls ( mean 4.1 ; range 0 to 29 ) . Thus , paced patients were significantly less likely to fall ( odds ratio 0.42 ; 95 % confidence interval : 0.23 , 0.75 ) than were controls . Syncopal events were also reduced during the follow-up period , but there were much fewer syncopal events than falls-28 episodes in paced patients and 47 in controls . Injurious events were reduced by 70 % ( 202 in controls compared to 61 in paced patients ) . CONCLUSIONS There is a strong association between non-accidental falls and cardioinhibitory CSH . These patients would not usually be referred for cardiovascular assessment . Carotid sinus hypersensitivity should be considered in all older adults who have non-accidental falls Background and aims : The most common cause of accidental injury and death in people over age 65 results from impacts associated with falling . Balance impaired older adults have poorer balance control than healthy young adults or healthy older adults . Lack of sufficient lower extremity strength and inability to rapidly produce muscle force may contribute to diminished balance control in the elderly . This study evaluated the effect of a 10-week high intensity strength- training program targeting key lower extremity muscles for the purpose of improving postural control in frail older adults . Methods : Thirteen experimental and fourteen control subjects , all balance impaired older adults were evaluated in response to unexpected platform perturbations that simulated slips . Results : Following strength training the experimental group was significantly stronger than the control group . Mean ankle moments improved in the experimental group following strength training during forward sway ( Right : p=0.067 , Left : p=0.009 ) and backward sway ( Right : p=0.031 , Left : p=0.058 ) . For the backward sway condition the ankle rate of torque production increased significantly in the experimental group ( Right : p=0.016 , Left : p=0.031 ) . Conclusions : Enhancement of lower extremity strength contributed to improvements in balance stability demonstrated by greater ankle force production , in response to balance threats OBJECTIVE to evaluate the impact of a staff-oriented intervention on the number of accidental falls  in residents with and without cognitive impairment . DESIGN clustered r and omised controlled trial . METHODS ten nursing wards from 7 nursing homes were r and omised in a control ( 5 wards ) and intervention ( 5 wards ) group . The nurses from the intervention group received multi-faceted training about the occurrence of accidental falls , risk factors for falls and possible environmental modifications . For each fall they were asked to record the relevant risk factors , to keep a fall diary and to evaluate fall causes and possible preventive actions . For all residents , cognition and mobility were evaluated using a  Mini-Mental State Examination ( MMSE )  and a Timed Up and Go Test ( TUGT ) . Fall rates were recorded in an identical way for 6 months before and after the start of the intervention . MAIN OUTCOME MEASURES primary outcome measure was the number of participants with at least one accidental fall requiring an intervention by a physician or a nurse during each period of recording . Secondary outcome was the number of falls for each participant during each period of recording . RESULTS the relative risk of falling at least once in people of the intervention versus the control group adjusted for the pre-intervention results was 0.46 ( 95 % CI : 0.26 - 0.79 ) . There was no difference between residents with and without cognitive impairment or impaired mobility . In those falling at least once , the difference between the average number of falls in the two intervention arms was not significant ( P = 0.10 ) . CONCLUSION a simple staff-oriented intervention had a substantial effect on the frequency of accidental falls General practice p 994 Older people frequently fall . This is a serious public health problem , with a substantial impact on health and healthcare costs.1 These guidelines translate trial evidence about prevention of falls into recommendations that can be implemented in different setting s , with the aim of reducing the rate of falls and injurious falls in people over 65 ( see boxes 2 3 ) . # # # # Summary points Multifaceted interventions reduce falls in older people ( those over 65 ) Home assessment of older people at risk of falls without referral or direct intervention is not recommended Assessment of high risk residents in nursing homes with relevant referral is effective Evidence from well design ed single trials shows that assessment and modification of risk factors of older people who have presented to an accident and emergency department after a fall and the provision of hip protectors in residents of nursing homes are effective We up date d two previous systematic review s to include any new evidence up to March 1998 . 4 5 We electronically search ed Medline for all r and omised controlled trials and systematic review s by using the terms fall(s ) , accidental falls , fracture , elderly , aged , older , and senior . We followed up relevant references in papers , and we contacted research ers in prevention of falls for information about other trial evidence and about studies from journals not catalogued by the National Library of Medicine . For inclusion , studies had to be r and omised controlled trials of interventions design ed to minimise or prevent exposure to the risk factors for falling ( or fracture ) in people aged 65 years or over living in either community or residential care . Outcomes had to include the number of people who had fallen or the number of falls or fractures . We excluded drug or dietary treatments for the prevention of fractures . Trials that fulfilled the inclusion criteria were review ed and summarised BACKGROUND As the number of patients aged > /=65 years starting haemodialysis ( HD )  continues to increase , more patients are at risk of falls , functional decline and cognitive impairment . In an earlier prospect i ve cohort study , we showed that 44 % of elderly HD patients had more than one fall within a 1-year period . The objective of this study was to assess whether falls remained predictive of increased mortality risk even after controlling for age , comorbidity , dialysis vintage and laboratory variables . METHODS Using a prospect i ve , cohort study design , patients aged > /=65 years and on chronic HD during the period April 2002 - 2003 were recruited . Patients were followed biweekly , and falls occurring within the first year were recorded . Outcome data were collected until death , study end ( 30 December 2006 ) , transplantation or transfer to another dialysis centre . RESULTS A total of 162 patients were followed for a median of 32.7 months ( quartiles 14 - 57 ) . In a univariate Cox model with a time-dependent variable for falls status , survival was worse amongst fallers compared to non-fallers ( HR 2.13 , 95 % CI 1.32 - 3.45 ; P = 0.002 ) . After adjustment for age , dialysis vintage , comorbidity and laboratory variables , falls were a significant predictor of mortality ( HR 1.78 , 95 % CI 1.07 - 2.98 , P = 0.03 ) . Exclusion of falls associated with concurrent illnesses did not alter the results ( HR 1.63 , CI 1.02 - 2.28 P = 0.05 ) . CONCLUSIONS We conclude that the occurrence of more than one accidental fall in a community-dwelling HD patient aged > /=65 years is associated with an independent increased risk of death . As fall interventions are effective , screening HD patients for falls may be a simple measure of clinical importance BACKGROUND falls are the leading causes of accidental death and fragility fractures in older adults . Interventions that assess and reduce falls risk are underutilised . OBJECTIVE to evaluate the impact of a multifaceted community-based programme aim ed at optimising evidence -based management of patients at risk for fall-related fractures . DESIGN this was a r and omised trial performed from 2003 to 2006 . SETTING community-based intervention in Ontario , Canada . PARTICIPANTS eligible patients were community-dwelling , aged > or = 55 years and identified to be at risk for fall-related fractures . A total of 201 patients were allocated to the intervention group or to usual care .  INTERVENTION components of the intervention included assessment of falls risk , functional status and home environment , and patient education . MEASUREMENTS primary outcome was the implementation of appropriate falls risk assessment at 6 months . Secondary outcomes included falls and fractures at 6 and 12 months . RESULTS the mean age of participants was 72 years , and 41 % had fallen with injury in the previous year . Compared to usual care , the intervention increased the number of referrals made to physiotherapy [ 21 % ( 21/101 ) vs 6.0 % ( 6/100 ) ; relative risk ( RR ) 3.47 , 95 % confidence interval ( CI ) 1.46 - 8.22 ] and occupational therapy [ 15 % ( 15/101 ) vs 0 % ; RR 30.7 , 95 % CI 1.86 to > 500 ] . At 12 months , the number of falls in the intervention group was greater than in the usual care group [ 23 % ( 23/101 ) vs 11 % ( 11/100 ) ; RR 2.07 , 95 % CI 1.07 - 4.02 ] . CONCLUSIONS compared to usual care , a multi-faceted intervention increased referrals to physiotherapy and occupational therapy but did not reduce risk of falls . Similar falls reduction interventions can not be recommended based on the results of this study OBJECTIVE To describe the incidence and associated factors of injury-causing falls by place of residence . DESIGN A prospect i ve population -based study . SETTING Five municipalities in northern Finl and . PARTICIPANTS All persons in the five communities aged 70 years or older living at home ( n = 1016 ) and in long-term institutionalized care ( n = 143 ) . MEASUREMENTS We recorded all fall incidents  during a 2-year period by occurrence and severity of injury , using diary reporting and regular calls and by examining the medical and nursing records of all participants . The times , places , circumstances , and medical treatment needed were recorded as well . RESULTS Men living at home experienced 71 minor injuries/1000 person years ( PY ) , 42 major soft tissue injuries/1000PY , and 12 fractures/1000PY ; women at home experienced 175 minor injuries/1000PY , 65 major soft tissue injuries/1000PY , and 33 fractures/1000PY . Institutionalized older men had 272 minor injuries/1000PY , 122 major soft tissue injuries/1000PY , and 41 fractures/1000PY ; institutionalized women had 292 minor injuries/1000PY , 131 major soft tissue injuries/1000PY , and 58 fractures/1000PY . Falls causing injury to older adults in long-term institutionalized care were more evenly distributed by time of day than those that occurred at home . The majority of the injuries sustained in long-term institutionalized care were injuries to the head . The incidence rate of fall injuries requiring medical attention in women , 113/1000PY , was twice that in men , 57/1000PY . CONCLUSIONS Injury-causing falls are more frequent in older people living in long-term institutionalized care , and the time-distribution and some circumstances differ from those of injury-causing falls in home-dwelling older people BACKGROUND knowledge of the circumstances and consequences of falls in older adults is important for underst and ing the aetiology of falls as well as for effective clinical assessment and design of fall prevention strategies . Such data , however , are relatively scarce , especially in community-dwelling elders . METHOD accidental falls ( including their circumstances and consequences ) occurring in 96 male and female participants between 60 and 88 years of age were monitored prospect ively for 1 year . After the monitoring period , participants were divided into three groups based on fall status : non-fallers ( n = 46 ) ,  one-time fallers ( n = 27 ) and recurrent fallers ( n = 23 ) . Frequency distributions were created for selected circumstances and consequences of falls and the prevalence of these consequences were examined . RESULTS 50 participants ( 52 % ) fell during the 1 year period , amassing 91 falls . Trips and slips were the most prevalent causes of falls , accounting for 59 % of falls . Falls most often occurred during the afternoon and while subjects walked on level or uneven surfaces . Fallers most commonly attributed falls to hurrying too much . Fractures result ed from five of the 91 falls and eight other falls result ed in soft tissue injuries that required treatment by a physician . There were no differences between one-time and recurrent fallers in the circumstances and consequences of falls . However , several notable differences were found between men ( n = 20 ) and women ( n = 30 ) who fell . Falls by men most often result ed from slips whereas falls by women most often result ed from trips . Moreover , women and men differed in the time of the year in which falls occurred , with men falling most often during winter and women during summer . CONCLUSIONS the results of this study provide insight into the circumstances and consequences of falls among independent community-dwelling older adults and suggest some possible ways of preventing falls . Preventive services , however , should not solely target recurrent fallers , nor should the type of services necessarily differ for one-time and recurrent fallers Objectives The aim of this study was to determine the prevalence and related predictors of dizziness in a sample of community-dwelling people 65 years of age and older living in a metropolitan area in Germany . Design Prospect i ve cohort study . Setting Interdisciplinary Centre of Gerontology at the University of Erlangen-Nuremberg , Germany . Participants 6000 people aged 65 years and older recruited and r and omized from the registration office , 1801 were fully evaluated at baseline and were re-evaluated in a prospect i ve follow-up two years later . A full data set was obtained for 620 participants , of which 297 ( 47.9 % ) were females . Mean age was 73.45 ± 6.05 . 200 participants ( 32.4 % ) were 65–69 years , 315 ( 51 % ) were 70–79 years , 92 ( 14.9 % ) 80–89 years and 11 ( 1.8 % ) 90 years and older . Measurements Demographic , medical , functional and psychological factors were measured by a st and ardised question naire in 2004 . In a follow-up survey participants were reevaluated in a prospect i ve design two years later ( 2006 ) , including a dizziness question naire , containing frequency , duration , space of dizziness and releasing positions and activities . Results At the second measurement 181 persons ( 29.2 % ) reported dizziness in the last 6 months . Dizziness was age dependent , with a prevalence of 27 % in participants aged 70 years and younger , up to 54 % in the group of 90 years and older . 96 ( 68.2 % ) persons reported daily or weekly dizziness . 46 ( 27.9 % ) participants reported multiple sensations of dizziness . In 108 ( 59.7 ) persons dizziness was released by multiple positions or activities . The main predictors of dizziness were age , female gender , cardiovascular disease , osteoporosis , depression , sleep disorder , disturbance of memory , shortsightedness ( defined by glasses ) , incontinence , 3 and more medical conditions , 4 and more medications , poor health status , falls and mobility problems . We found similar risk factors for dizziness and falls . Conclusion Dizziness is a very common symptom in older community dwelling persons . Comorbidity , poor health status and mobility problems are strong medical predictors ; age and female gender and decline in mobility are important predictors as well . Our study suggests , that dizziness in older age is often caused by multifactorial medical and functional conditions . Gait disorders and mobility problems also seem to play an important role in dizziness among older people . Therefore , interventions in dizziness should be developed in a multifactorial way . We suggest , that the interventions to be tested first , should be those that have been previously successful in older persons with gait disorders and falls BACKGROUND In the primary analysis of the Aspirin in Reducing Events in the Elderly ( ASPREE ) trial , now published in the Journal , we report that the daily use of aspirin did not provide a benefit with regard to the primary end point of disability‐free survival  among older adults . A numerically higher rate of the secondary end point of death from any cause was observed with aspirin than with placebo . METHODS From 2010 through 2014 , we enrolled community‐dwelling persons in Australia and the United States who were 70 years of age or older ( or ≥65 years of age among blacks and Hispanics in the United States ) and did not have cardiovascular disease , dementia , or disability . Participants were r and omly assigned to receive 100  mg of enteric‐coated aspirin or placebo . Deaths were classified according to the underlying cause by adjudicators who were unaware of trial‐group assignments . Hazard ratios were calculated to compare mortality between the aspirin group and the placebo group , and post hoc exploratory analyses of specific causes of death were performed . RESULTS Of the 19,114 persons who were enrolled , 9525 were assigned to receive aspirin and 9589 to receive placebo .  A total of 1052 deaths occurred during a median of 4.7 years of follow‐up . The risk of death from any cause was 12.7 events per 1000 person‐years in the aspirin group and 11.1 events per 1000 person‐years in the placebo group ( hazard ratio , 1.14 ; 95 % confidence interval [ CI ] , 1.01 to 1.29 ) . Cancer was the major contributor to the higher mortality in the aspirin group , accounting for 1.6 excess deaths per 1000 person‐years . Cancer‐related death occurred in 3.1 % of the participants in the aspirin group and in 2.3 % of those in the placebo group ( hazard ratio , 1.31 ; 95 % CI , 1.10 to 1.56 ) . CONCLUSIONS Higher all‐cause mortality was observed among apparently healthy older adults who received daily aspirin than among those who received placebo and was attributed primarily to cancer‐related death . In the context of previous studies , this result was unexpected and should be interpreted with caution . ( Funded by the National Institute on Aging and others ; ASPREE Clinical Trials.gov number , NCT01038583 . Background Gait and balance impairments may increase the risk of falls , the leading cause of accidental death in the elderly population . Fall-related injuries constitute a serious public health problem associated with high costs for society as well as human suffering . A rapid step is the most important protective postural strategy , acting to recover equilibrium and prevent a fall from initiating . It can arise from large perturbations , but also frequently as a consequence of volitional movements . We propose to use a novel water-based training program which includes specific perturbation exercises that will target the stepping responses that could potentially have a profound effect in reducing risk of falling . We describe the water-based balance training program and a study protocol to evaluate its efficacy ( Trial registration number # NCT00708136 ) . Methods / Design The proposed water-based training program involves use of unpredictable , multi-directional perturbations in a group setting to evoke compensatory and volitional stepping responses . Perturbations are made by pushing slightly the subjects and by water turbulence , in 24 training sessions conducted over 12 weeks . Concurrent cognitive tasks during movement tasks are included . Principles of physical training and exercise including awareness , continuity , motivation , overload , periodicity , progression and specificity were used in the development of this novel program . Specific goals are to increase the speed of stepping responses and improve the postural control mechanism and physical functioning . A prospect i ve , r and omized , cross-over trial with concealed allocation , assessor blinding and intention-to-treat analysis will be performed to evaluate the efficacy of the water-based training program . A total of 36 community-dwelling adults ( age 65–88 ) with no recent history of instability or falling will be assigned to either the perturbation-based training or a control group ( no training ) . Voluntary step reaction times and postural stability using stabiliogram diffusion analysis will be tested before and after the 12 weeks of training . Discussion This study will determine whether a water-based balance training program that includes perturbation exercises , in a group setting , can improve speed of voluntary stepping responses and improve balance control . Results will help guide the development of more cost-effective interventions that can prevent the occurrence of falls in the elderly Background A restriction in functional capacity occurs in all hip fractures and a variety of factors have been shown to influence patient functional outcome . This study sought to provide new and comprehensive insights into the role of factors influencing functional recovery six months after an accidental hip fracture . Methods A prospect i ve cohort study was conducted of patients aged 65 years or more who attended the Emergency Room ( ER ) for a hip fracture due to a fall .  The following were studied as independent factors : socio-demographic data ( age , sex , instruction level , living condition , received help ) , comorbidities , characteristics of the fracture , treatment performed , destination at discharge , health-related quality of life ( 12-Item Short Form Health Survey ) and hip function ( Short Western Ontario and McMaster Universities Osteoarthritis Index ) . As main outcome functional status was measured ( Barthel Index and Lawton Instrumental Activities of Daily Living Scale ) . Data were collected during the first week after fracture occurrence and after 6 months of follow-up . Patients were considered to have deteriorated if there was worsening in their functional status as measured by Barthel Index and Lawton IADL scores . Factors associated with the outcome were studied via logistic regression analysis . Results Six months after the fall , deterioration in function was notable , with mean reductions of 23.7 ( 25.2 ) and 1.6 ( 2.2 ) in the Barthel Index and Lawton IADL Scale scores respectively . Patients whose status deteriorated were older , had a higher degree of comorbidity and were less educated than those who remained stable or improved . The multivariate model assessing the simultaneous impact of various factors on the functional prognosis showed that older patients , living with a relative or receiving some kind of social support and those with limited hip function before the fall had the highest odds of having losses in function . Conclusion In our setting , the functional prognosis of patients is determined by clinical and social factors , already present before the occurrence of the fracture . This could make it necessary to perform comprehensive assessment s for patients with hip fractures in order to identify those with a poor functional prognosis to tackle their specific needs and improve their recovery OBJECTIVE To determine if home environmental hazards increase the risk of fall injury events among community-dwelling older persons . DESIGN Population -based case-control study . SETTING South Miami Beach , Florida . PARTICIPANTS 270 persons aged 65 years and older who sought treatment at six area hospitals for injuries result ing from falls within the dwelling unit and 691 controls , frequency matched for sex and age , selected r and omly from Health Care Financing Administration ( Medicare ) files . MAIN INDEPENDENT VARIABLES The  home environment of each person , assessed directly by interviewers using a st and ardized instrument . RESULTS Environmental hazards were present in nearly all dwelling units . After adjusting for important confounding factors , most of these hazards were not associated with an increased risk of fall injury events among most older persons . Increasing numbers of tripping hazards , or total hazards in the dwelling unit , did not increase the risk of fall injury events , nor was there an increasing trend in risk . CONCLUSIONS Current fall-prevention strategies of finding and changing all environmental hazards in all community-dwelling older persons ' homes may have less potential effect than previously thought . The usefulness of grab bars , however , appears to warrant further evaluation OBJECTIVE To determine whether a 12-month program of regular exercise can improve balance , reaction time , neuromuscular control , and muscle strength and reduce the rate of falling in older women . DESIGN A r and omized , controlled trial of 12 months duration . SETTING Conducted as part of the R and wick Falls and Fractures Study in Sydney , Australia . PARTICIPANTS One hundred ninety-seven women aged 60 to 85 years ( mean age 71.6 , SD = 5.4 ) who were r and omly recruited from the community . OUTCOME MEASURES Accidental falls , postural sway , reaction time , neuromuscular control , and lower limb muscle strength . MAIN RESULTS Exercise and control subjects were tested before , midway through , and at the end of the trial . At initial testing , exercisers and controls performed similarly in all tests and were well matched in relevant health and lifestyle factors . The mean number of classes attended for the 75 exercise subjects who completed the program was 60.0 ( range 26 - 82 ) . At the end of the trial , the exercise subjects showed improved performance in all five strength measures , in reaction time , neuromuscular control , body sway on a firm surface with the eyes open , and body sway on a compliant surface with the eyes open and closed . In contrast , there were no significant improvements in any of the test measures in the controls . In one test measure , hip flexion strength , the exercisers showed continued improvement throughout the study year . There was no significant difference in the proportion of fallers between the exercise and control subjects . Interesting trends were evident , however , between falls frequency and adherence to the exercise program . CONCLUSIONS These findings show that exercise can produce long-term benefits with regard to improving sensorimotor function in older persons . The findings also suggest that high compliance to an exercise program may reduce falls frequency , although further studies are required to conclusively demonstrate that exercise offers an effective means of preventing falls The objective of the study was to examine the predictive effect of prospect ively registered falls on survival within a r and omly selected group of elderly women . A longitudinal study , with 9 years follows up after 1 year prospect i ve fall registration was design ed . Persons age 75 or more living in the community . A total of 300 Norwegian women ; mean age was 80.8 participated in the study . Base-line registration s of health , functioning and medication were made .  Falls  which occurred during a 1-year period after baseline were registered as well as the date of death within a 9-year period after the end of the fall registration period . Half of the women reported one or more falls ( 1–11 ) . Eighty-six women ( 28.7 % ) experienced only one fall and 65 ( 21.7 % ) had at least two . During the 9-year follow-up period , 41.7 % died . Cox regression analyzes demonstrated that frequent falling , old age and a self-reported worsening of health were significantly associated with mortality during the follow-up period . Their relative risks of death when experiencing at least two falls was 1.6 ( 95 % CI 1.1–2.4 ) , P = 0.04 , when compared with no falls . Older fallers appear to have markedly increased mortality . Since falls are common among elderly people , this is a relevant fact for public health policy . Increasing age , poor self-rated health and high frequency of falls predict independently mortality in our 9 years follow up study . Because women represent the largest proportion of the elderly and falls are amendable , fall preventive may have the potential for significant impact on increasing year of life BACKGROUND Falls occur frequently in older people and strongly affect quality of life . Guidelines recommend multifactorial , targeted fall prevention . We evaluated the effectiveness of a multifactorial intervention in older persons with a high risk of recurrent falls . METHODS A r and omized controlled trial was conducted from April 3 , 2005 , to July 21 , 2008 , at the geriatric outpatient clinic of a university hospital and regional general practice s in the Netherl and s. Of 2015 persons identified , 217 persons aged 65 years or older were selected to participate . They had a high risk of recurrent falls and no cognitive impairment and had visited the emergency department or their family physician after a fall . The geriatric assessment and intervention were aim ed at reduction of fall risk factors . Primary outcome measures were time to first and second falls after r and omization . Secondary outcome measures were fractures , activities of daily living , quality of life , and physical performance . RESULTS Within 1 year , 55 ( 51.9 % ) of the 106 intervention participants and 62 ( 55.9 % ) of the 111 usual care ( control ) participants fell at least once . No significant treatment effect was demonstrated for the time to first fall ( hazard ratio , 0.96 ; 95 % confidence interval , 0.67 - 1.37 ) or the time to second fall ( 1.13 ; 0.71 - 1.80 ) . Similar results were obtained for secondary outcome measures and for per- protocol analysis . One intervention participant died vs 7 in the control group ( hazard ratio , 0.15 ; 95 % confidence interval , 0.02 - 1.21 ) . CONCLUSION This multifactorial fall-prevention program does not reduce falls in high-risk , cognitively intact older persons . Trial Registration is rct n.org Identifier : IS RCT N11546541 BACKGROUND Whether putative suicide risk factors , such as conduct and emotional disorders , are specific to suicide or are general associations of a continuum between subintentional and intentional self-destruction is not clear . We undertook an investigation of this issue in a UK population -based birth cohort . METHODS Using competing-risks analysis , we examined links between prospect ively collected childhood and adolescent temperamental and behavioural variables and the risk of natural , accidental , and suicidal death , occurring between the ages of 16 and 50 years . Of the 5362 members of the cohort , full data were available for 3591 . A panel of psychiatrists scored deaths on likely suicidal intention . These scores were used in a weighted logistic regression to examine independence of risk factors for (sub)intentional self-destruction . FINDINGS There were 167 deaths among the risk-set between the 16th and 50th birthdays . 120 were due to natural causes ; of the other 47 , the panel of psychiatrists judged that 36 were accidental deaths and 11 were suicides ( certainty rating > or = 51 % ) . Adolescent emotional instability and conduct problems had different associations with the various causes of premature death , being lowest for natural death ( odds ratio 1.0 [ 95 % CI 0.8 - 1.2 ] and 1.2 [ 1.0 - 1.5 ] ) , intermediate for accidental death ( 1.1 [ 0.8 - 1.5 ] and 1.3 [ 1.0 - 1.7 ] ) , and highest for suicidal death ( 2.0 [ 1.2 - 3.6 ] and 1.8 [ 1.3 - 2.5 ] ) . Emotional instability ( boys 1.3 [ 1.0 - 1.7 ] , girls 1.4 [ 1.0 - 1.9 ] ) increased risk for subintentional or intentional self-destruction , as did low anxiety in adolescence ( 1.7 [ 1.3 - 2.5 ] ) and nocturnal enuresis at age 4 ( 1.4 [ 1.2 - 1.7 ] ) in boys , and conduct problems in girls ( 1.4 [ 1.0 - 2.0 ] ) . INTERPRETATION Suicide shares important risk factors with other causes of premature death . These findings suggest an aetiological continuum of self-destruction from subintentional to intentional . Research on premature mortality associated with psychological disorder should include all causes of death A r and omized trial of falls prevention program that addressed home safety , exercise , and behavioral risks was conducted with 3,182 independently living HMO members age 65 and older . The intervention decreased the odds of falling by 0.85 , but only reduced the average number of falls among those who fell by 7 % . The effect was strongest among men age 75 and older . The likelihood of avoiding falls requiring medical treatment was not significantly affected by the intervention . We conclude that the intervention dose was not of sufficient intensity or duration to have a marked protective effect on older persons . Future research should focus on more intensive intervention approaches because serious falls do not appear to be amendable to low-intensity environment/behavioral efforts INTRODUCTION One out of three persons aged 65 and older falls annually and 20 % to 30 % of falls result in injury . The purpose of this cost-benefit analysis was to identify community-based fall interventions that were feasible , effective , and provided a positive return on investment ( ROI ) . METHODS A third-party payer perspective was used to determine the costs and benefits of three effective fall interventions . Intervention effectiveness was based on r and omized controlled trial results . National data were used to estimate the average annual benefits from averting the direct medical costs of a fall . The net benefit and ROI were estimated for each of the interventions . RESULTS For the  Otago Exercise Program delivered to persons aged 65 and older , the net benefit was $ 121.85 per participant and the ROI was 36 % for each dollar invested . For Otago delivered to persons aged 80 and older , the net benefit was $ 429.18 and the ROI was 127 % . Tai chi : Moving for Better Balance had a net benefit of $ 529.86 and an ROI of 509 % and Stepping On had a net benefit of $ 134.37 and an ROI of 64 % . CONCLUSIONS All three fall interventions provided positive net benefits . The ROIs showed that the benefits not only covered the implementation costs but also exceeded the expected direct program delivery costs . These results can help health care funders and other community organizations select appropriate and effective fall interventions that also can provide positive returns on investment Dialysis patients are increasingly older and more disabled . In community-dwelling seniors without kidney disease , falls commonly predict hospitalization , the onset of frailty , and the need for institutional care . Effective fall prevention strategies are available . On the basis of retrospective data , it was hypothesized that the fall rates of older ( > or = 65 yr ) chronic outpatient hemodialysis ( HD ) patients would be higher than published rates for community-dwelling seniors ( 0.6 to 0.8 falls/patient-year ) . It also was hypothesized that risk factors for falls in dialysis out patients would include polypharmacy , dialysis-related hypotension , cognitive impairment , and decreased functional status . Using a prospect i ve cohort study design , HD patients who were > or = 65 yr of age at a large academic dialysis unit were recruited . All study participants underwent baseline screening for fall risk factors . Patients were followed prospect ively for a minimum of 1 yr . Falls were identified through biweekly patient interviews in the HD unit . A total of 162 patients ( mean age 74.7 yr ) were recruited ; 57 % were male . A total of 305 falls occurred in 76 ( 47 % ) patients over 190.5 person-years of follow-up ( fall-incidence 1.60 falls/person-year ) . Injuries occurred in 19 % of falls ; 41 patients had multiple falls . Associated risk factors included age , comorbidity , mean predialysis systolic BP , and a history of falls . In the HD population , the fall risk is higher than in the general community , and fall-related morbidity is high . Better identification of HD patients who are at risk for falls and targeted fall intervention strategies are required OBJECTIVES To examine the influence of distinct clusters of psychiatric symptoms on subsequent cause-specific mortality in older persons living in the community . DESIGN A prospect i ve cohort study over 7.5 years . SETTING Otsuki-town , Kochi prefecture , Japan . PARTICIPANTS Nine hundred eighty community-dwelling persons , aged 65 to 84 in 1991 . MEASUREMENTS  Psychiatric symptoms  at baseline were measured using the 30-item version of the General Health Question naire ( GHQ-30 ) . A factor analysis was performed on the responses of all 980 subjects . The relationships between subscale scores on the identified factors and causes of deaths occurring over 7.5 years in 817 respondents with no physical disability at baseline were assessed using a proportional hazards model adjusted for age , gender , chronic conditions under treatment , regular physical activity , and availability of close or casual neighbors . RESULTS The factor analysis identified three clusters of psychiatric symptoms : depression , apathy/anergia , and anxiety . In the proportional hazards model , which included three GHQ subscales depicting these factors simultaneously , the depression subscale was associated with increased mortality from cerebrovascular disease ( multivariate adjusted hazard ratio per unit increase in the st and ard score on the depression subscale=2.04 , 95 % confidence interval (CI)=1.17 - 3.55 ) , and the apathy/anergia subscale was associated with increased mortality from noncancer and noncardiovascular causes ( multivariate adjusted hazard ratio per unit increase in the st and ard score on the apathy/anergia subscale=1.71 , 95 % CI=1.25 - 2.34 ) . The anxiety subscale was not associated with any cause of death . CONCLUSION Depressive symptoms and symptoms indicating apathy/anergia have differential influences on subsequent causes of death in older persons living in the community . Identification of specific psychiatric symptom clusters may contribute to the prevention of deaths from specific causes in older population Study design : Prospect i ve multicentre cohort study . Objectives : To determine mortality , causes and determinants of death of individuals with spinal cord injury ( SCI ) within five years after first inpatient rehabilitation .  Setting : The Netherl and s. Methods : Patients were included on admission to first clinical rehabilitation after traumatic or nontraumatic SCI . Inclusion criteria : age between 18 and 65 , American Spinal Injury Association impairment scale A – D and expected long-term wheelchair dependency . Information about survival , cause of death , relevant comorbidity and psychosocial circumstances was obtained from the rehabilitation physician or general practitioner . Determinants of death were retrieved from a prospect ively collected data base . Deceased persons and survivors were compared using χ2-test and t-test . Cox regression analysis was performed to describe independent predictors of death . The Kaplan – Meier method was used to calculate survival curves for independent predictors . Excess mortality was described by a st and ardized mortality ratio ( SMR ) . Results : Mean duration of follow up was 6.2 years . A total of 27 persons ( 12.2 % ) died during this period ( SMR 5.3 ) . Main causes of death were cardiovascular disease ( 37.0 % ) , pulmonary disease ( 29.6 % ) and neoplasm ( 14.8 % ) . Older age at injury , nontraumatic SCI , family history of cardiovascular disease , less social support and a history of other medical conditions on admission were related to death . Older age at injury , nontraumatic SCI and a history of other medical conditions were independent predictors of death . Conclusion : Twelve per cent of persons with SCI who had survived the acute hospital phase  died during follow up ( SMR 5.3 ) . The main causes of death were cardiovascular and pulmonary disease Background / Aims : Having dementia increases patients ’ risk for accidental falls . However , it is unknown if having mild cognitive deficits also elevates a person ’s risk for falls . This study sought to clarify the relationship between subtle cognitive impairment , measured with a widely-used , clinic-based assessment , the Mini Mental State Exam ( MMSE ) , and risk for falls . Methods : In a secondary analysis of the Kenosha County Falls Prevention Study , a r and omized controlled trial targeting older adults at risk for falls , we examined the association between baseline  MMSE  and prospect i ve rate of falls over 12 months in 172 subjects r and omized to control group . Results : Using univariate analysis , the rate of falls increased with each unit decrease in MMSE score down to at least 22 ( rate ratio 1.25 , 95 % confidence interval ( CI ) 1.09–1.45 , p = 0.0026 ) . Using stepwise multivariate regression , controlling for ability to perform activities of daily living , use of assistive device , current exercise , and arthritis , the association between MMSE score and falls rate persisted ( rate ratio 1.20 , 95 % CI 1.03–1.40 , p = 0.021 ) . Conclusion : Minimal decrements on the MMSE were associated with elevations in rate of falls , suggesting that subtle cognitive deficits reflected in MMSE scores above a cut-off consistent with a diagnosis of dementia , can influence risk for falls Background : Research on older people ’s perception regarding their quality of life and services and supports needed to maintain their independence was identified as a priority for the South Australian Department of Health in 2000–2001 . This population survey was conducted to examine issues that older persons considered important in the areas of housing , transport , finances and information provision . Objective : The aim of this article is to present the characteristics of community-dwelling older adults who reported falling in the previous 12 months . Method : A r and om representative sample of community-dwelling adults , living in South Australia , and aged 65 years and over were selected based on a sample from the electronic white pages telephone directory . Overall , 2,619 interviews were conducted ( 70.5 % response rate ) using Computer-Assisted Telephone Interviewing technology . Results : Approximately 30 % of older adults had experienced a fall in the previous 12 months . The characteristics of people who had fallen included those in the older age groups , with fair or poor general health , whose health had worsened in the last 12 months , with lower socioeconomic status , those born in an English-speaking country , needing assistance at home , and with a home in need of repair . Of the respondents who had experienced a fall in the previous 12 months , 71.8 % did not consider that they were at risk of having another fall . Conclusion : There is a wide range of characteristics associated with community-dwelling older adults over the age of 65 who report falling in the previous 12 months . Perceptions of the risk of falling also vary . All factors need to be considered when targeting interventions to reduce the risk of both initial and multiple falls BACKGROUND Older persons are at risk of both poor nutrition and increased oxidative stress . Plasma ascorbate concentrations fall with increasing age , and concentrations of other antioxidants may also be reduced . OBJECTIVE The goal was to examine the association between antioxidants and mortality in older persons . DESIGN We r and omly selected persons aged 75 - 84 y from the lists of 51 British family practitioners taking part in a r and omized trial of assessment of older persons . A total of 1214 participants provided a blood sample  and were interviewed about their usual diet with the use of a food-frequency question naire . Statistical analyses were based on deaths after a median of 4.4 y of follow-up , and hazard ratios were estimated for quintiles of dietary or blood antioxidants . RESULTS We found strong inverse trends for blood ascorbate concentrations with all-cause and cardiovascular disease mortality , which were only marginally reduced after adjustment for confounders or supplement use . Those in the lowest fifth ( < 17 micromol/L ) had the highest mortality , whereas those in the highest fifth ( > 66 micromol/L ) had a mortality risk nearly half that ( hazard ratio = 0.54 ; 95 % CI : 0.34 , 0.84 ) . Similar results were found after the exclusion of those subjects with cardiovascular disease or cancer at baseline ( hazard ratio = 0.51 ; 0.28 , 0.93 ) . In fully adjusted models , there was no evidence for an influence of alpha-tocopherol , beta-carotene , or retinol on total mortality .  Dietary antioxidants measured by the food-frequency question naire were not associated with all-cause or cardiovascular disease mortality . CONCLUSION Low blood vitamin C concentrations in the older British population are strongly predictive of mortality Background : A poor postural stability in older people is associated with an increased risk of falling . The posturographic tool has widely been used to assess balance control ; however , its value in predicting falls remains unclear . Objective : The purpose of this prospect i ve study was to determine the predictive value of posturography in the estimation of the risk of recurrent falls , including a comparison with st and ard clinical balance tests , in healthy non-institutionalized persons aged over 65 . Methods : Two hundred and six healthy non-institutionalized volunteers aged over 65 were tested .  Postural control  was evaluated by posturographic tests , performed on static , dynamic and dynamized platforms ( static test , slow dynamic test and Sensory Organization Test [ SOT ] ) and clinical balance tests ( Timed ‘ Up & Go ’ test , One-Leg Balance , Sit-to-St and -test ) .  Subsequent falls were monitored prospect ively with self- question naire sent every 4 months for a period of 16 months after the balance testing . Subjects were classified prospect ively in three groups of Non-Fallers ( 0 fall ) , Single-Fallers ( 1 fall ) and Multi-Fallers ( more than 2 falls ) . Results : Loss of balance during the last trial of the SOT sensory conflicting condition , when visual and somatosensory inputs were distorted , was the best factor to predict the risk of recurrent falls ( OR = 3.6 , 95 % CI = 1.3–10.11 ) . Multi-Fallers showed no postural adaptation during the repetitive trials of this sensory condition , contrary to Non-Fallers and Single-Fallers . The Multi-Fallers showed significantly more sway when visual inputs were occluded . The clinical balance tests , the static test and the slow dynamic test revealed no significant differences between the groups . Conclusion : In a sample of non-institutionalized older persons aged over 65 , posturographic evaluation by the SOT , especially with repetition of the same task in sensory conflicting condition , compared to the clinical tests and the static and dynamic posturographic test , appears to be a more sensitive tool to identify those at high-risk of recurrent falls Background Falls are a major cause of morbidity and mortality in dementia , but there have been no prospect i ve studies of risk factors for falling specific to this patient population , and no successful falls intervention/prevention trials . This prospect i ve study aim ed to identify modifiable risk factors for falling in older people with mild to moderate dementia . Methods and Findings 179 participants aged over 65 years were recruited from outpatient clinics in the UK ( 38 Alzheimer 's disease ( AD ) , 32 Vascular dementia ( VAD ) , 30 Dementia with Lewy bodies ( DLB ) , 40 Parkinson 's disease with dementia ( PDD ) , 39 healthy controls ) . A multifactorial assessment of baseline risk factors was performed and fall diaries were completed prospect ively for 12 months . Dementia participants experienced nearly 8 times more incident falls ( 9118/1000 person-years ) than controls ( 1023/1000 person-years ; incidence density ratio : 7.58 , 3.11–18.5 ) . In dementia , significant univariate predictors of sustaining at least one fall included diagnosis of Lewy body disorder ( proportional hazard ratio ( HR ) adjusted for age and sex : 3.33 , 2.11–5.26 ) , and history of falls in the preceding 12 months ( HR : 2.52 , 1.52–4.17 ) . In multivariate analyses , significant potentially modifiable predictors were symptomatic orthostatic hypotension ( HR : 2.13 , 1.19–3.80 ) , autonomic symptom score ( HR per point 0–36 : 1.055 , 1.012–1.099 ) , and Cornell depression score ( HR per point 0–40 : 1.053 , 1.01–1.099 ) . Higher levels of physical activity were protective ( HR per point 0–9 : 0.827 , 0.716–0.956 ) . Conclusions The management of symptomatic orthostatic hypotension , autonomic symptoms and depression , and the encouragement of physical activity may provide the core elements for the most fruitful strategy to reduce falls in people with dementia . R and omised controlled trials to assess such a strategy are a priority BACKGROUND Regular physical activity reduces falls , hip fractures , and all-cause mortality , but physical activity levels are low in older age groups . AIM To evaluate two exercise programmes promoting physical activity among older people . DESIGN AND SETTING Pragmatic three-arm , parallel- design cluster r and omised controlled trial involving 1256 people aged ≥65 years ( of 20 507 invited ) recruited from 43 general practice s in London , Nottingham , and Derby . METHOD Practice s were r and omised to the class-based Falls Management Exercise programme ( FaME ) , the home-based Otago Exercise Program ( OEP ) , or usual care . The primary outcome was the proportion reaching the recommended physical activity target 12 months post-intervention . Secondary outcomes included falls , quality of life , balance confidence , and costs . RESULTS In total , 49 % of FaME participants reached the physical activity target compared with 38 % for usual care ( adjusted odds ratio 1.78 , 95 % confidence interval [ CI ] = 1.11 to 2.87 , P = 0.02 ) . Differences between FaME and usual care persisted 24 months after intervention . There was no significant difference comparing those in the OEP ( 43 % reaching target at 12 months ) and usual-care arms . Participants in the FaME arm added around 15 minutes of moderate-to-vigorous physical activity per day to their baseline level ; this group also had a significantly lower rate of falls ( incident rate ratio 0.74 , 95 % CI = 0.55 to 0.99 , P = 0.042 ) . Balance confidence was significantly improved in both intervention arms . The mean cost per extra person achieving the physical activity target was £ 1740 . Attrition and rates of adverse reactions were similar . CONCLUSION The FaME programme increases self-reported physical activity for at least 12 months post-intervention and reduces falls in people aged ≥65 years , but uptake is low . There was no statistically significant difference in reaching the target , or in falls , between the OEP and usual-care arms Objective To study the relation between low walking speed and the risk of death  in older people , both overall and with regard to the main causes of death . Design Prospect i ve cohort study . Setting Dijon centre ( France ) of the Three-City study . Participants 3208 men and women aged ≥65 living in the community , recruited from 1999 to 2001 , and followed for an average of 5.1 years . Main outcome measures Mortality , overall and according to the main causes of death , by thirds of baseline walking speed ( measured at maximum speed over six metres ) , adjusted for several potential confounders ; Kaplan-Meier survival curves by thirds of baseline walking speed . Vital status during follow-up . Causes of death . Results During 16 414 person years of follow-up , 209 participants died ( 99 from cancer , 59 from cardiovascular disease , 51 from other causes ) . Participants in the lowest third of baseline walking speed had an increased risk of death ( hazard ratio 1.44 , 95 % confidence interval 1.03 to 1.99 ) compared with the upper thirds . Analyses for specific causes of death showed that participants with low walking speed had about a threefold increased risk of cardiovascular death ( 2.92 , 1.46 to 5.84 ) compared with participants who walked faster . There was no relation with cancer mortality ( 1.03 , 0.65 to 1.70 ) . In stratified analyses , cardiovascular mortality was increased across various strata defined by sex , median age , median body mass index ( BMI ) , and level of physical activity . Conclusion Slow walking speed  in older people is strongly associated with an increased risk of cardiovascular mortality Background . Quantitative posturography has been reported as a reliable tool to measure balance in people with multiple sclerosis ( MS ) . However , data on its diagnostic accuracy in predicting the occurrence of falls are lacking . Objective . To determine sensitivity , specificity , predictive values , and accuracy of  posturography  in detecting falls  in MS subjects over a 3-month follow-up period . Methods . One hundred consecutive patients with MS were tested by the  Berg Balance Scale ( BBS ) and by  static posturography on a monoaxial platform . Participants recorded the occurrence of accidental falls for the next 3 months . Abnormal cutoff values for static st and ing balance measures were set at 2 st and ard deviations above the mean values obtained from 50 healthy controls ( HC ) . The diagnostic accuracy of the BBS and static posturography was analyzed with respect to the prospect ively collected data on the occurrence of falls . Results . Posturometric measures in participants with MS were significantly worse than in HC ( all P values < .0001 ) ; however , only the center of pressure ( COP ) path with open eyes condition had substantial test – retest reliability .  Static posturography  was more sensitive ( 88 % vs 37 % ) and accurate ( 75 % vs 63 % ) , but slightly less specific ( 67 % vs 81 % ) , than the BBS in predicting accidental falls . A logistic regression analysis revealed that the worse the COP path , the greater the risk for accidental falls ( odds ratio = 1.08 ; P < .0001 ) , even after adjusting for sex , age , disease duration , body mass index , MS subtype , Exp and ed Disability Status Scale , and BBS score . Conclusion . The COP path measurement in static position is a sensitive and accurate tool to identify people with MS who are at risk of accidental falls Objectives To investigate the relationship between physical activity and two measures of fall incidence in an elderly population using person-years as well as hours walked as denominators and to compare these two approaches . Design Prospect i ve cohort study with one-year follow-up of falls using fall calendars . Physical activity was defined as walking duration and recorded at baseline over one week using a thigh-worn uni-axial accelerometer ( activPAL ; PAL Technologies , Glasgow , Scotl and ) . Average daily physical activity was extracted from these data and categorized in low ( 0–59 min ) , medium ( 60–119 min ) and high ( 120 min and more ) activity . Setting The ActiFE Ulm study located in Ulm and adjacent regions in Southern Germany . Participants 1,214 community-dwelling older people ( ≥65 years , 56.4 % men ) . Measurements Negative-binomial regression models were used to calculate fall rates and incidence rate ratios for each activity category each with using ( 1 ) person-years and ( 2 ) hours walked as denominators stratified by gender , age group , fall history , and walking speed . All analyses were adjusted either for gender , age , or both . Results No statistically significant association was seen between falls per person-year and average daily physical activity . However , when looking at falls per 100 hours walked , those who were low active sustained more falls per hours walked . The highest incidence rates of falls were seen in low-active persons with slow walking speed ( 0.57 ( 95 % confidence interval ( 95 % CI ) : 0.33 to 0.98 ) falls per 100 hours walked ) or history of falls ( 0.60 ( 95 % CI : 0.36 to 0.99 ) falls per 100 hours walked ) . Conclusion Falls per hours walked is a relevant and sensitive outcome measure . It complements the concept of incidence per person years , and gives an additional perspective on falls in community-dwelling older people Accidents are the leading cause of death in children and a major factor in lost productive life . This case-control study investigates childhood accidents in the home by r and omly surveying children presenting to a Dublin Accident and Emergency Department . Risk factors for home accidents are examined by comparing cases ( those with accidental injuries sustained at home ) with controls . Of the 174 accident attenders , 59.2 % were boys ; 66 % of all surveyed were under 5 years . Cases were more likely to belong to Social Class 5 - 6 ( P < 0.01 ) , their fathers were less likely to be employed ( p < 0.01 ) and mothers were less likely to be working outside the home ( P < 0.01 ) . Over 50 % of injuries were due to falls ( 50.8 % ) . Blows and cuts accounted for 22.6 % of injuries , while 13 % were due to burns , 7.9 % were due to poisoning , and 5.7 % due to foreign bodies . Children under 5 were more likely than older children to have been supervised at the time of the accident . Most of the injuries were minor . However , 34 children ( 19.5 % ) required hospital admission .  Measures to prevent accidents at home should be targeted towards those at most risk-parents of pre-school children and the lower social class groups . Accident prevention requires a three-pronged approach i.e. environmental change , enforcement of legislation and educational measures Objective —To investigate seasonal variations in the incidence of fall related fractures among people 65 years and older . Population and methods —A prospect i ve , population based cohort study was performed on people aged 65 years and older followed up from 1990 to 1997 , a total of 459 904 person years . Cases were identified through a prospect i ve registration system . Results —There were 10 992 ( 2390 per 100 000 person years ) fall related fractures . The risk was higher in the colder seasons ( October through March ) among people aged 65–79 years ( relative risk ( RR ) = 1.39 , 95 % confidence interval ( CI ) 1.32 to 1.47 ) and in people aged 80 years and older ( RR = 1.17 , 95 % CI 1.09 to 1.22 ) . For arm fractures , the RR was 1.69 ( 95 % CI 1.56 to 1.83 ) among people aged 65–79 years and 1.30 ( 95 % CI 1.13 to 1.43 ) among those aged 80 years and older . The RR for hip fractures was 1.27 ( 95 % CI 1.15 to 1.37 ) among people aged 65–79 years and 1.08 ( 95 % CI 1.00 to 1.15 ) for people aged 80 years and older . Slipping on ice and snow seems to entirely explain the excessive incidence of hip and arm fractures during winter months . Conclusion —Season affects the incidence of all types of fractures in elderly people . Slipping on ice and snow seems to be a causal mechanism behind the seasonal effect . Preventive measures targeting this causal mechanism are likely to reduce the risk of fracture , but the size of the effect is difficult to estimate with certainty Background Although older adults are disproportionately affected by painful musculoskeletal conditions and receive more opioid analgesics than persons in other age groups , insufficient evidence is available regarding opioid harms in this age group . Objective To examine longitudinal relationships between opioid use and falls , clinical fractures , and changes in physical performance . We hypothesized that opioid use would be associated with greater risks of falling and incident clinical fractures and greater declines in physical performance . Design We analyzed data from the Osteoporotic Fractures in Men Study ( MrOS ) , a large prospect i ve longitudinal cohort study . Participants completed baseline visits from 2000 to 2002 and were followed for 9.1 ( SD 4.0 ) years . Participants MrOS enrolled 5994 community-dwelling men ≥ 65 years of age . The present study included 2902 participants with back , hip , or knee pain most or all of the time at baseline . Main Measures The exposure of interest was opioid use , defined at each visit as participant-reported daily or near-daily use of any opioid-containing analgesic . Among patients , 309 ( 13.4 % ) reported opioid use at one or more visits . Participants were queried every 4 months about falls and fractures . Physical performance scores were derived from tests of grip strength , chair st and s , gait speed , and dynamic balance . Key Results In the main analysis , the adjusted risk of falling did not differ significantly between opioid use and non-use groups ( RR 1.10 , 95 % CI 0.99 , 1.24 ) . Similarly , adjusted rates of incident clinical fracture did not differ between groups ( HR 1.13 , 95 % CI 0.94 , 1.36 ) . Physical performance was worse at baseline for the  opioid use group , but annualized change in physical performance scores did not differ between groups ( −0.022 , 95 % CI −0.138 , 0.093 ) . Conclusions Additional research is needed to determine whether opioid use is a marker of risk or a cause of falls , fractures , and progressive impairment among older adults with persistent pain BACKGROUND Falls frequently occur in the elderly and are a major cause of morbidity and mortality . OBJECTIVE The objective of the study was to prospect ively investigate the association between serum 25-hydroxyvitamin D [ 25(OH)D ] levels and risk of recurrent falling  in older men and women . DESIGN This was a prospect i ve cohort study . SETTING An age- and sex-stratified r and om sample of the Dutch older population was determined . SUBJECTS Subjects included 1231 men and women ( aged 65 yr and older ) participating in the Longitudinal Aging Study Amsterdam . MEASUREMENTS Baseline serum 25(OH)D was determined by a competitive protein binding assay . During 1 yr , falls were prospect ively recorded by means of a fall calendar . RESULTS Low 25(OH)D ( < 10 ng/ml ) was associated with an increased risk of falling . After adjustment for age , sex , education level , region , season , physical activity , smoking , and alcohol intake , the odds ratios ( 95 % confidence interval ) were 1.78 ( 1.06 - 2.99 ) for subjects who experienced two falls or more as compared with those who did not fall or fell once and 2.23 ( 1.17 - 4.25 ) for subjects who fell three or more times as compared with those who fell two times or less . There was a statistically significant effect modification by age , and stratified analyses ( < 75 and > or = 75 yr ) showed that the associations were particularly strong in the younger age group ; the odds ratios ( 95 % confidence interval ) were 5.21 ( 2.03 - 13.40 ) for two falls or more and 4.96 ( 1.52 - 16.23 ) for three falls or more . CONCLUSIONS Poor vitamin D status is independently associated with an increased risk of falling  in the elderly , particularly in those aged 65 - 75 yr CONTEXT Falls cause injury and death for persons of all ages , but risk of falls increases markedly with age . Hospitalization further increases risk , yet no evidence exists to support short-stay hospital-based fall prevention strategies to reduce patient  falls . OBJECTIVE To investigate whether a fall prevention tool kit ( FPTK ) using health information technology ( HIT ) decreases patient falls in hospitals . DESIGN , SETTING , AND PATIENTS Cluster r and omized study conducted January 1 , 2009 , through June 30 , 2009 , comparing patient fall rates in 4 urban US hospitals in units that received usual care ( 4 units and 5104 patients ) or the intervention ( 4 units and 5160 patients ) . INTERVENTION The FPTK integrated existing communication and workflow patterns into the HIT application . Based on a valid fall risk assessment scale completed by a nurse , the FPTK software tailored fall prevention interventions to address patients ' specific determinants of fall risk . The FPTK produced bed posters composed of brief text with an accompanying icon , patient education h and outs , and plans of care , all communicating patient-specific alerts to key stakeholders . MAIN OUTCOME MEASURES The primary outcome was patient falls per 1000 patient-days adjusted for site and patient care unit . A secondary outcome was fall-related injuries . RESULTS During the 6-month intervention period , the number of patients with falls differed between control ( n = 87 ) and intervention ( n = 67 ) units ( P=.02 ) . Site-adjusted fall rates were significantly higher in control units ( 4.18 [ 95 % confidence interval { CI } , 3.45 - 5.06 ] per 1000 patient-days ) than in intervention units ( 3.15 [ 95 % CI , 2.54 - 3.90 ] per 1000 patient-days ; P = .04 ) . The FPTK was found to be particularly effective with patients aged 65 years or older ( adjusted rate difference , 2.08 [ 95 % CI , 0.61 - 3.56 ] per 1000 patient-days ; P = .003 ) . No significant effect was noted in fall-related injuries . CONCLUSION The use of a fall prevention tool kit in hospital units compared with usual care significantly reduced rate of falls . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00675935 BACKGROUND A prospect i ve cohort analysis of mortality , among entrants to a  population -based psychiatric case register  , was undertaken to identify specific causes of death responsible for the increased risk of mortality previously reported in this large group of unselected patients . METHODS The analysis was based on a study population of 16,871 cases , aged 15 - 89 years , from Worcester and Kidderminster Health Districts , entering the case register between 1974 and 1984 and generating a total of 85,073 patient-years ( PYR ) of observation . The underlying cause of death was coded to the relevant revision of the International Classification of Diseases ( ICD ) . Numbers of deaths observed in the study population were compared with the number of deaths expected on the basis of mortality rates for Engl and and Wales . Comparisons were made for eight main causes of death , aggregated at Chapter level of the ICD , and 11 categories of psychiatric diagnoses . Two indices of mortality were used for evaluation : relative risk ( RR ) = observed deaths/expected deaths ; and excess mortality rate ( EMR ) = ( observed-expected deaths)/PYR . RESULTS RRs were significantly raised for accidents , including suicides , as anticipated , and for various main causes of death . The increased risk of accidental death was found across the majority of the 11 psychiatric diagnostic groups although the EMRs were low at less than 5/1000 PYR . Deaths from respiratory disorders gave rise to the highest RRs after accidental deaths , and were responsible for substantial excess mortality among in- patients and patients with psychotic illnesses ( especially dementia ) . The largest numbers of deaths of both sexes were due to diseases of the circulatory system , with a 40 per cent excess of observed over expected values in the whole series . The excess was due mainly to deaths of in- patients and of patients with psychotic diagnoses . No excess of deaths owing to neoplasms was found for either in- patients or out-patient groups . CONCLUSIONS The findings that psychiatric illness is associated with an increased risk of death from " natural ' causes and that the level of risk was related to the severity and to the diagnostic category of the illness have implication s for patterns of care and use of re sources OBJECTIVES To develop a classification tree for predicting the risk of recurrent falling in community-dwelling older persons using tree-structured survival analysis ( TSSA ) . DESIGN A prospect i ve cohort study . SETTING A community in the Netherl and s. PARTICIPANTS One thous and three hundred sixty-five community-dwelling older persons ( > /=65 ) from the Longitudinal Aging Study Amsterdam ( LASA ) . MEASUREMENTS In 1995 , physical , cognitive , emotional , and social aspects of functioning were assessed . Subsequently , a prospect i ve fall follow-up , specifically on recurrent falls ( two falls within 6 months ) was conducted for 3 years . RESULTS The classification tree included 11 end groups differing in risk of recurrent falling based on a minimum of two and a maximum of six predictors . The first split in the tree involved two or more falls versus fewer than two falls in the year preceding the interview . Respondents with two or more falls in the year preceding the interview ( n=193 ) and with at least two functional limitations ( n=98 ) had a 75 % risk of becoming a recurrent faller , whereas respondents with fewer than two functional limitations were further divided into a group with regular dizziness ( n=11 , risk of 68 % ) and a group with no regular dizziness ( n=84 , risk of 30 % ) . In respondents with fewer than two falls in the year preceding the interview ( n=1,172 ) , the risk of becoming a recurrent faller varied between 9 % and 70 % . Predictors in this branch of the tree were low performance , low h and grip strength , alcohol use , pain , high level of education , and high level of physical activity . CONCLUSION This classification tree included 11 end groups differing in the risk of recurrent falling based on specific combinations of a maximum of six easily measurable predictors . The classification tree can identify subjects who are eligible for preventive measures in public health strategies Falls are very common in older persons and can result in substantial disability and distress . By undertaking strength and balance training ( SBT ) exercises , older people can reduce their risk of falling . The Internet offers a potentially cost-effective means of disseminating information about SBT to older people and their carers . A particular advantage of using the Internet for this purpose is that the advice given can be ' tailored ' to the needs of the individual . This study used a r and omized controlled design to evaluate an interactive web-based program that tailored advice about undertaking SBT activities . The participants were 280 people with an age range of 65 - 97 years recruited by advertising the website by email and the Internet . Those r and omized to the tailored advice were presented with advice tailored to their personal self-rated balance capabilities , health problems and activity preferences . Those in the control group were presented with all the advice from which the tailored advice was selected . After reading the advice , those in the tailored advice group ( n = 144 ) had more positive attitudes ( p < 0.01 ) than those in the control group ( n = 136 ) , reporting greater perceived relevance of the SBT activities , greater confidence in the ability to carry them out , and hence stronger intentions to undertake the activities . This study provides an initial indication that an interactive website might offer a cost-effective way to provide personalized advice to some older people . Further research is required to determine whether website-based advice on falls prevention changes behavior as well as intentions and whether the advice needs to be supplemented by other forms of support Background and aims : The process applied to identify fall risks in frail elderly persons remains a matter of debate . We intended to develop a fall screening instrument for clinical ly defined subgroups of long-term care residents , to be administered by nursing staff . Methods : Fall risk indicators were selected by multiple logistic regression in three pre-defined subgroups . The first consisted of residents who were not able to transfer , defined as a change from sit-to-st and position , without physical assistance ( NAT ) . The second subgroup comprised residents who were able to transfer , but who had had a recent fall during the last 6 months ( AT-F ) . Residents who were able to transfer but had had no recent fall ( AT-NF ) were in the third subgroup . The prospect i ve observational study included 472 long-stay residents ( mean age 84 years , 79 % female ) from three community nursing homes , with a followup period of 12 months . Results : Fall incidence was highest in the AT-F subgroup : 6066 per 1000 resident years . The risk indicators identified included a positive fall history and restraint use in the NAT group , transfer assistance in the AT-F group , and urinary incontinence and visual impairment in the AT-NF group . Conclusions : The identification of different risk indicators in the subgroups indicates that specific strategies may be more appropriate to improve the effectiveness of fall prevention in long-term care , than the application of one strategy to all residents . The identification of incontinence , visual impairment , and restraints as risk indicators stresses the need for intervention studies which specifically address these items One hundred healthy men and women aged 65 - 85 took part in a prospect i ve study . They were clinical ly examined and underwent laboratory tests of gait , balance and reaction time at the start of an observation year . All falls occurring in that year were analysed in detail . Three-quarters of them were trips or slips ; however , ten personal factors were identified which , if present , increased the likelihood of a fall occurring . These were : disturbance of gait following a rest period accompanied by a lighting change ( in persons aged 70 and over ) ; an absent or abnormal plantar reflex ; failure to wear prescribed spectacles ; the presence of anxiety/depression , of a foot problem , or of two or more self-perceived limitations on mobility ; a history of former wearing of high heels ; a sustained drop in pulse pressure 5 min after cessation of a rest period ; restricted neck movements ; and the presence of an inverse Romberg ratio . The number of circumstantial and personal factors contributing to the falls varied between thr Background : Falls are the most common cause of injury and hospitalization and one of the principal causes of death and disability in older adults worldwide . This study aim ed to determine if a method based on body-worn sensor data can prospect ively predict falls in community-dwelling older adults , and to compare its falls prediction performance to two st and ard methods on the same data set . Methods : Data were acquired using body-worn sensors , mounted on the left and right shanks , from 226 community-dwelling older adults ( mean age 71.5 ± 6.7 years , 164 female ) to quantify gait and lower limb movement while performing the ‘ Timed Up and Go ’ ( TUG ) test in a geriatric research clinic . Participants were contacted by telephone 2 years following their initial assessment to determine if they had fallen . These outcome data were used to create statistical models to predict falls . Results : Results obtained through cross-validation yielded a mean classification accuracy of 79.69 % ( mean 95 % CI : 77.09–82.34 ) in prospect ively identifying participants that fell during the follow-up period . Results were significantly ( p < 0.0001 ) more accurate than those obtained for falls risk estimation using two st and ard measures of falls risk ( manually timed TUG and the Berg balance score , which yielded mean classification accuracies of 59.43 % ( 95 % CI : 58.07–60.84 ) and 64.30 % ( 95 % CI : 62.56–66.09 ) , respectively ) . Conclusion : Results suggest that the quantification of movement during the TUG test using body-worn sensors could lead to a robust method for assessing future falls risk BACKGROUND Little is known about the prevalence of falls and the related risk factors in the general population of community-living older people in Germany . OBJECTIVES To assess the prevalence and related predictors of different types of falls  in a sample of community-dwelling 65 years and older people in Germany living in a metropolitan area . Study design and setting prospect i ve cohort study in 622 community dwelling people aged > or = 65 years . RESULTS A total of 107 persons ( 17.2 % ) reported falling at least once ( occasional fallers ) , while 36 ( 5.7 % ) experienced two or more falls ( recurrent fallers ) in the last 6 months . Main predictors for all fallers were age ( OR 1.8 ; 95 % CI 1.1 - 3.0 ) , being female ( OR 1.7 ; 95 % CI 1.1 - 2.2 ) , living alone ( OR 1.9 ; 95 % CI 1.2 - 2.9 ) , poor health status ( OR 3.3 ; 95 % CI 2.1 - 5.3 ) , varifocals ( OR 1.7 ; 95 % CI 1.0 - 3.1 ) , disturbance of memory ( OR 1.7 ; 95 % CI 1.0 - 3.0 ) , depression ( OR 4.8 ; 95 % CI 2.5 - 9.2 ) , sleep disturbances ( OR 2.7 ; 95 % CI 1.7 - 4.3 ) , incontinence ( OR 2.1 ; 95 % CI 1.3 - 4.9 ) , dizziness ( OR 3.0 ; 95 % CI 1.9 - 5.0 ) , 3 medical conditions or more ( OR 3.3 ; 95 % CI 2.1 - 5.1 ) , lower physical functioning and mobility . Two of the strongest predictors were reported falls ( OR 4.9 ; 95 % CI 3.1 - 7.7 ) and recurrent falls ( OR 10.0 ; 95 % CI 5.0 - 20.0 ) in the last 6 months . CONCLUSION Older adults living at home should be screened for falls in history and problems in gait and mobility in any anamnesis to identify those who are at risk for falls IMPORTANCE The appropriate treatment target for systolic blood pressure ( SBP ) in older patients with hypertension remains uncertain . OBJECTIVE To evaluate the effects of intensive ( < 120 mm Hg ) compared with st and ard ( < 140 mm Hg ) SBP targets in persons aged 75 years or older with hypertension but without diabetes . DESIGN , SETTING , AND PARTICIPANTS A multicenter , r and omized clinical trial of patients aged 75 years or older who participated in the Systolic Blood Pressure Intervention Trial ( SPRINT ) . Recruitment began on October 20 , 2010 , and follow-up ended on August 20 , 2015 . INTERVENTIONS Participants were r and omized to an SBP target of less than 120 mm Hg ( intensive treatment group , n = 1317 ) or an SBP target of less than 140 mm Hg ( st and ard treatment group , n = 1319 ) . MAIN OUTCOMES AND MEASURES The primary cardiovascular disease outcome was a composite of nonfatal myocardial infa rct ion , acute coronary syndrome not result ing in a myocardial infa rct ion , nonfatal stroke , nonfatal acute decompensated heart failure , and death from cardiovascular causes . All-cause mortality was a secondary outcome . RESULTS Among 2636 participants ( mean age , 79.9 years ; 37.9 % women ) , 2510 ( 95.2 % ) provided complete follow-up data . At a median follow-up of 3.14 years , there was a significantly lower rate of the primary composite outcome ( 102 events in the intensive treatment group vs 148 events in the st and ard treatment group ; hazard ratio [ HR ] , 0.66 [ 95 % CI , 0.51 - 0.85 ] ) and all-cause mortality ( 73 deaths vs 107 deaths , respectively ; HR , 0.67 [ 95 % CI , 0.49 - 0.91 ] ) . The overall rate of serious adverse events was not different between treatment groups ( 48.4 % in the intensive treatment group vs 48.3 % in the st and ard treatment group ; HR , 0.99 [ 95 % CI , 0.89 - 1.11 ] ) . Absolute rates of hypotension were 2.4 % in the intensive treatment group vs 1.4 % in the st and ard treatment group ( HR , 1.71 [ 95 % CI , 0.97 - 3.09 ] ) , 3.0 % vs 2.4 % , respectively , for syncope ( HR , 1.23 [ 95 % CI , 0.76 - 2.00 ] ) , 4.0 % vs 2.7 % for electrolyte abnormalities ( HR , 1.51 [ 95 % CI , 0.99 - 2.33 ] ) , 5.5 % vs 4.0 % for acute kidney injury ( HR , 1.41 [ 95 % CI , 0.98 - 2.04 ] ) , and 4.9 % vs 5.5 % for injurious falls ( HR , 0.91 [ 95 % CI , 0.65 - 1.29 ] ) . CONCLUSIONS AND RELEVANCE Among ambulatory adults aged 75 years or older , treating to an SBP target of less than 120 mm Hg compared with an SBP target of less than 140 mm Hg result ed in significantly lower rates of fatal and nonfatal major cardiovascular events and death from any cause . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01206062 OBJECTIVES This study was undertaken to determine whether vigorous and frail older people who identify environmental hazards in their homes have an increased risk for falls . METHODS A 1-year prospect i ve study was conducted among 266 female and 59 male community-dwelling volunteers aged 60 to 93 years who had fallen at least once during the previous year . Composite measures of home safety and of frailty were derived using principal components analysis . Participants were divided into vigorous and frail groups , and associations between baseline home safety measures and falls at home over the follow-up year were compared between the two groups . RESULTS Frail individuals were more than twice as likely as vigorous individuals to fall during follow-up ( rate ratio [ RR ] = 2.24 ; 95 % confidence interval [ CI ] = 1.54 , 3.27 ) . In the study group as a whole , falls were not strongly associated with the presence of home hazards . However , when compared with vigorous older persons living with fewer home hazards , vigorous older persons living with more home hazards were more likely to fall . The increased risk for falls among vigorous elderly was limited to falls where home hazards were present . By contrast , living with more home hazards was not associated with increased likelihood of falls among frail older persons . CONCLUSIONS While frail older persons experience higher overall fall rates , vigorous older persons should not be overlooked in fall prevention projects BACKGROUND polypharmacy is an important risk factor for falls , but recent studies suggest only when including medications associated with increasing the risk of falls . DESIGN a prospect i ve , population -based cohort study . SUBJECTS 6,666 adults aged ≥50 years from The Irish Longitudinal study on Ageing . METHODS participants reported regular medication use at baseline . Any subsequent falls , any injurious falls and the number of falls were reported 2 years later . The association between polypharmacy ( > 4 medications ) or fall risk-increasing medications and subsequent falls or injurious falls was assessed using modified Poisson regression . The association with the number of falls was assessed using negative binomial regression . RESULTS during follow-up , 231 falls per 1,000 person-years were reported . Polypharmacy including antidepressants was associated with a greater risk of any fall ( adjusted relative risk ( aRR ) 1.28 , 95 % CI 1.06 - 1.54 ) , of injurious falls ( aRR 1.51 , 95 % CI 1.10 - 2.07 ) and a greater number of falls ( adjusted incident rate ratio ( aIRR ) 1.60 , 95 % CI 1.19 - 2.15 ) , but antidepressant use without polypharmacy and polypharmacy without antidepressants were not . The use of benzodiazepines was associated with injurious falls when coupled with polypharmacy ( aRR 1.40 , 95 % CI 1.04 - 1.87 ) , but was associated with a greater number of falls ( aIRR 1.32 , 95 % CI 1.05 - 1.65 ) , independent of polypharmacy . Other medications assessed , including antihypertensives , diuretics and antipsychotics , were not associated with outcomes . CONCLUSION in middle-aged and older adults , polypharmacy , including antidepressant or benzodiazepine use , was associated with injurious falls and a greater number of falls
ORs were generally higher for recurrent fallers than for all fallers .
This meta- analysis provides comprehensive evidence -based assessment of risk factors for falls in older people , confirming their multifactorial etiology .
Some nonspecific indicators of high baseline risk were also strong predictors of the risk of falling
BACKGROUND Falls are the main cause of accidental death in persons aged 65 years or older .