Injuries. Incidence, risk factors and consequences of falls among elderly subjects living in the community. A criteria-based analysis

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Abstract
In order to obtain an overview of the incidences, risk factors and health consequences of falls among elderly persons living in the community from the available literature, a Medline computer search of publications over the period 1981–1994 was carried out. Fourteen studies met the following inclusion criteria: i) the study is an original investigation of falls among the elderly, ii) the study deals with the incidence, risk factors and/or consequences of falls among the elderly and iii) the study refers to a population at risk consisting of persons aged 60 years or over belonging to a population relevant to general practice. The selected studies were subjected to a methodological assessment on the basis of 10 methodological criteria. All the studies were independently assessed by 1 author and 1 assistant to obtain a methodological consensus. The relevant outcomes of these studies are reported. Pooling of data was not performed because of relevant differences between the studies. Two studies met all methodological criteria and 2 other studies were second best. These 4 studies were given preference. Approximately 30% of subjects older than 65 years fall at least once a year and approximately 15% fall recurrently. The main risk factors for falls among the elderly belong to the intrinsic (patient-related) risk factors: cognitive impairment, balance and gait disorders, use of sedatives and hypnotics, a history of stroke, advanced age, arthritis of the knee and a high level of dependence. Extrinsic (environment-related) risk factors did not play a significant role in any of the studies. Not all studies dealt with the health consequences of falls among the elderly. Major injuries were reported in 0.5–9% and fractures in 3–14%.

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