Trends in Deaths From Falls Among Adults Aged 65 Years or Older in the US, 1999-2020.

This study examines trends in deaths from falls among adults aged 65 years or older by sex and by race and ethnicity between 1999 and 2020 in the US.

Big data on the prevalence of injury deaths among 187 488 elderly Chinese in the past 20 years (2000-2020): a systematic review and meta-analysis.

BACKGROUND: This study systematically reviewed injury death and causes in the elderly population in China from 2000 to 2020, to prevent or reduce the occurrence of injuries and death. METHODS: The CNKI, VIP, Wan Fang, MEDLINE, Embase, SinoMed, and Web of Science databases were searched to collect epidemiological characteristics of injury death among elderly over 60 years old in China from January 2000 to December 2020. Random effects meta-analysis was performed to pool injury mortality rate and identify publication bias, with study quality assessed using the AHRQ risk of bias tool. RESULTS: (1) A total of 41 studies with 187 488 subjects were included, covering 125 million elderly. The pooled injury mortality rate was 135.58/105 [95%CI: (113.36 to 162.14)/105], ranking second in the total death cause of the elderly. (2)Subgroup analysis showed that male injury death (146.00/105) was significantly higher than that of females (127.90/105), and overall injury mortality increased exponentially with age (R2 = 0.957), especially in those over 80 years old; the spatial distribution shows that the injury death rate in the central region is higher than that in the east and west and that in the countryside is higher than that in the city; the distribution of death time shows that after entering an aging society (2000-2020) is significantly higher than before (1990-2000). (3) There are more than 12 types of injury death, and the top three are falling, traffic accidents, and suicide. CONCLUSIONS: China's elderly injury death rate is at a high level in the world, with more males than females, especially after the age of 80. There are regional differences. The main types of injury death are falling, traffic, and suicide. During the 14th Five-Year Plan period, for accidental injuries and death, a rectification list for aging and barrier-free environments was issued. PROSPERO REGISTRATION: The systematic review was registered in PROSPERO under protocol number CRD42022359992.

An Overview of Amish Mortalities at a Level I Trauma Center.

BACKGROUND: The Amish population is a unique subset of patients that may require a specialized approach due to their lifestyle differences compared to the general population. With this reasoning, Amish mortalities may differ from typical trauma mortality patterns. We sought to provide an overview of Amish mortalities and hypothesized that there would be differences in injury patterns between mortalities and survivors. METHODS: All Amish trauma patients who presented and were captured by the trauma registry at our Level I trauma center over 20 years (1/2000-2004/2020) were analyzed. A retrospective chart review was subsequently performed. Patients who died were of interest to this study. Demographic and clinical variables were analyzed for the mortalities. Mortalities were then compared to Amish patients who survived. RESULTS: There were 1827 Amish trauma patients during the study period and, of these, 32 (1.75%) were mortalities. The top 3 mechanisms of injury leading to mortality were falls (34.4%), pedestrian struck (21.9%), and farming accidents (15.6%). Pediatric (age ≤ 14y) (25%) and geriatric (age ≥ 65y) (28.1%) had the highest percentage of mortalities. Mortalities in the Amish population were significantly older (mean age: 39 years vs 27 years, P = .003) and had significantly higher ISS (mean ISS: 29 vs 10, P < .001) compared to Amish patients who survived. DISCUSSION: The majority of mortalities occurred in the pediatric and geriatric age groups and were falls. Further intervention and outreach in the Amish population should be done to highlight this particular cause of mortality. LEVEL OF EVIDENCE: Level III, epidemiological.

Falls - the socio-economic and medical aspects important for developing prevention and treatment strategies.

INTRODUCTION: Although falls occur extremely frequently, they are still one of the least investigated causes of death. According to the World Health Organization, around 37.3 million falls occur globally every year resulting in the deaths of over 660,000 adults and almost 30,000 children. OBJECTIVE: The aim of this review is to evaluate the most up-to-date and comprehensive knowledge on falls and their consequences, especially in populations at the highest risk of fatal falls. BRIEF DESCRIPTION OF STATE OF KNOWLEDGE: Currently, there is a limited amount of literature which analyzes falls. Falls affect all age groups, but their location, cause, and severity vary among different populations. Individuals who are particularly at risk of falling at home include younger children and the elderly. Research indicates that falls are one of the main causes of work-related injuries and deaths, especially those occurring at significant heights. Falls in the home environment are the second most common cause of death in over 33% of accidents and the main cause of injury in 41.2% of accidents. During patient hospitalizations, falls generate additional burdens and costs on the healthcare system. CONCLUSIONS: This review elaborated on the nature of falls in different populations and analyzed the influence falls have on the healthcare system, in society, and on the economy. This knowledge is particularly important in an aging society, which will inevitably face increasing problems due to falls in the near future. As the emphasis on falls increases, leaders and lawmakers will be pushed to establish individualized prevention measures, as described in this review, for specific risk groups to effectively prevent falls and their consequences.

Factors influencing the injury severity score and the probability of survival in patients who fell from height.

In Japan, falls from height result in the second highest trauma mortality rate after traffic motor vehicle collisions and the highest trauma-related mortality rate amongst young people. We aimed to identify factors that worsen injury severity and lower survival probability of patients who fell from height and to contribute to the improvement of their prehospital and in-hospital care. This retrospective analysis retrieved hospital records of 179 patients aged ≥ 15 years who were transported to our hospital after a fall from height during April 2014-March 2020. On multiple regression analysis, fall height ≥ 5 m more significantly resulted in higher the injury severity score. Logistic regression analysis revealed that fall height ≥ 5 m with the reference of 2-3 m significantly resulted in lower the survival probability with odds ratio (95% confidence interval) of 0.10 (0.02-0.55). Using 'feet-first' as the reference body position, the odds ratios (95% confidence interval) of survival for those who impacted the surface on the lateral or dorsal regions were 0.11 (0.02-0.64) and 0.17 (0.03-0.99), respectively. Collecting information on the abovementioned factors at pre-hospitalisation may facilitate prompt diagnosis and treatment. These results may help improve prehospital and in-hospital care, avoiding preventable trauma deaths.

Epidemiological changes of geriatric trauma in the United Arab Emirates.

ABSTRACT: We aimed to study the epidemiological changes in geriatric trauma in Al-Ain City, United Arab Emirates, in the past decade to give recommendations on injury prevention.Trauma patients aged 65 years and above who were hospitalized at Al-Ain Hospital for more than 24 hours or died in the hospital after their arrival regardless of the length of stay were studied. Data were extracted from the Al-Ain Hospital trauma registry. Two periods were compared; March 2003 to March 2006 and January 2014 to December 2017. Studied variables which were compared included demography, mechanism of injury and its location, and clinical outcome.There were 66 patients in the first period and 200 patients in the second period. The estimated annual incidence of hospitalized geriatric trauma patients in Al-Ain City was 8.5 per 1000 geriatric inhabitants in the first period compared with 7.8 per 1000 geriatric inhabitants in the second period. Furthermore, mortality was reduced from 7.6% to 2% (P = 0.04). There was a significant increase in falls on the same level by14.9% (62.1%-77%, P = 0.02, Pearson χ2 test). This was associated with a significant increase of injuries occurring at home (55.4%-78.7% P = 0.0003, Fisher Exact test). There was also a strong trend in the reduction of road traffic collision injuries which was reduced by 10.8% (27.3%-16.5%, P = 0.07, Fisher Exact test).Although the incidence and severity of geriatric trauma did not change over the last decade, in-hospital mortality has significantly decreased over time. There was a significant increase in injuries occurring at homes and in falls on the same level. The home environment should be targeted in injury prevention programs so as to reduce geriatric injuries.

Trends in Geriatric Ground-Level Falls: Report from the National Trauma Data Bank.

INTRODUCTION: Ground-level falls (GLF) are typically reported as a minor mechanism of injury; however, they represent a significant portion of hospitalized geriatric trauma patients as they can result in multisystem injury in this subset of the population. Our study aimed to analyze trends in geriatric trauma falls on the national level. METHODS: We performed a 5-y (2011-2015) analysis of the American College of Surgeons National Trauma Data Bank (ACS-NTDB) and included all geriatric trauma patients (age ≥ 65 y) who presented with GLF. GLF was identified using ICD-9 E CODES. Our outcome measures were national incidence of GLF, and overall discharge disposition and trauma center level discharge disposition following GLF. We used Cochran Armitage test and multivariate regression analysis. RESULTS: We analyzed a total of 1,017,326 geriatric trauma patients, of which 39% had had a fall as a mechanism of injury. Among those who fell, mean age was 78 ± 7, 63% were females, and 85% were whites. The incidence of falls significantly increased over the study period, and was noted to be proportional to age, with a plateau beyond age 85 y old. The rate of discharge to SNF and/or Rehab significantly increased over the study period; however, discharge to home and mortality rates trended downwards over the study period. Discharge to SNF and/or Rehab was significantly lower among level I trauma centers compared to other level trauma centers. Conversely, discharge to home was higher in level I trauma centers compared to other level trauma centers. CONCLUSION: Around one in three elderly trauma patients were admitted following a GLF with an overall increased incidence of falls over time. Although overall mortality rates decreased, there was an increase in adverse discharge disposition and loss of functional independence over the study period, mostly among those admitted to non-level I trauma centers.

Falls are common, morbid, and predictable in patients with cirrhosis.

BACKGROUND & AIMS: Falls are a devastating complication of cirrhosis. The risk of falls in patients without hepatic encephalopathy (HE) is unclear. Further, bedside tools for predicting falls are lacking. Thus, we aimed to internally validate a predictive model for falls and evaluate the association between incident falls and mortality. METHODS: We prospectively enrolled 299 patients with currently compensated Child A-B (70% Child-Pugh A) cirrhosis and portal hypertension without prior HE from 7/2016-8/2018. We followed patients for a median of 1,003 days (IQR 640-1,102) for incident falls accounting for the competing risk of death or transplantation. Candidate baseline fall predictors included patient-reported outcomes (e.g. Short-Form-8), physical function (e.g. chair-stands), blood tests (e.g. model for end-stage liver disease-sodium [MELD-Na] and its components), and cognitive function (using inhibitory control testing). RESULTS: During follow-up: 141 (47%) patients experienced falls, with 38 (13%) sustaining injuries, 49 (16%) died and 13 (4%) received transplants. Median time to a fall was 279 (98-595) days. The overall probability of falls was 28.8% and 50.2% at years 1 and 3; the probability of injurious falls was 9.1% and 16.5%, respectively. We derived a predictive model for falls. The FallSSS score (prior falls, chair-stands, sodium, and SF-8) had an AUROC for injurious falls at 6- and 12-months of 0.79 and 0.81, while MELD-Na's AUROC was 0.57 for both. Adjusting for baseline Child-Pugh class, MELD-Na, albumin level, disability status, and comorbidities, both incident falls (subdistribution hazard ratio [sHR] 2.76; 95% CI 1.46-5.24) and HE (sHR 4.25; 95% CI 2.15-8.41) were strongly and independently associated with mortality. CONCLUSION: Our prospective study of patients with cirrhosis without a baseline history of HE demonstrates that falls are common, morbid, and predictable. These data highlight both the value of expanding screening to patients with cirrhosis and the potential for benefit in studies of interventions to address fall-risk in this vulnerable population. LAY SUMMARY: Falls are a devastating complication of cirrhosis. Bedside tools for predicting falls are lacking. We found that falls were very common and often associated with serious injuries. Falls were also associated with an increased risk of death. Falls could be predicted with an algorithm called FallSSS - based on prior history of falls, blood sodium level, number of chair-stands performed in 30 seconds, and quality of life.

Redefining geriatric trauma: 55 is the new 65.

INTRODUCTION: As the prevalence of geriatric trauma patients has increased, protocols are being developed to address the unique requirements of this demographic. However, categorical definitions for geriatric patients vary, potentially creating confusion concerning which patients should be cared for according to geriatric-specific standards. The aim of this study was to identify data-driven cut points for mortality based on age to support implementation of age-driven guidelines. METHODS: Adults aged 18 to 100 years with blunt or penetrating injury were selected from 95 hospitals' trauma registries. Change point analysis techniques were used to detect inflection points in the proportion of deaths at each age. Based on these calculated points, patients were allocated into age groups, and their characteristics and outcomes were compared. Logistic regression was used to estimate risk-adjusted in-hospital mortality controlling for sex, race, Injury Severity Score, Glasgow Coma Scale, and number of comorbidities. RESULTS: A total of 255,099 patients were identified (female, 45.7%; mean age, 59.3 years; mean Injury Severity Score, 8.69; blunt injury, 92.6%). Statistically significant increases in mortality rate were noted at ages 55, 77, and 82 years. Compared with the referent group (age, <55 years), adjusted odds ratios (AORs) showed increases in mortality if age 55 to 76 years (AOR, 2.42), age 77 to 81 years (AOR, 4.70), or age 82 years or older (AOR, 6.43). National Trauma Data Standard-defined comorbidities significantly increased once age surpassed 55 years, as the rate more than doubled for each of the older age categories (p < 0.001). As age increased, each group was more likely to be female, have dementia, sustain a ground level fall, and be discharged to a skilled nursing facility (p < 0.001). CONCLUSION: This large multicenter analysis established a clinically and statistically significant increase in mortality at ages 55, 77, and 82 years. This research strongly suggests that trauma patients older than 55 years be considered for inclusion in geriatric trauma protocols. The other age inflection points identified (77 and 82 years) may also warrant additional specialized care considerations. LEVEL OF EVIDENCE: Epidemiological study, level III; Care management, level IV.

Injury-related deaths in the Ontario provincial trauma system: a retrospective population-based cohort analysis.

BACKGROUND: Although Ontario has an established trauma system, it experiences a substantial burden of morbidity and mortality from injury. Our objective was to describe patterns of fatal injury in Ontario, with a focus on location of death (out of hospital, trauma or non-trauma centre) and receipt of surgical intervention before death. METHODS: We conducted a retrospective population-based cohort study using linked administrative data on fatal injuries in children and adults (no age restrictions) in Ontario between 2000 and 2016. We identified injury-related deaths in the Ontario Registrar General Death database. We developed descriptive statistics for injury characteristics and causes of death. We calculated the fatal injury incidence rate for each year of the study. The primary outcome was cause of death; the secondary outcome was receipt of surgical intervention. RESULTS: The analysis included 19 408 people. The mean annual incidence of fatal injury averaged 8.7 (95% confidence interval 7.7-9.6) per 100 000. The most common mechanisms of injury were motor vehicle collisions (12 065, 62.2%), followed by gunshot wounds (3134, 16.1%) and falls (2387, 12.3%). Deaths frequently occurred out of hospital (72.6%), rather than at a trauma centre (14.2%) or non-trauma centre (13.2%). Patients treated at trauma centres were significantly more likely to receive a surgical intervention (standardized difference 0.6) than those treated at non-trauma centres. INTERPRETATION: Most injury deaths in Ontario occur in the out-of-hospital setting or are managed at non-trauma centres; many patients receive no surgical intervention before death. There are likely opportunities to improve access to specialized injury care in Ontario's trauma system.

Fall-related hospitalization of patients in Iran.

PURPOSE: Trauma has been called the neglected disease of modern society. According to WHO, fall is the second major cause of trauma or deaths resulting from unintentional accidents. The aim of this study was to investigate the different types of fall according to International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) in hospitalized patients visiting specialized accident and trauma hospitals of Mashhad, Iran. METHODS: This was a cross sectional retrospective study performed between March 20, 2013 and March 20, 2014. The research population consisted of all medical records of patients for fall injuries in three specialized accident and trauma hospitals. ICD-10 was adopted to categorize all types of falls (w00-w19). The results obtained were analyzed by SPSS 16. RESULTS: Altogether 7,448 cases were included. The codes w18 (fall on same level) and w09 (fall involving playground equipment) with the frequencies of 1,856 and 1,303, respectively in both genders had the maximum number of falls. The maximum percentage of mortality has been related to "fall on and from ladder"," fall from cliff "and "fall on same level involving ice and snow". CONCLUSION: As falls can cause irrecoverable injuries including mortality of people, thus health authorities and policymakers should take preventive measures given the causes of falls and the root of this type of injuries, so that the costs resulting from this cause and its injuries can be reduced.

Relationship of injuries detected in fatal falls with sex, body mass index, and fall height: An autopsy study.

Falls from height are the most common cause of blunt trauma after traffic accidents. The focus of this retrospective study was to analyze the relationship between injuries in fatal falls and fall height, body mass index (BMI), and sex in 206 autopsy reports. Age, sex, weight, height, place of the fall, fall height, period between the incidence and death, external examination findings in the autopsy, intracranial findings, fractures, internal organ injuries, and information about the causes of death were recorded. Accidents and men were the largest groups. Injuries to the upper and lower extremities were frequently detected in accidents. Lower extremity injuries were more common in women. The occurrence of head and neck injuries were rare in overweight individuals. When evaluated by manner of death, there were differences in extremities and posterior body injuries. There was no difference between sex in terms of autopsy findings. It was observed that the injuries increased as the height increased. There was a statistical difference between the BMI groups in terms of liver, rib and sternum injuries. The most common cause of death was head injuries. Many factors have been known to affect injury patterns in cases of falls from height. Fall height, BMI, and gender are just a few of these factors. This study will be beneficial to support the findings of this study with larger-scale studies and statistical modeling that consider more factors affecting injuries in cases of falls.

When falls become fatal-Clinical care sequence.

OBJECTIVES: This study encompassed fall-related deaths, including those who died prior to medical care, that were admitted to multiple healthcare institutions, regardless of whether they died at home, in long-term care, or in hospice. The common element was that all deaths resulted directly or indirectly from injuries sustained during a fall, regardless of the temporal relationship. This comprehensive approach provides an unusual illustration of the clinical sequence of fall-related deaths. Understanding this pathway lays the groundwork for identification of gaps in healthcare needs. DESIGN: This is a retrospective study of 2014 fall-related deaths recorded by one medical examiner's office (n = 511) within a larger dataset of all trauma related deaths (n = 1848). Decedent demographic characteristics and fall-related variables associated with the deaths were coded and described. RESULTS: Of those falling, 483 (94.5%) were from heights less than 10 feet and 394 (77.1%) were aged 65+. The largest proportion of deaths (n = 267, 52.3%) occurred post-discharge from an acute care setting. Of those who had a documented prior fall, 216 (42.3%) had a history of one fall while 31 (6.1%) had ≥2 falls prior to their fatal incident. For the 267 post-acute care deaths, 440 healthcare admissions were involved in their care. Of 267 deaths occurring post-acute care, 129 (48.3%) were readmitted within 30 days. Preventability, defined as opportunities for improvement in care that may have influenced the outcome, was assessed. Of the 1848 trauma deaths, 511 (27.7%) were due to falls of which 361 (70.6%) were determined to be preventable or potentially preventable. CONCLUSION: Our data show that readmissions and repeated falls are frequent events in the clinical sequence of fall fatalities. Efforts to prevent fall-related readmissions should be a top priority for improving fall outcomes and increasing the quality of life among those at risk of falling.

Long-Term Trends in Unintentional Fall Mortality in China: A Population-Based Age-Period-Cohort Study.

Background: Unintentional falls seriously threaten the life and health of people in China. This study aimed to assess the long-term trends of mortality from unintentional falls in China and to examine the age-, period-, and cohort-specific effects behind them. Methods: This population-based multiyear cross-sectional study of Chinese people aged 0-84 years was a secondary analysis of the mortality data of fall injuries from 1990 to 2019, derived from the Global Burden of Disease Study 2019. Age-standardized mortality rates of unintentional falls by year, sex, and age group were used as the main outcomes and were analyzed within the age-period-cohort framework. Results: Although the crude mortality rates of unintentional falls for men and women showed a significant upward trend, the age-standardized mortality rates for both sexes only increased slightly. The net drift of unintentional fall mortality was 0.13% (95% CI, -0.04 to 0.3%) per year for men and -0.71% (95% CI, -0.96 to -0.46%) per year for women. The local drift values for both sexes increased with age group. Significant age, cohort, and period effects were found behind the mortality trends of the unintentional falls for both sexes in China. Conclusions: Unintentional falls are still a major public health problem that disproportionately threatens the lives of men and women in China. Efforts should be put in place urgently to prevent the growing number of fall-related mortality for men over 40 years old and women over 70 years old. Gains observed in the recent period, relative risks (RRs), and cohort RRs may be related to improved healthcare and better education.

Antiplatelet and anticoagulant agents have minimal impact on traumatic brain injury incidence, surgery, and mortality in geriatric ground level falls: A multi-institutional analysis of 33,710 patients.

BACKGROUND: Falls are the leading cause of traumatic brain injury (TBI) and TBI-related deaths for older persons (age, ≥65 years). Antiplatelet and/or anticoagulant therapy (antithrombotics [ATs]) is generally felt to increase this risk, but the literature is inconsistent. The purpose of this study was to determine the impact of AT use on the rate, severity, and outcomes of TBI in older patients following ground level falls. METHODS: Ground level fall patients from 90 hospitals' trauma registries were selected. Patients were excluded if younger than 65 years or had an Abbreviated Injury Scale score of >2 in a region other than head. Electronic medical record data for preinjury AT therapy were obtained. Patients were grouped by regimen for no AT, single, or multiple agents. Groups were compared on rates of diagnosed TBI, TBI surgery, and mortality. RESULTS: There were 33,710 patients (35% male; mean age, 80.5 years; mean Glasgow Coma Scale, 14.6), with 47.6% on single or combination AT therapy. The proportion of patients with TBI diagnoses did not differ between those on no AT (21.25%) versus AT (21.61%; p = 0.418). Apixaban (15.7%; p < 0.001) and rivaroxaban (13.19%; p = 0.011) were associated with lower rates of TBI, and acetylsalicylic acid-clopidogrel was associated with a higher TBI rate (24.34%; p = 0.002) versus no AT. acetylsalicylic acid-clopidogrel was associated with a higher cranial surgery rate (2.9%; p = 0.006) versus no AT (1.96%), but surgery rates were similar for all other regimens. No regimen was associated with higher mortality. CONCLUSION: In this large multicenter study, the intake of ATs in older patients with ground level falls was associated with inconsistent effects on risk of TBI and no significant increases in mortality, indicating that AT use may have negligible impact on patient clinical management. A large, confirmatory, prospective study is needed because the commonly held belief that ATs uniformly increase the risk of traumatic intracranial bleeding and mortality is not supported. LEVEL OF EVIDENCE: Therapeutic/care management, level II.

Using Machine Learning to Make Predictions in Patients Who Fall.

BACKGROUND: As the population ages, the incidence of traumatic falls has been increasing. We hypothesize that a machine learning algorithm can more accurately predict mortality after a fall compared with a standard logistic regression (LR) model based on immediately available admission data. Secondary objectives were to predict who would be discharged home and determine which variables had the largest effect on prediction. METHODS: All patients who were admitted for fall between 2012 and 2017 at our level 1 trauma center were reviewed. Fourteen variables describing patient demographics, injury characteristics, and physiology were collected at the time of admission and were used for prediction modeling. Algorithms assessed included LR, decision tree classifier (DTC), and random forest classifier (RFC). Area under the receiver operating characteristic curve (AUC) values were calculated for each algorithm for mortality and discharge to home. RESULTS: About 4725 patients met inclusion criteria. The mean age was 61 ± 20.5 y, Injury Severity Score 8 ± 7, length of stay 5.8 ± 7.6 d, intensive care unit length of stay 1.8± 5.2 d, and ventilator days 0.7 ± 4.2 d. The mortality rate was 3% and three times greater for elderly (aged 65 y and older) patients (5.0% versus 1.6%, P < 0.001). The AUC for predicting mortality for LR, DTC, and RFC was 0.78, 0.64, and 0.86, respectively. The AUC for predicting discharge to home for LR, DTC, and RFC was 0.72, 0.61, and 0.74, respectively. The top five variables that contribute to the prediction of mortality in descending order of importance are the Glasgow Coma Score (GCS) motor, GCS verbal, respiratory rate, GCS eye, and temperature. CONCLUSIONS: RFC can accurately predict mortality and discharge home after a fall. This predictive model can be implemented at the time of patient arrival and may help identify candidates for targeted intervention as well as improve prognostication and resource utilization.

Riesgo de mortalidad asociado a caídas de personas mayores: México, 2001 ­ 2018 / Risk of mortality associated with falls in the elderly people: mexico, 2001 ­ 2018

INTRODUCCIÓN: Las caídas representan uno de los principales factores de riesgos a la salud de las personas mayores. El objetivo de esta investigación fue estimar los efectos de las caídas accidentales recurrentes en la mortalidad general de las personas con 60 y más años de edad. MATERIALES Y MÉTODO: Se realizó un análisis longitudinal con datos disponibles del Estudio Nacional de Salud y Envejecimiento en México 2001 - 2018. Se evaluó la recurrencia de las caídas definiéndola como la presencia de 1, 2 o 3 y más eventos en la entrevista basal. La mortalidad se estimó con modelos de riesgos proporcionales de Cox ajustando por un conjunto de variables asociadas a la presencia de caídas. RESULTADOS: En comparación con las personas sin reporte de caídas, se calculó un mayor riesgo de mortalidad entre quienes declararon una sola o dos y más caídas, aunque solo la estimación sin ajustar fue significativa, mientras que el mayor riesgo de muerte se estimó entre quienes declararon tres o más caídas incluso ajustando por variables sociodemográficas y de la salud. DISCUSIÓN: Las caídas recurrentes aumentan el riesgo de mortalidad entre las personas de edades avanzadas. Se sugiere el desarrollo de programas para la prevención y el tratamiento de las complicaciones derivadas de las caídas en adultos mayores. (AU)

INTRODUCTION: Falls represent one of the main health risks in the lives of older people. The objective of this research was to estimate the effects of recurrent accidental falls on the general mortality of people 60 years and older. MATERIALS AND METHOD: A longitudinal analysis was conducted with available data from the Mexican Health and Aging Study 2001 - 2018. The recurrence of falls was evaluated, categorized as 1, 2 or 3 and more falls in the baseline interview. Mortality was estimated relying on Cox proportional hazards models, deducting a set of variables associated with the presence of falls. RESULTS: Compared with people without reported falls, a higher risk of mortality was observed among those who reported one or two and more falls, although only the unadjusted estimate was significant, while the highest risk of death was estimated among those who reported three or more falls even adjusting for sociodemographic and health variables. DISCUSSION: Recurrent falls increase the risk of mortality among elderly people. The development of programs for the prevention and treatment of complications derived from falls in older adults is suggested. (AU)

Fall-related mortality trends in Australia and the United Kingdom: Implications for research and practice.

OBJECTIVES: To characterise changes in nationwide fall-related mortality rates in Australia and the United Kingdom (UK) between 2006 and 2016 by age group and sex. STUDY DESIGN: Trend analysis of falls mortality data from World Health Organization (WHO) Mortality Database for the Australian and UK population. MAIN OUTCOME MEASURES: We assessed age-specific, sex-specific and age-adjusted mortality rates. Mortality trends were assessed via the annual percentage change (APC) using joinpoint regression. RESULTS: The annual average age-adjusted falls mortality rate was 38.63 per 1,000,000 population in Australia, and 34.12 per 1,000,000 population in the UK. From 2006 to 2016, age-adjusted mortality rate due to falls increased in Australia and the UK by an average annual rate of 3.77% (95% CI 2.91% to 4.64%; p<0.01) and 2.11% (95% CI 1.43% to 2.80%; p<0.01) respectively. Death rates from falls increased with age. People aged ≥95 years had the highest mortality rate from falls in Australia and the UK. Men had a higher annual average age-adjusted mortality rate from falls than women (1.6 times higher in Australia and 1.7 times higher in the UK). Women had a larger annual percentage increase in falls mortality rate compared to men over the study period. CONCLUSIONS: There was a major increase in reported fall-related deaths in Australia and the UK between 2006 and 2016, especially in the very elderly. Men had a higher mortality rate from falls than women. Factors contributing to the apparent increases in fall-related mortality may include reduced cancer and cardiovascular mortality and better ascertainment of cause of death.

Characteristics, injuries, and clinical outcomes of geriatric trauma patients in Japan: an analysis of the nationwide trauma registry database.

Geriatric trauma is a major socio-economic problem, especially among the aging Japanese society. Geriatric people are more vulnerable to trauma than younger people; thus, their outcomes are often severe. This study evaluates the characteristics of geriatric trauma divided by age in the Japanese population. We evaluated trauma characteristics in patients (n = 131,088) aged ≥ 65 years by segregating them into 2 age-based cohorts: age 65-79 years (65-79 age group; n = 70,707) and age ≥ 80 years (≥ 80 age group; n = 60,381). Clinical characteristics such as patient background, injury mechanism, injury site and severity, treatment, and outcome were examined. Injuries among men were more frequent in the 65-79 age group (58.6%) than in the ≥ 80 age group (36.3%). Falls were the leading cause of trauma among the 65-79 age group (56.7%) and the ≥ 80 age group (78.9%). In-hospital mortality was 7.7% in the 65-79 age group and 6.6% in the ≥ 80 age group. High fall in the ≥ 80 age group showed 30.5% mortality. The overall in-hospital mortality was 11.8% (the 65-79 age group, 12.3%; the ≥ 80 age group, 11.2%). Most hospitalized patients were transferred to another hospital (the 65-79 age group, 52.5%; the ≥ 80 age group, 66.2%). We demonstrated the epidemiological characteristics of Japanese geriatric trauma patients. The overall in-hospital mortality was 11.8%, and fall injury in the ≥ 80 age group required caution of trauma care.

Increase in fall-related hospitalization, mortality, and lethality among older adults in Brazil.

OBJECTIVE To estimate the trends of fall-related hospitalization, mortality, and lethality among older adults in Brazil and regions. METHODS This is a descriptive study based on data from the Hospital Information System of the Brazilian Unified Health System. We included records of every older adult, aged 60 years or older, hospitalized for accidental fall from January, 1998 to November, 2015 in all Brazilian regions. We selected the codes E885, E886, E880, E884, E884 from the International Classification of Diseases, 9th revision, and W01, W03, W10, W17, W18 from the 10th revision, and calculated fall-related hospitalization and mortality rates per 100,000 inhabitants, as well as lethality. To estimate trends, we applied the Prais-Winsten regression for time series analysis. RESULTS During the period, 1,192,829 fall-related hospitalizations occurred, among which 54,673 had a fatal outcome; lethality was 4.5%. Hospitalization rates showed upward trends, with seasonality, in Brazil (11%), and in the Northeast (44%), Midwest (13%), and South regions (14%). The North showed a decreasing hospitalization rate (48%), and the Southeast a stationary one (3%). CONCLUSIONS In Brazil, fall-related hospitalizations, mortality, and lethality among older adults showed an upward trend from 1998 to 2015, with seasonal peaks in the second and third quarters. Considering we are in plain demographic transition, to improve hospital healthcare and encourage falls prevention programs among older adults is essential.