Differential risk factor profiles for indoor and outdoor falls in older people living at home in Nottingham, UK

The objectives of this work were: to estimate the incidence of falls within an at-risk group of community-dwelling elderly people; to assess the risk factors associated with incident falls; to examine the effects of incident falls on survival. A random sample of 1042 community-dwelling older people in Nottingham (UK) were interviewed in 1985 and survivors re-interviewed at 4-year follow-up. The at-risk group was defined as survivors who had not f allen in the year prior to the baseline interview (n = 444). One-year fall recall was assessed using a questionnaire and included physical health, mob ility, prescribed drugs and time spent walking. Body-weight and handgrip st rength were measured. Eight-year post-fall mortality was recorded. In 1989 117 new fallers were identified. These people fell a total of 233 times in the year prior to re-interview (incidence rate: 524.8 per 1000 person-years at risk; 95% confidence intervals (CI): 473.3-576.3). People aged less tha n 75 were more likely to fall outdoors than people aged 75 and over (chi(2) = 5.715; df = 1, p = 0.017). Risk factors associated with falling were: be ing less healthy (odds ratio (OR): 0.55; p = 0.052); having a walking speed in the range stroll/very slow/non-ambulant compared with normal/brisk/fast (OR: 1.99; p < 0.01); and number of prescribed drugs (OR: 1.30; p = 0.01). When analysed separately, indoor and outdoor falls presented differential risk profiles, with evidence that indoor falls were associated with frailty , while outdoor falls were associated with compromised health status in mor e active people. In 8-year post-fall monitoring, multiple (3+) fallers and indoor fallers showed a significant excess mortality. The differences in ri sk factors for, and prognoses following, indoor and outdoor falls, emphasis e the complex interactions between intrinsic and extrinsic factors associat ed with falling among older people.