Heikki Luukinen

Incidence of Injury-Causing Falls Among Older Adults by Place of Residence: A Population-Based Study

OBJECTIVE: To describe the incidence and associated factors of injury‐causing falls by place of residence.

Fracture risk associated with a fall according to type of fall among the elderly.

Abstract: The kinetic energy and direction of a fall contribute to the occurrence of fracture. However, the fracture risk associated with different types of fall, different amounts of energy and different landing directions is poorly understood. u2003We recorded all falls and fall-related fractures over 7 years in an aged semi-rural home-dwelling population (n= 980), using intensive fall recording. The falls were classified according to type and place of occurrence into slip falls (SLFs), trip falls (TRFs), other extrinsic falls on the level (OEFs), intrinsic falls on the level (IFs), stair falls (STFs), falls from an upper level (ULFs) and nondefined falls (NDFs) occurring indoors or outdoors. Incidences of falls and fractures were calculated for the whole follow-up period. The population was clinically examined to assess general risk factors of fracture, after which the risk of fracture was determined in the first fall according to the different fall types. Comparison was made with intrinsic falling on the level. The overall incidences of indoor and outdoor falls were 328 (95% CI 314–345) and 198 (186–210) per 1000 person-years (PY), respectively, and those of fractures 23 (19–27) and 11 (8–14) per 1000 PY, respectively. Indoor SLFs, TRFs, OEFs, IFs, STFs, ULFs and NDFs occurred relatively evenly throughout the study period. The crude and adjusted relative fracture risks were greater in SLFs, OEFs and STFs compared with IFs. Indoor falls and fractures are more common than those occurring outdoors in aged home-dwelling persons. The kinetic energies produced in SLFs, OEFs and STFs may be higher than those generated in IFs, leading to increased risk of fracture.

Factors predicting fractures during falling impacts among home-dwelling older adults.

OBJECTIVE: To investigate the predictors of fractures during falling impacts among home‐dwelling older adults.

Orthostatic hypotension and the risk of myocardial infarction in the home‐dwelling elderly

Objectives.u2002 We investigated the prognostic significance of orthostatic hypotension on the risk of myocardial infarction (MI) amongst the elderly.

Falls risk among a very old home-dwelling population.

Objective. The aim of this prospective study was to examine risk factors of falling in a very old home-dwelling population. Design. A prospective study of home-dwelling elderly people. Methods. Baseline data were collected by home-nursing staff through postal questionnaires and clinical tests. Data on falls were recorded in telephone interviews every other month during a follow-up of 11 months constituting 494 person years (PY). Negative binomial modeling was used to assess fall risk. Setting. General community. Subjects. A population sample of home-dwelling subjects aged 85 years or older (n = 555). Main outcome measures. Fall rate and risk factors of falls. Results. Altogether 512 falls occurred in 273 (49%) subjects, incidence rate 1.03/PY. According to a multivariate model, history of recurrent falling, trouble with vision when moving, use of antipsychotic drug, and feelings of anxiety, nervousness, or fear were independent risk factors for subsequent falls. Conclusion. Appropriate care of poor vision and feelings of anxiety, nervousness, or fear, and avoidance of use of antipsychotic drugs might be useful in the prevention of falls among the most elderly home-dwellers.

Prevention of disability by exercise among the elderly: A population-based, randomized, controlled trial

Objective. To assess the effectiveness of an intervention planned and implemented by regional geriatric care teams in order to prevent disability in an elderly population. Design. Randomized, controlled trial with intention-to-treat and subgroup analyses. Subjects and setting. All home-dwelling persons aged 85 years or older in the City of Oulu (nu200a=u200a555, 67%), including 486 persons with a history of recurrent falls or at least one risk factor for disability in the activities of daily living (ADL) or mobility. Interventions. Programme consisting of home exercise, walking exercise, group exercise, and self-care exercise. Main outcome measures. Change in ADL and mobility during the intervention. Results. Change in ADL performance did not differ (pu200a=u200a0.462) but a positive change was found in mobility performance (pu200a=u200a0.013) in the intervention subjects (nu200a=u200a243) compared with the controls (nu200a=u200a243). At the end of the intervention period, severe mobility restrictions existed similarly in intervention and control subjects: 48 (34%) and 46 (31%) (pu200a=u200a0.650) respectively. Frequency of admissions into long-term institutional care were similar in intervention and control groups: 15 (7%) and 13 (6%) (pu200a=u200a0.669). Impaired balance existed in fewer intervention subjects (64, 45%) than controls (89, 59%) (pu200a=u200a0.015). Frequency and times of home exercise activity reduced in control subjects (pu200a<u200a0.001) but did not change in subjects assigned to home exercise intervention (pu200a>u200a0.05). Conclusion. A pragmatic intervention slowed down the reduction of movement performance but positive effects could not be found in subjects with severe movement and any ADL dysfunction. Positive effects were also found in balance performance.

Recurrent traumatic brain injury is predicted by the index injury occurring under the influence of alcohol

Background: Little is known of the role of alcohol intoxication as a risk factor for recurrent traumatic brain injuries (TBI). This study was a population-based longitudinal study to investigate this problem. Methods: The record linkage technique was used and data gathered from the Finnish Hospital Discharge Register, hospital records and by a questionnaire of family characteristics regarding the 12 058 subjects forming the Northern Finland Birth Cohort of 1966. Excluded were TBI subjects injured before the age of 12 years. Results: Of the 236 patients who had survived their first (mainly mild) TBI, 21 had had a recurrent TBI and three of them two recurrent TBIs during the follow-up period (from 1978–2000). An alcohol-related first injury (RR 4.41, 95% CI 1.53–12.70) and urban place of birth (RR 4.39, 95% CI 1.68–11.48) were significant independent predictors of recurrent TBI. A significant positive correlation between the first and recurrent TBIs with respect to alcohol involvement (rs= 0.61, p= 0.003) was observed. Conclusions: A first TBI related to alcohol drinking is predictive of recurrent TBI, which will often similarly be alcohol-related. The risk of recurrent injury seems to extend over several years after the first TBI. To prevent recurrence, efforts should be made to identify those with an alcohol-related first TBI. A brief intervention focused on drinking habits is needed as an immediate preventive measure.

Risk factors for cervical and trochanteric hip fracture during a fall on the hip.

Objective - The aim of this study was to elucidate factors related to hip fracture in patients who fall on the hip in order to identify those patients who might benefit from the use of hip protectors. Design - The study was performed by comparing 146 persons who had fallen and sustained a soft tissue injury in the hip region with 146 cervical hip fracture and 146 trochanteric hip fracture patients matched for age, sex and place of residence. Patients - The fall group was drawn from a prospectively collected cohort of 1061 elderly people participating in an epidemiological survey on fall injuries; the fracture group was drawn from a prospectively recorded hip fracture database of the Oulu University Hospital (n = 1714). Outcome measures - Demographic data, place and mechanism of falling, walking ability, associated diseases, medication. Results - In a stepwise polychotomous conditional logistic regression analysis, the following significant and independent risk factors for both fracture types were seen: low weight, tall height, falling from standing height and respiratory disease. Falling indoors was a risk for only trochanteric fractures, while inability to walk alone outdoors was a risk for only cervical hip fractures. Conclusions - Elderly persons with low weight, tall height, respiratory disease, tendency to fall indoors and inability to walk alone outdoors should be candidates for the use of hip protectors.

Recent decline in heavy outdoor work activity predicts occurrence of fractures among the home-dwelling elderly.

Abstract: The contribution of reduced physical activity of a defined duration to the risk of fall-related fractures and serious soft tissue injuries is not known. We conducted a prospective population-based study among the home-dwelling elderly to examine the association between a recent decline in physical activity and the occurrence of fall-related fractures and soft tissue injuries. The study population consisted of representative sample of home-dwelling older adults who conducted heavy outdoor work activity at least once a week at baseline (n= 284; 136 men, 148 women) and among whom in 93 persons (33%) heavy outdoor work activity was found to have declined during the 21/2 years follow-up. Fall-related fractures (n= 24) and serious soft tissue injuries (n= 49) were recorded from the time of the follow-up examination until the end of a further follow-up period lasting 31/2 years on average. A decline in heavy outdoor work activity did not predict the occurrence of soft tissue injuries (Mantel–Cox 0.795, pu2002=u20020.373), but a greater proportion of those with a decline (n= 14, 15%) than of others (n= 10, 5%) suffered fractures (Mantel–Cox 10.231, p= 0.001). Other risk factors for fractures were female sex (p= 0.03), slow choice reaction time (p= 0.02) and dependency as regards at least one basic activity of daily living (p= 0.01). According to the Cox proportional hazard model, the adjusted hazard ratio of fracture as regards a decline in heavy outdoor work activity was 2.7 (95% CI 1.14–6.62). A recent decline in heavy outdoor work activity predicts the occurrence of fractures, but not the occurrence of serious soft tissue injuries. Early recognition of a decline in physical activity may help in prevention of fractures among the elderly.

Depression in Elderly Spouse Pairs

OBJECTIVEnThis study aimed to investigate the prevalence of depression in aged spouse pairs and the associations between the occurrence of depression in one spouse (respondent) and the variables representing the respondent himself/herself and his/her partner.nnnMETHODnElderly (65 years or older) male (N = 176) and female (N = 176) spouses who constituted married couples that had participated in the epidemiological study on depression in old age conducted in Ahtäri, Finland, in 1989-1990 made up the study series. The data were collected by postal questionnaires, interviews, and clinical investigations. Depression was determined according to the DSM-III criteria.nnnRESULTSnBoth husband and wife were depressed in 5.7% of the married couples. The husband was depressed and the wife was nondepressed in 10.2% of the couples; and the wife was depressed and the husband nondepressed in 10.8% of the couples. Among male respondents, poor physical health of the respondent, poor marital or family relations felt by the respondent, poor family relations felt by the marital partner, and a loss of the father by the marital partner while the partner was under 20 years of age were independently related to depression. Lowered functional abilities of the respondent was the only factor independently associated with the occurrence of depression in female respondents.nnnCONCLUSIONSnThe coexistence of depression in both elderly spouses is not uncommon. The results also give some evidence to suggest that the vulnerability for the development of depression in the wives may have some effects on the development of depression in elderly men.