Circumstances and consequences of injurious falls among older women

From the Anderson Group, Division of Public Health Sciences

In older adults, falls are the leading cause of unexpected injury and older women are more likely to experience injurious falls than older men.  Around 30% of older adults, 65 years of age or greater, fall annually. Very few studies have examined risk factors associated with injurious falls in older adults. Dr. Garnet Anderson, Senior Vice President and Director of the Public Health Science Division, reported facts about falls in older populations, “Every year, 30% of Women’s Health Initiative (WHI) participants report falls and around 40% of falls result in an injury and 30% of those were serious, requiring medical attention.  Those that involve fractures or head injuries can cause severe morbidity and may even be life threatening.” There are predetermined risk factors for injurious falls from prospective studies: older age, female sex, white race, cognitive impairment, neuromuscular deficits, chronic conditions, and low body weight.  Circumstantial factors associated with injurious falls include stairs, turning around, or falling from at least body height.  Many studies have only examined serious fall injuries and evaluated participants with a high risk of falling, which is why it’s important to understand not only the risk factors but the circumstances and determinants of fall-related injuries over the complete spectrum of injury severity.

Dr. Anderson emphases the value of WHI for these types of studies: “The WHI participants, who now range in age from lower 70s to 101, are providing important insights into the health concerns of the increasingly US population of older women.” One effort that has recently yielded important results is the Objective Physical Activity and Cardiovascular Health (OPACH) study, an ancillary study of the Women’s Health Initiative (WHI), led by Dr. Andrea LaCroix, a WHI colleague from UCSD and a former Fred Hutch Member. OPACH recruited women from urban, suburban, and rural areas; 17% of minorities participated in the study. The purpose of OPACH was to identify associations of accelerometer-measured physical activity with incident cardiovascular and fall-related injuries.  Participants reported falls over a 13-month calendar.  Women were asked to update their calendar daily and report each individual fall; the falls were reported to the coordinating center monthly. In the event of a fall, women were interviewed via telephone to collect the details of the fall.  A total of 1043 women completed fall telephone interviews; 3593 women in the study did not fall.

The data collected from the interviews permitted Anderson and her colleagues, Dr. Elizabeth Phelan, a UW-based Geriatrician, and Drs. Lisa Johnson and Eileen Rillamas-Sun from the WHI Clinical Coordinating Center in  Public Health Sciences, to examine factors associated with injurious and non-injurious falls. The objective of the study included: (1) describing the health and behavioral characteristics of women who did not fall, fell without injury, fell with an injury and fell with serious injury, (2) identifying risk factors for fall-related injuries, (3) comparing circumstances and consequences of injurious and non-injurious falls.  The paper is published in Injury Prevention.

Graphical Representation of  Artist’s name:  Toa55 /
Artist’s name: Toa55 / Image from Dr. Elizabeth Phelan

Women who reported two or more falls in the past year had odds of experiencing an injurious fall in the subsequent year that were four times higher than women who did not report a fall in the previous year (OR =4.0, CI: 2.7 to 5.8) after controlling for other risk factors.  Interestingly, being black was associated with 0.6 lower odds of experiencing an injurious fall (CI: 0.4 to 0.9) after controlling for other risk factors. Approximately 37% of injurious falls occurred away from home and only 4% of injurious falls occurred while exercising.   About 60% of the falls within the 13-month calendar period were self-treated; 30% of the falls were considered serious injuries. Often, injurious falls result in women needing help or laying in place until help arrived.

Dr. Anderson summarized the study’s results, “WHI contributes unique and valuable information from the database on the health and lifestyles of these women developed over the last 25+ years.  We can look at these factors as predictors of future health conditions.  In this manuscript, developed with a new collaborator, Dr. Phelan and our team wanted to determine how to identify women at high risk of injurious falls. Repeated falls in the last year was the most potent predictor of injurious falls, eclipsing all other risk factors.” To follow-up this study’s results, Dr. Anderson along with Dr. Phelan and Dr. Hendrika W Meischke of the UW School of Public Health propose to develop and test a public health intervention to reduce the risk of injurious falls in older women. With the aging population and the so-called silver tsunami of cancer survivors, injurious falls and similar concerns will only increase. Dr. Anderson concluded, “By looking at older populations, we may find ways to help the older cancer patient as well.”

The WHI program is funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, U.S. Department of Health and Human Services through contracts HHSN268201600018C, HHSN268201600001C, HHSN268201600002C, HHSN268201600003C, and HHSN268201600004C.

Fred Hutch/UW Cancer Consortium member: Garnet L. Anderson.

Phelan EA, Rillamas-Sun E, Johnson L, LaMonte MJ, Buchner DM, LaCroix AZ, Anderson GL. Determinants, circumstances and consequences of injurious falls among older women living in the community. Injury Prevention. 2020 Jan 15.