Risk factors for ground-level fall injuries during active activity in older patients
1Department of Emergency Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, 44033 Ulsan, Republic of Korea
2Department of Emergency Medicine, College of Medicine, Chosun University, 61453 Gwangju, Republic of Korea
3Department of Emergency Medicine, School of Medicine, Hallym University, 05355 Seoul, Republic of Korea
4Department of Emergency Medicine, Yonsei University College of Medicine, 03722 Seoul, Republic of Korea
5Department of Emergency Medicine, Ewha Womans University, School of Medicine, 07985 Seoul, Republic of Korea
6Department of Emergency Medicine, Ajou University School of Medicine, 16499 Suwon, Republic of Korea
Submitted: 21 August 2023 Accepted: 21 September 2023
Online publish date: 24 October 2023
In older patients, ground-level falls are the most common cause of injury. Many intrinsic and extrinsic factors influence ground fall injuries. However, the characteristics and severity of ground fall injuries have not been compared according to the activity levels. We compared the characteristics of ground fall injuries by the activity level to establish a preventive strategy for ground fall injuries in older patients. We retrospectively reviewed the records of older patients who were admitted to six university hospitals for ground-level fall injuries from 2011 to 2020. The patients were classified into active and inactive groups. Active activities were defined as paid work, exercise and leisure activities. General and clinical characteristics of both groups for ground-level fall injury were analyzed. Propensity score matching analysis (1:1) was performed for baseline characteristics (sex, age and alcohol consumption). A total of 33,924 patients were enrolled, of which 4887 (14.4%) were classified in the active group. Injury severity was not different between the active and inactive groups. The main factors significantly associated with ground fall injuries during activities in elderly patients were male sex, age from 65 to 74 years and 75 to 84 years compared to greater than 85 years, an injury time other than 00:00–05:59, alcohol consumption, sloping floor and floor type other than concrete. After propensity score matching analysis, the factors associated with ground-level fall injuries in older patients when they were active were a time of injury from 06:00–17:59 compared to 00:00–05:59, slippery floor, slope, the absence of obstacles and type of floor other than concrete. We should establish preventive strategies for reducing ground-level fall injuries in older patients during activity, which could include wearing compatible footwear, caution on sloping areas, and maintenance of unpaved roads.
Ground-level fall injury; Older patient; Active; Floor; Time of injury; Severity
Jung Sung Hwang,Sun Hyu Kim,Sang Cheal Lee,SunPyo Kim,Gyu Chong Cho,Min Joung Kim,Duk Hee Lee,Yura Ko. Risk factors for ground-level fall injuries during active activity in older patients. Signa Vitae. 2023.doi:10.22514/sv.2023.099.
 Kim M, Chang M, Nam E, Kim SG, Cho S, Ryu DH, et al. Fall characteristics among elderly populations in urban and rural areas in Korea. Medicine. 2020; 99: e23106.
 Hwang JS, Kim SH. Severe ground fall injury associated with alcohol consumption in geriatric patients. Healthcare. 2022; 10: 1111.
 Kim SH, Kim S, Cho GC, Lee JH, Park EJ, Lee DH. Characteristics of fall-related head injury versus non-head injury in the older adults. BMC Geriatrics. 2021; 21: 196.
 Bergen G, Stevens MR, Burns ER. Falls and fall injuries among adults aged ³65 years—United States, 2014. Morbidity and Mortality Weekly Report. 2016; 65: 993–998.
 Shim S, Yu JY, Jekal S, Song YJ, Moon KT, Lee JH, et al. Development and validation of interpretable machine learning models for inpatient fall events and electronic medical record integration. Clinical and Experimental Emergency Medicine. 2022; 9: 345–353.
 Miyoshi Y, Kondo Y, Hirano Y, Ishihara T, Sueyoshi K, Okamoto K, et al. Characteristics, injuries, and clinical outcomes of geriatric trauma patients in Japan: an analysis of the nationwide trauma registry database. Scientific Reports. 2020; 10: 19148.
 Jung HY, Kim SH, Lee SC, Kim S, Cho GC, Kim MJ, et al. Relating factors to severe injury from outdoor falls in older people. Geriatrics & Gerontology International. 2018; 18: 80–87.
 Bae S, Song SW, Kim WJ, Kang Y, Kang KW, Park CB, et al. Traumatic brain injury in patients aged ≥65 years versus patients aged ≥80 years: a multicenter prospective study of mortality and medical resource utilization. Clinical and Experimental Emergency Medicine. 2021; 8: 94–102.
 Zhou TY, Yuan XM, Ma XJ. Canan outdoor multisurface terrain enhance the effects of fall prevention exercise in older adults? A randomized controlled trial. International Journal of Environmental Research and Public Health. 2020; 17: 7023.
 Choi JH, Kim SH, Kim SP, Jung KY, Ryu JY, Choi SC, et al. Characteristics of intentional fall injuries in the ED. The American Journal of Emergency Medicine. 2014; 32: 529–534.
 Chatha H, Sammy I, Hickey M, Sattout A, Hollingsworth J. Falling down a flight of stairs: the impact of age and intoxication on injury pattern and severity. Trauma. 2018; 20: 169–174.
 Wade C, Davis J, Weimar WH. Balance and exposure to an elevated sloped surface. Gait & Posture. 2014; 39: 599–605.
 Lee S. Falls associated with indoor and outdoor environmental hazards among community-dwelling older adults between men and women. BMC Geriatrics. 2021; 21: 547.
 Ham AC, Swart KM, Enneman AW, van Dijk SC, Oliai Araghi S, van Wijngaarden JP, et al. Medication-related fall incidents in an older, ambulant population: the B-PROOF study. Drugs Aging. 2014; 31: 917–927.
 Dong RG, Wu JZ, Dai F, Breloff SP. An alternative method for analyzing the slip potential of workers on sloped surfaces. Safety Science. 2021; 133: 105026.
 Cai Y, Leveille SG, Andreeva O, Shi L, Chen P, You T. Characterizing fall circumstances in community-dwelling older adults: a mixed methods approach. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences. 2023; 78: 1683–1691.
 Rundle AG, Crowe RP, Wang HE, Lo AX. A methodology for the public health surveillance and epidemiologic analysis of outdoor falls that require an emergency medical services response. Injury Epidemiology. 2023; 10: 4.
 Xu Q, Ou X, Li J. The risk of falls among the aging population: a systematic review and meta-analysis. Frontiers in Public Health. 2022; 10: 902599.
 Choi SW, Woo JH, Hyun SY, Jang JH, Choi WS. Factors associated with injury severity among users of powered mobility devices. Clinical and Experimental Emergency Medicine. 2021; 8: 103–110.
 Duckham RL, Procter-Gray E, Hannan MT, Leveille SG, Lipsitz LA, Li W. Sex differences in circumstances and consequences of outdoor and indoor falls in older adults in the MOBILIZE Boston cohort study. BMC Geriatrics. 2013; 13: 133.
 Kim SH. Risk factors for severe injury following indoor and outdoor falls in geriatric patients. Archives of Gerontology and Geriatrics. 2016; 62: 75–82.
 Pham Nguyen TP, Gray SL, Newcomb CW, Liu Q, Hamedani AG, Weintraub D, et al. Potentially inappropriate medications in older adults with Parkinson disease before and after hospitalization for injury. Parkinsonism & Related Disorders. 2023; 114: 105793.
 Wang S, Wang M, Leung ISH, Ge S, Xu X, Chen S, et al. The association of cognitive frailty and the risk of falls among older adults: a systematic review and meta‐analysis. International Journal of Nursing Practice. 2023; 29: e13181.
Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.
Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.
Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.
Index Copernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.
Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.
Scopus: CiteScore 1.0 (2022) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.
Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.