Prognosis of falls among elderly nursing home residents.

The survival rate of 207 nursing home residents who fell during a two-month study period was followed for 12 months and compared with that of 94 residents of the same nursing home who did not fall during the same period. One year after the fall, 74 fallers and 13 controls had died. In the group of fallers, the main factors associated with mortality were male gender, dementia, Parkinsonism, the use of antidepressants, diuretics and vasodilators. Among the controls, the main factors associated with mortality were Parkinsonism, diabetes and the use of diuretics. Thirty-eight fallers (33 women and 5 men) and one (female) control suffered a fracture; 32 of them required hospital attention, and 15 (47%) died during the same hospital stay. These results indicate that falls are an ominous sign, particularly if the subject has dementia, depression or Parkinsonism, or uses diuretics. The male subjects in this study had a lower injury rate than females, but their mortality rate was higher. In terms of prevention, the major concern should be the effective treatment of depression and Parkinsonism. Withdrawal of diuretics, when possible, may have an effect on mortality. Physical training and other stimulating activities should be beneficial, but subjects with severe dementia seem to be beyond this kind of prevention.

Falls among elderly nursing home residents.

The purpose of this study was to measure the rate of falls and to identify the causes, consequences and opportunities for preventing falls among 796 permanent residents of a nursing home. Altogether 377 falls were reported among 207 residents during the study period. The most important association discovered was that between impaired visual acuity and falls. In addition, 49% of the fallers suffered from severe and 19% from mild dementia. In the group of demented subjects it was impossible to assess visual acuity in 30% of the fallers as the subjects were unable to fixate at request. This finding may be one explanation for the increased incidence of falls in demented subjects. We conclude that the high number of subjects suffering from dementia among institutionalized elderly limits the possibility of training in prevention. The main emphasis in prevention of falls in institutions should be in proper design of the environment, including the visual environment.

Orthostatic reactions in the 85-year olds.

Testing of the orthostatic reaction is recommended in the examination of elderly fallers. This test usually includes blood pressure and instantaneous heart rate measurement but is difficult to perform in very elderly people according to the guidelines suggested for younger subjects. One reason for this is that old people often stand up slowly. The use of a tilt table, which enables a rapid change in posture from recumbent to erect position, is tempting as it could provide a method for a better standardized test. To study the usefulness of the tilt table as well as the degree of orthostatic reaction in the very elderly, we examined a sample of 85-year olds who did not suffer from falls. All were tested both with the tilt table and with active rising. The drop in blood pressure was equal in the two test types, but the increase in heart rate was significantly larger in active rising. Many test subjects were afraid of the tilt table, and two developed cardiac arrhythmia, i.e., atrial fibrillation, during the test. In our opinion, active rising is the method of choice in old persons. While the test subjects were in unusually good health for their age and thus could provide a suitable reference group for this test, the systolic blood pressure dropped considerably in several during the test. Criteria and indexes developed for younger subjects are not useful, and different evaluation criteria should be developed for the very elderly.