FALLS AND OUTCOMES AMONGST OLD PEOPLE IN RURAL DWELLINGS


A.O. Adebiyi, O.C. Uchendu, O.T. Ikotun, O.W. Oluleye, O.P. Olukotun

Department of Community Medicine, College of Medicine, University of Ibadan.

Abstract

Background: Falls are the leading cause of injury deaths among people 65 years and older. This study gives an insight into the prevalence of falls among older people and how they occur in a rural setting in Nigeria.

Methods: A community based survey of 210 consenting old people aged 65 years and above selected using a multi-stage sampling technique was done. Study instrument was a semi-structured interviewer administered questionnaire and visual acuity was tested using Snellens chart.

Results: Incidence of falls was 21.4%. Of those who had falls, 86.7% were walking while 11.1% were either sitting or running when it occurred. The nature of the fall was tripping in 44.4%, slipping in 35.6% and hitting an object in 17.8% of cases. Consequences of falls included pain 48.9%, bruises 22.2%, lacerations 13.3% and fractures 11.1%. Females had more falls than males; 23.8% vs 19.0%, p = 0.40. Major injuries resulting from falls also occurred more frequently amongst females than males; 30.7% vs. 15.0%, p = 0.3. History of diabetes and alcohol use increased the odds of falling (OR 4.1, 95% CI 1.0 – 16.0; OR 2.2, 95% CI 1.0 – 4.6 respectively). Being in a monogamous marriage and having normal sight were protective of having falls (OR 0.4, 95% CI 0.2 – 0.9; OR 0.4, 95% CI 0.2 – 0.9 respectively).

Conclusion: Falls often occur from tripping and slipping while females are more likely to have major injuries. Risk factors for falls were alcohol use and diabetes while having normal sight and being monogamous were protective. Prevention should aim at a life course approach to addressing these intrinsic and extrinsic factors.

Correspondence:

Dr A.O. Adebiyi
Department of Community Medicine
College of Medicine,
University of Ibadan
E-mail: adebiyi 20012002@yahoo.com


Introduction

A fall is a sudden, unintentional change in position causing an individual to land at a lower level, on an object, the floor, or the ground, other than as a consequence of sudden onset of paralysis, epileptic seizure or overwhelming external force1. Internationally, it is estimated that one in three people over 65 years living in the community will fall each year2,3 and in half of these cases, falls are recurrent3. About 20-30% of those who fall suffer injuries that reduce mobility and independence and increase the risk of premature death4,5. In addition, falls are the leading cause of injury deaths among people 65years and older and half of these falls occur in their own home6,7. Thus falls and fall-related injuries among older people are now becoming major issues for health and care givers world wide7.

The risk factors for falls have been described as internal and external or in more exact terms as intrinsic/personal such as impaired strength, poor vision e.t.c and extrinsic/environmental like loose surfaces and poor lightning8. Often falls increases with age and are more commoner amongst females than males9,10. Other factors that have been documented to increase the risk of falling include: a previous history of fall, living alone, chronic disease burden, dizziness and use of one or more medications. Furthermore, some studies have reported that between 30% and 50% of falls among older people living in communities are due to environmental causes while 20% of falls are due to major external factors that can cause any healthy adult to fall11,12. Thus environmental hazards like poor lighting, slippery floors, and uneven surfaces would contribute substantially to the rising prevalence of falls.

The consequences of falls is the increased morbidity and mortality often associated with them4,5. Injuries amongst the elderly reduce length and quality of life and take up a large proportion of the health spending especially in a rural setting, but its prevention is quite cheap and simple. This study documents the occurrence of falls and its associated risk factors among older people in a rural setting in Nigeria. This information which is largely unavailable in Nigerian studies would be crucial in prevention of falls amongst the elderly.

METHODS
A community based survey of 210 consenting old people aged 65 years and above residing in Oyo State, Nigeria was done using an interviewer administered questionnaire. Igboora is the headquarters of Ibarapa Central Local Government in Oyo State, southwestern Nigeria. It is a rural town slowly undergoing urbanization with a population of . The minimum sample size calculated at 5% precision using a prevalence of falls of 14% (13) among community elderly people was 184 and the sampling technique was multistage. Two blocks were selected out of the six blocks in Igboora by simple random sampling and all consenting households within the selected wards were enrolled for the study. One male and one female were selected as the final sampling unit from each consenting household. Where there was more than one female or male in the household, balloting was done to select the study participant. Informed consent was obtained from each participant before the interview. Questionnaire contained questions on sociodemographic characteristics, existing morbidities and related issues, occurrence of falls, outcomes of falls and social habits. Visual acuity was also checked using the Snellens chart. Research assistants were medical students who had earlier been trained on the use of the Snellens chart. However, a training test run was done to standardize its use by all research assistants. Low vision was defined as vision of 6/18 and below. At the end of each interview, health education was given and any interviewee with acute or chronic condition for which medical attention has not been sought was referred to the health centre within the community. Data was analysed using the SPSS version 11.0