Inability to get up after falling, subsequent time on floor, and summoning help: prospective cohort study in people over 90
BMJ 2008; 337 doi: https://doi.org/10.1136/bmj.a2227 (Published 17 November 2008) Cite this as: BMJ 2008;337:a2227
- Jane Fleming, research nurse/study coordinator ,
- Carol Brayne, professor of public health medicine
- and the Cambridge City over-75s Cohort (CC75C) study collaboration
- 1Department of Public Health and Primary Care, University of Cambridge, Institute of Public Health, Cambridge CB2 0SR
- Correspondence to: jane.fleming{at}phpc.cam.ac.ukcarol.brayne{at}medschl.cam.ac.uk
- Accepted 5 September 2008
Abstract
Objectives To describe the incidence and extent of lying on the floor for a long time after being unable to get up from a fall among people aged over 90; to explore their use of call alarm systems in these circumstances.
Design 1 year follow-up of participants in a prospective cohort study of ageing, using fall calendars, phone calls, and visits.
Setting Participants’ usual place of residence (own homes or care homes), mostly in Cambridge.
Participants 90 women and 20 men aged over 90 (n=110), surviving participants of the Cambridge City over-75s Cohort, a population based sample.
Main outcome measures Inability to get up without help, lying on floor for a long time after falling, associated factors; availability and use of call alarm systems; participants’ views on using call alarms to summon help if needed after falling.
Results In one year’s intensive follow-up, 54% (144/265) of fall reports described the participant as being found on the floor and 82% (217/265) of falls occurred when the person was alone. Of the 60% who fell, 80% (53/66) were unable to get up after at least one fall and 30% (20/66) had lain on the floor for an hour or more. Difficulty in getting up was consistently associated with age, reported mobility, and severe cognitive impairment. Cognition was the only characteristic that predicted lying on the floor for a long time. Lying on the floor for a long time was strongly associated with serious injuries, admission to hospital, and subsequent moves into long term care. Call alarms were widely available but were not used in most cases of falls that led to lying on the floor for a long time. Comments from older people and carers showed the complexity of issues around the use of call alarms, including perceptions of irrelevance, concerns about independence, and practical difficulties.
Conclusions Lying on the floor for a long time after falling is more common among the “oldest old” than previously thought and is associated with serious consequences. Factors indicating higher risk and comments from participants suggest practical implications. People need training in strategies to get up from the floor. Work is needed on access and activation issues for design of call alarms and information for their effective use. Care providers need better understanding of the perceptions of older people to provide acceptable support services.
Footnotes
We gratefully acknowledge the contributions of previous investigators and past research team members (see www.cc75c.group.cam.ac.uk/pages/studypersonnel), collaborating general practitioners and their practice teams, and, most particularly, the study respondents, their families and friends, and the staff in many care homes. Rosemary Abbott, Stephen Barclay, Tom Dening, Morag Farquhar, Felicia Huppert, Ann-Louise Kinmonth, Fiona Matthews, Elizabeta Mukaetova-Ladinska, Graciela Muniz, Angela O’Sullivan, Eugene Paykel, Kathryn Richardson, and Emily Zhao (current CC75C collaborators) commented on earlier drafts of this paper.
Contributors: CB (with Tom Dening, Felicia Huppert, and Eugene Paykel) contributed to the development of the cohort study overall. JF, under CB’s supervision, helped to develop the protocol for the falls study follow-up survey of the cohort, conducted all the interviews for this wave and the prospective falls data collection, analysed the data, and wrote the original manuscript draft. Both authors are guarantors.
Funders: This study was supported by an NHS executive research and development unit health services research fellowship and CC75C is currently supported by the BUPA Foundation. No funders (see www.cc75c.group.cam.ac.uk/pages/grant for full list) had any role in the study design, analysis, or writing of this paper.
Competing interests: None declared.
Ethical approval: For each participant written informed consent was obtained either in person or from the proxy informant, as approved by Cambridge research ethics committee.
Provenance and peer review: Not commissioned; externally peer reviewed.
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