Correspondence:
Dr.Jamal Alshawabkeh
Email: drjamalss@yahoo.com

Falls are common among the elderly, and represent the leading cause of neck of femur fractures with associated complications as organ system failure and mobility dysfunction. A lot of causes of falls in older people are reported including medical conditions, increasing age, medication use and social factors.

The rapid growth of the elderly population has resulted in a proportional rise in the number of elderly individuals with chronic disability during this phase of life. Chronic disability directly interferes with the quality of life of the elderly, since it changes their way of living and their health conditions(1).

The aim of our study is to retrospectively detect the causes of falls to decrease the risk of neck of femur fractures in elderly patients.

In this retrospective study,which was done in four hospitals of the Royal Medical Services, four hundred patients with neck of femur fractures after falling down between April 2004 and November 2006 were included in this study. The causes of falls in these patients investigated and classified into intrinsic and extrinsic factors depending on sociodemographic variables, physical activity, acute and chronic health problems and medications. The intrinsic factors are age-related physiologic changes, diseases and medications ( Sedative-hypnotic and anxiolytic drugs, antihypertensive and cardiac drugs ) or extrinsic factors as poor lighting, unsafe stairways and irregular floor surfaces. Pathologic and high energy trauma associated fractures were excluded from the study.
The information about the causes of falls were taken from the patient’s medical files in the hospitals and those patients with inadequate history were contacted by telephone.
Results

Out of the four hundred patients,243 were females and 157 were males with the mean age of 63 year old. The major causes were detected and the distribution in both males and females shown in the table below.

Neurological disturbances as postural instability; syncope and epileptic attacks; decline of central integration of visual, vestibular and proprioceptive senses found to be a major risk factor with a percentage of 25%.The extrinsic causes represent a significant factor.

Fall-related injuries are the leading cause of injury deaths and disabilities among older adults (i.e., persons aged >65 years). The most serious fall injury is hip fracture; one half of all older adults hospitalized for hip fracture never regain their former level of function(2).

Fall prevention programs have reduced falls and fall-related injuries among high-risk populations using multifaceted approaches that include education, exercise, environmental modifications, and medication review(2).

Trips and slips were the most prevalent causes of falls, accounting for 59% of falls(3).
Individuals living in institutions were almost four times more likely to sustain a hip fracture than those living in a private homes. Specific factors that place these individuals at increased risk need to be identified, in order to develop intervention strategies(4).
The prevalence of previous strokes among patients with femoral neck fracture ranged from 16.4% to 38.5%(5). Stroke has been reported as a risk factor for hip fracture among younger men in particular and as a risk factor for suffering a second hip fracture (6).

Visual impairment has been shown to be associated with falls in several studies and risk factors include reduced visual acuity,reduced contrast sensitivity,poor depth perception, and visual field loss (7,8) .

Muscle weakness,lower limb dysfunction and using walking aids have been associated with increased incidence of hip fractures(9,10).

Research demonstrates that effective fall prevention strategies require a multifaceted approach with both behavioral and environmental components.

There are several causes of falls in elderly patients resulting in hip fractures leading to increased morbidity and mortality. Therefore important elements including education and skill building to increase knowledge about fall risk factors, exercise to improve strength and balance, home modifications to reduce fall hazards, and medication assessment to minimize side effects (e.g., dizziness and grogginess) will improve the quality of life to these people.

1. Evolution of Brazilian elderly with hip fracture secondary to a fall, Rosamaria Garcia; Mariana Deckers Leme; Luiz Eugênio Garcez-Leme, Clinics vol.61 no.6  São Paulo  2006
   
2. Reducing Falls and Resulting Hip Fractures Among Older Women, Judy A. Stevens Phd, Sarah Olson, M.S.,MMWR,March 31, 2000 / 49(RR02);1-12
   
3. Circumstances and consequences of falls in independent community-dwelling older adults, WILLIAM P. BERG, HELAINE M. ALESSIO, EUGENIA M. MILLS1 and CHEN TONG, Oxford Journal1997 volume 26 –no 4.
   
4. Residential status and risk of hip fracture, R Norton, AJ Campbell, IR Reid, M Butler, R Currie, E Robinson, Age and Ageing, Vol 28, 135-139 -1999 .
   
5. Stroke, a Major and Increasing Risk Factor for Femoral Neck Fracture, Anna Ramnemark, MD, PhD; Mikael Nilsson, MD; Stroke. 2000;31:1572.)© 2000 American Heart Association, Inc
   
6. Sherrington C, Lord SR. Increased prevalence of fall risk factors in older people following hip fracture. Gerontology. 1998;44:340–344
   
7. Ivers RQ, Cumming RG, Mitchell P, et al. Visual impairment and falls in older adults: The Blue Mountains Eye Study. J Am Geriatr Soc 1998;46:58–64.
   
8. Klein BE, Klein R, Lee KE, et al. Performance-based and self-assessed measures of visual function as related to history of falls, hip fractures, and measured gait time: The Beaver Dam Eye Study. Ophthalmology 1998;105:160–4
   
9. Wolinsky FD,Fitzgerald JF,The risk of hip fractures among non institutionalized older adults,1994;49:165-175 .
   
10. Crisso JA,Kelsey JL et al,The risk factors for hip fractures in black women,The north east hip fractures study group,N Engl. J Med. 1994;330:1555-9.