OBJECTIVES: This prospective cohort study was undertaken to determine the incidence of falls and the identification of risk factors in elderly persons in a nursing home facility and those seen at the Rehabilitation Medicine Out-Patient Department (OPD) of the Philippine General Hospital (PGH), and to propose interventions to reduce or prevent falls in both populations.
METHODS: Filipino elderly aged 60 years old and above, male or female, who consulted at the Rehabilitation Medicine - OPD of the PGH in Manila, and the elderly aged 60 and above in a nursing home facility for religious sisters in Rizal were included. The following data that may present as risk factors for falls were collected: demographic characteristics, health status, medications, and chronic illness. Environmental hazards were checked. Physical examinations were conducted to test for cognitive function, balance, and visual acuity. Follow-up interviews were done every two months for 10 months to monitor incidence of falls and their causes. Data were analyzed to identify the significant risk factors for falling.
RESULTS: A total of 156 subjects were included, 116 subjects from the OPD and 40 subjects from the nursing home. At the end of the study, a total of 50 out of 156 subjects (32.1%) from both populations had falls within 10 months. Twenty-seven (27) out of 116 subjects (23.3%) in the OPD elderly and 23 out of 40 elderly (57.5%) in the nursing home had falls. Significant risk factors that contributed to falls in the elderly seen at the OPD were poor vision and history of falls. In the nursing home population, significant risk factors identified were cognitive impairment and presence of chronic diseases. Major cause of falls for both populations was presence of slippery floors in the bathroom or bedroom in the homes of the OPD elderly (67%) and presence of the slippery areas in the nursing home (65%).
CONCLUSION: Falls in the elderly are considered to be one of the main causes for morbidity, decline in function, and death. Among the Rehabilitation Medicine OPD elderly, it is important to identify those with visual problems and those with history of previous falls as likely candidates for falling within the year or so. Elderly with cognitive impairment and chronic disease in the nursing home population should be closely monitored because of greater risk of falling. In both populations, interventions should include the provision of a safe environment to prevent or reduce the incidence of future falls.