Falls in the Elderly: Reliability of a Classification System

To determine risk factors for falls, previous studies have classified falls according to the contribution of factors both intrinsic and extrinsic to the host. Due partly to the lack of operational definitions and the absence of information on reliability, no consensus on classification has been reached. Consequently, in a 3‐year prospective study of falls occurring in a probability sample of community‐dwelling elderly (n = 1,358), a fall classification system was developed and tested for interrater reliability. The 366 falls in the first year of the study were independently classified by two reviewers on the basis of a narrative description and structured interview. The falls in the four major categories of the classification system included: falls related to extrinsic factors (55%), falls related to intrinsic factors (39%), falls from a non‐bipedal stance (8%) and unclassified falls (7%). The interrater reliability for the four major categories was 89.9% with a kappa of 0.828. The system provides operational definitions for types of falls and a reliable and flexible method for classifying falls in the elderly.

[1]  Henry Hobbs.  Falls in Old Age , 1960 .

[2]  S. Cummings,et al.  Risk factors for recurrent nonsyncopal falls. A prospective study. , 1989, JAMA.

[3]  J. Brocklehurst,et al.  Fracture of the femur in old age: A two-centre study of associated clinical factors and the cause of the fall. , 1978, Age and ageing.

[4]  S. Folstein,et al.  "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. , 1975, Journal of psychiatric research.

[5]  Are falls a manifestation of brain failure? , 1978, Age and ageing.

[6]  L. Rubenstein,et al.  Predictors of falls among elderly people. Results of two population-based studies. , 1989, Archives of internal medicine.

[7]  G. Sorock,et al.  Benzodiazepine sedatives and the risk of falling in a community-dwelling elderly cohort. , 1988, Archives of internal medicine.

[8]  D. Prudham,et al.  Factors associated with falls in the elderly: a community study. , 1981, Age and ageing.

[9]  A. N. Exton-smith,et al.  Falls in the elderly related to postural imbalance. , 1977, British medical journal.

[10]  A. Farquharson.  Falls in Old Age: Clinical Aspects , 1985 .

[11]  B. Isaacs,et al.  Prognosis of falls in old people at home. , 1981, Journal of epidemiology and community health.

[12]  S. Cummings,et al.  Forgetting Falls , 1988, Journal of the American Geriatrics Society.

[13]  J. M. Morfitt.  Falls in old people at home: intrinsic versus environmental factors in causation. , 1983, Public health.

[14]  S. Ebrahim,et al.  Falls by elderly people at home: prevalence and associated factors. , 1988, Age and ageing.

[15]  B. Everitt,et al.  Statistical methods for rates and proportions , 1973 .

[16]  A. Campbell,et al.  Risk factors for falls in a community-based prospective study of people 70 years and older. , 1989, Journal of gerontology.

[17]  B Isaacs,et al.  Clinical and laboratory studies of falls in old people. Prospects for prevention. , 1985, Clinics in geriatric medicine.

[18]  A. J. Campbell,et al.  Falls in old age: a study of frequency and related clinical factors. , 1981, Age and ageing.

[19]  M. Kataria.  Fits, Faints and Falls in Old age , 1985, Modern Geriatrics Series.

[20]  J. A. Waller.  Falls among the elderly—Human and environmental factors☆ , 1978 .

[21]  M. Tinetti,et al.  Risk factors for falls among elderly persons living in the community. , 1988, The New England journal of medicine.

[22]  J. Morris,et al.  Senile dementia of the Alzheimer's type: an important risk factor for serious falls. , 1987, Journal of gerontology.

[23]  M. Tinetti,et al.  Prevention of falls among the elderly. , 1989, The New England journal of medicine.

[24]  R. Tideiksaar.  Falls and instability in the elderly. , 1993, NeuroRehabilitation.

[25]  W A Ray,et al.  Benzodiazepines of long and short elimination half-life and the risk of hip fracture. , 1989, JAMA.

[26]  U. Lucht.  A prospective study of accidental falls and resulting injuries in the home among elderly people. , 1971, Acta socio-medica Scandinavica.

[27]  B. Isaacs,et al.  Description, classification and prevention of falls in old people at home. , 1981, Rheumatology and rehabilitation.

[28]  U. Nayak,et al.  Falls in the healthy elderly: predisposing causes. , 1985, Ergonomics.

[29]  B. Isaacs,et al.  The post-fall syndrome. A study of 36 elderly patients. , 1982, Gerontology.

[30]  R. Sattin,et al.  Fall Injuries Among the Elderly , 1988, Journal of the American Geriatrics Society.