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Falls in the elderly.

FALLS are common problems for older people. Approximately 30 to 50% of community residing people report having fallen or a liability to fall during the past 12 months. 1-5 Among the institutionalized elderly, up to 20% of hospital patients6 and 45% of long-term-care facility residents will fall.7 Unfortunately, these figures understate the problem, since the vast majority of falls by older people are underreported.8 Typically, the only falls reported are those that lead to physical injury or a significant decline in functional status. In the community, older people may not report a fall because they falsely attribute the event to a "normal" consequence of aging, or fear that reporting a fall will lead to restriction of activities or placement in a nursing home. As well, the personal embarrassment one suffers from falling or a denial of the incident, especially if it reminds one of increasing frailty and dependency, may be further reasons for underreporting by the aged. Within the institutional setting, patients may fail to report their fall if they have an element of cognitive dysfunction, fear of physical restraints, or concern over being denied discharge back to the community. In terms of mortality, falls represent the leading cause of death due to unintentional injury. ' Fall-related mortality increases with advanced age and more than doubles with each decade of life.9 While falls are associated with excess mortality, most falls do not end in death.10 However, the morbidity associated with falling is considerable. A fracture is the most common injury, and the hip is the most common fracture to result in acute hospitalization. 1I Of the 200,000 hip fractures that occur annually, 84% occur to persons 65 years of age and older. 12 The length of hospital stay for hip fracture patients is nearly twice the stay for all other causes of hospital admission by the elderly, 12 and approximately 40% of older people with hip fractures die within six months of the injury.'3 Of these persons who survive the hip fracture 60%