Reevaluating the implications of recurrent falls in older adults: location changes the inference

To compare characteristics of indoor and outdoor recurrent fallers and explore some implications for clinical practice, in which a fall risk assessment for all recurrent fallers has been recommended.

Prospective cohort study.

Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly of Boston Study, a study of falls etiology in community-dwelling older individuals from randomly sampled households in the Boston, Massachusetts, area.

Seven hundred thirteen women and men, mostly aged 70 and older, with at least 1 year of follow-up.

Data at baseline and from an 18-month follow-up examination were collected by questionnaire and comprehensive clinic examination. During follow-up, participants recorded falls on daily calendars. A telephone interview queried location and circumstances of each fall.

One hundred forty-five participants reported recurrent falls (≥2) during the first year. Those who had fallen only outdoors had good health characteristics, whereas those who had fallen only indoors were generally in poor health. For instance, 25.5% of indoor-only recurrent fallers had gait speeds of slower than 0.6 m/s, compared with 2.9% of outdoor-only recurrent fallers; the respective percentages were 44.7% and 8.8% for Berg balance score less than 48. Recurrent indoor fallers generally had poor health characteristics regardless of their activity at the time of their falls, whereas recurrent outdoor fallers who fell during vigorous activity or walking were especially healthy. A report of any recurrent falls in the first year did not predict number of positive findings on a comprehensive or abbreviated fall risk assessment at the 18-month follow-up examination.

Characteristics of community-dwelling older people with recurrent indoor and outdoor falls are different. If confirmed, these results suggest that different types of fall risk assessment are needed for specific categories of recurrent fallers.