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Predictors and prognosis of inability to get up after falls among elderly persons
M E Tinetti1, W L Liu, E B Claus
1Department of Medicine, Yale University School of Medicine, New Haven, Conn. 06510-8056.
Objective:
To identify the predictors and prognosis associated with inability to get up after falling.
Design:
Cohort study with a mean 21-month follow-up.
Setting:
General community.
Subjects:
1103 New Haven, Conn, residents aged 72 years and older who were able to follow simple commands and walk unassisted.
Main Outcome Measures:
Self-reported inability to get up without help after falls not resulting in serious injury; activity restriction and hospitalization after a fall; death; and placement in a nursing home.
Results:
Inability to get up without help was reported after 220 of 596 non-injurious falls. Of 313 non-injured fallers, 148 (47%) reported inability to get up after at least one fall. Compared with non-fallers, the risk factors independently associated with inability to get up included the following: an age of at least 80 years (adjusted relative risk [RR], 1.6; 95% confidence interval [CI], 1.2 to 2.1); depression (RR, 1.5; CI, 1.1 to 2.0); and poor balance and gait (RR, 2.0; CI, 1.5 to 2.7). Previous stroke (RR, 1.6; CI, 1.0 to 2.4) and sedative use (RR, 1.5; CI, 0.9 to 2.2) did not achieve significance. Among fallers, older age and poor balance and gait were associated marginally with inability to get up. Compared with fallers who were able to get up, fallers who were unable to get up were more likely to suffer lasting decline in activities of daily living (35% vs 26%). Fallers who were unable to get up were more likely to die, to be hospitalized, and to suffer a decline in activities of daily living for at least 3 days, and were less likely to be placed in a nursing home than were fallers who were able to get up, but these trends were not statistically significant.
Conclusions:
The risk factors for inability to get up were similar to those for falling, although certain factors imparted a particular risk of inability to get up without help. The frequency of inability to get up and the short- and long-term morbidity associated with this inability suggest the need for preventive and treatment efforts.