Characteristics of Falls Among Older People — China, 2018
What is already known about this topic?
The incidence of falls among older people is 20.7% in China. Falls are the top cause for death from injuries in people aged 65 years and above, and mortality rates increase with age in China. There are few reports on the epidemiological characteristics of falls in older people nationwide in recent years.
What is added by this report?
This study found that among older people with falls reported in the National Injury Surveillance System (NISS) in 2018, there were more females than males. The peak time for falls was in the morning. Home was the most common site where falls occurred, and leisure activities and housework were the main activities when falls occurred. After falling, the lower limbs and head were most often injured with bruises and fractures. The degree of injury was mainly mild and moderate.
What are the implications for public health practice?
Data based on the NISS can be used as an additional data source for research on falls in China. This study identified priorities for the control and prevention of falls.
As defined by the World Health Organization (WHO), a fall is an event that results in a person inadvertently coming to rest on the ground, floor, or other lower level. Falls have become a serious public health problem worldwide. The study data were from the National Injury Surveillance System (NISS) in China, and descriptive analysis was applied on characteristics of falls among persons aged 60 years and above. In total, 100,551 cases of falls were collected from the NISS in China, including 41,821 males and 58,730 females. Falls most commonly occurred at home (55.97%), and leisure activities (30.27%) were the main activity category when falls occurred. The elderly should be treated as the targeted population for effective prevention of falls.
Globally, the number of deaths from falls was double in 2017 compared with 1990. In 2017,there was an estimated 75,000 deaths attributed to falls among people over 70 years of age in China. Falls can result in limited mobility and disability — even death on older adults — which compromises health conditions and quality of life and causes large strains on medical resources . The data of this study were medical and health institution based and suggested the importance of prioritizing the prevention of falls in older adults for injury prevention and control through describing the characteristics of falls in the elderly in China.
The NISS was established in 2006 and covers 84 surveillance points (33 rural and 51 urban), including 252 medical and health institutions. Cases of falls were obtained from the outpatient or emergency departments of 252 medical and health institutions. The doctors and nurses in the outpatient or emergency departments filled in "national injury surveillance report cards" and sent those reports to the local CDCs regularly. The local CDCs were responsible for collecting, summarizing, and inputting information and regularly reporting the data to the National Center for Chronic and Noncommunicable Disease Control and Prevention of China CDC through administrative channels. Sampling methods, quality of data, and other detailed information of the NISS have been reported in published articles. Software SPSS (version 25.0, SPSS Inc, Chicago, IL, USA) was used for statistical analysis. The data utilization of the NISS had been reviewed and approved by the Ethical Review Committee of the National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention (ethical application grant number: 201502).
In total, 100,551 cases of falls among older persons aged 60 years and above were collected by the NISS in 2018, including 58,730 females and 41,821 males with a gender ratio of 1.40. The number of falls was evenly distributed in 12 months. Falls mainly occurred in the daytime (06∶01–18∶00), and the peak time was the morning (06∶01–12∶00). Home (55.97%), road/street (18.69%), and public residential institution (12.80%) were the sites where falls most often occurred.
In different age groups, the top 3 sites of falls were essentially the same, and the proportion of falls at home increased with age. Females (60.08%) had a higher proportion of falls at home than males (50.21%). The most common 3 activities when falls occurred were leisure activities (30.27%), housework (22.36%), and walking (20.20%). The activities when falls occurred differed based on age group. Higher proportions of falls occurred during housework for females (25.30%) than for males (18.23%). (Table 1)
In 2018, bruises (37.73%), fractures (34.34%), and sprains (14.94%) were the main natures of injury of falls in older persons aged 60–79 years, and the top 3 natures of injury of falls in older persons aged 80 years and above were fractures (41.62%), bruises (35.21%), and sharps injury, bites, and open wounds (8.74%). Higher proportions of fractures caused by falls were found in females (39.33%) than in males (27.34%). The most common body parts that falls affected were lower limbs (32.43%), head (21.48%), and torso (20.57%). The top 3 body parts that falls affected were lower limbs (31.95%), torso (21.08%), and head (19.44%) in older persons aged 60–69 years. Males (27.38%) had a higher proportion of head injuries caused by falls than females (17.27%).
About 60% of cases were mild in each age group, and moderate injury accounted for 34.66%. With an increase of age, the proportion of mild injury decreased, while severe injury increased. Overall, 70.49% of cases were discharged from the hospital after treatment, 24.64% required hospitalization, and 157 cases were fatal. The proportion of deaths increased with age.
From: CCDC Weekly