Circumstances of falls resulting in hip fractures among older people

OBJECTIVES: To describe the circumstances of falls resulting in hip fractures among older people and to determine whether the circumstances differ by gender, age, and residential status. DESIGN: Cross-sectional study. SETTING: Two hospitals in Auckland, New Zealand, in which all individuals aged 60 years or older with a fracture of the proximal femur are hospitalized. PARTICIPANTS: A total of 911 individuals (97% response rate) were hospitalized with fractures of the proximal femur; 77% were women, 66% were aged 80 years or older, and 58% were living in private homes at the time of fracture. MEASUREMENTS: Data were collected face-to-face by a trained interviewer using a standardized questionnaire. RESULTS: Ninety-six percent of the fractures were associated with a fall, with fewer that 2% of subjects reporting that their fractures occurred spontaneously before a fall. Sixteen percent of fractures were associated with an acute medical or physical condition. Although 85% of the fractures involving a fall occurred at home, only about 25% of these were associated with an environmental hazard, and only a proportion of these were likely to have been amenable to modification. The circumstances of falls differed significantly by age and residential status. CONCLUSION: Strategies aimed at preventing fall-related hip fractures among the old old and among institutionalized individuals should focus primarily on the modification of intrinsic factors. Modification of environmental hazards has the greatest potential for prevention among the young old and those living in private homes.