Age and Ageing Advance Access originally published online on January 18, 2006
Age and Ageing 2006 35(2):205-206; doi:10.1093/ageing/afj046
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Post-fall syndrome: a matter to study in patients with hip fractures admitted to orthopaedic wards
SIR—We have read with pleasure Dr Martín et al.’s [1] very interesting paper about fear of falling limiting activity in young-old women being associated with reduced functional mobility. We would like to contribute our experience.A prospective study was carried out for 2 years (2003 and 2004). All patients with hip fractures admitted to orthopaedic wards of a teaching hospital and referred to the geriatrician were included. The geriatrician makes a daily ward round taking medical control of the patients, and a study record was completed for each of the patients. In this study, all the independent predictive variables of functional recovery after hip fracture in the elderly were collected [2]. One of them was the presence of post-fall syndrome detected by the geriatrician during in-hospital stay. Follow-up outcome data were collected by telephone, 3 and 6 months after injury.
A total of 196 patients were recruited. The mean age was 84 years and post-fall syndrome was identified in 5.1% of patients. These patients were older (86.1 versus 82.7) and had a greater number of past medical diagnoses (5.6 versus 4.9), but these differences were not statistically significant. The proportion of patients presenting with falls 6 months prior to the injury was similar (30.0 versus 32.3%) in patients with or without post-fall syndrome. The functional and mental status before the fracture were also comparable (Barthel index 89 versus 87.4/100; and the Red Cross Hospital Mental Disability Scale [3], 0.5 versus 0.3). Eighty per cent of patients with post-fall syndrome were admitted with a subcapital hip fracture versus 40.3% admitted with the same type of fracture but without post-fall syndrome. The patients with post-fall syndrome had lower rates of preoperative risk measured by the American Society of Anaesthesiologists’ classification (ASA ģII 20.0 versus 46.2%), but they had a greater number of complications after surgery (mean 4.5 versus 3.1 per patient).
The mean hospital length of stay was similar in both groups (16.7 days in patients with post-fall syndrome versus 17 in patients without post-fall syndrome). On discharge, the proportion of patients walking independently or with minimal help of one person was almost the same, 60.0 versus 62.5%.
The probability of being able to walk over time with and without post-fall syndrome is presented as a Kaplan–Meier curve. The patients with post-fall syndrome who were unable to walk on discharge did not regain this ability in subsequent months, in contrast to the continued improvement seen in those patients without post-fall syndrome.
The proportion of patients reporting falls during the months prior to the fracture was similar to that reported by Martin et al. [1] and other authors [4, 5]. Our patients with post-fall syndrome also showed alteration in their functional status 6 months later. The low prevalence of post-fall syndrome detected in our study is notable in spite of having used for their detection the fear of falling and loss of self-confidence. The need to specify a greater number of characteristics defining or coming along with the post-fall syndrome bring up to us. That may help to an earlier clinical detection during the immediate post-surgical period in elderly patients with hip fracture. The small size of the sample in our study does not allow us to deal with this problem.
Without any doubt, the knowledge of the characteristics that define the post-fall syndrome has a great relevance for the detection of frailty and functional recovery after a hip fracture. Dr Martin’s study helps to improve the scanty knowledge existing in this field of geriatrics.
Servicio de Geriatría, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain
* To whom correspondence should be addressed at: Email: talarcon.hulp{at}salud.madrid.org
References
- Martín FC, Hart D, Spector T, Doyle DV, Harari D. Fear of falling limiting activity in young-old women is associated with reduced functional mobility rather than psychological factors. Age Ageing 2005; 34: 281–7.
[Abstract/Free Full Text] - Alarcón T, González Montalvo JI. Fractura osteoporótica de cadera. Factores predictivos de recuperación funcional a corto y largo plazo. An Med Interna (Madrid) 2004; 21: 75–8.
- Guillén F, Garcia A. Ayuda a domicilio. Aspectos médicos en Geriatría. Rev Esp Gerontol 1972; 7: 339–46.
- Vellas BJ, Wayne SJ, Romero LJ, Baumgartner RN, Garry PJ. Fear of falling and restriction of mobility in elderly fallers. Age Ageing 1997; 26: 189–93.
[Abstract/Free Full Text] - Murphy SL, Dubin JA, Gill TM. The development of fear of falling among community-living older women: predisposing factors and subsequent fall events. J Gerontol A Biol Sci Med Sci 2003; 58: M943–7.
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