The prognosis of falls in elderly people living at home.

BACKGROUND there are few longitudinal studies of the prognosis of falling at home. OBJECTIVE to determine outcomes in older people who fall once and more than once. DESIGN longitudinal prospective cohort study. SETTING primary care in the UK. SUBJECTS 1815 subjects over 75 who had a standardized and validated health check. METHOD annual interviews over 4 years. Practice records were used to establish death and admission to institutions. RESULTS risk of death was increased at 1 year [odds ratio (OR) 2.6, 95% confidence interval (CI) 1.4-4.7] and 3 years (OR 1.9, 95% CI 1.2-3.0) for recurrent fallers but not single fallers (OR 0.9, 95% CI 0.5-1.6 at 1 year; OR 0.97, 95% CI 0.7-1.4 at 3 years). Risk of admission to long-term care over 1 year was markedly increased both for single fallers (OR 3.8, 95% CI 1.8-8.3) and recurrent fallers (OR 4.5, 95% CI 1.7-12). Functional decline was not related to faller status, the latter being very variable from one year to the next. CONCLUSIONS the stronger relationship between falling and admission to long-term care rather than mortality supports the hypothesis that the perceived risks for those who fall only once are exaggerated.