Friday February 23, 1996

History of falling no predictor of mortality

A person's history of falling does not predict mortality, even when the fall results in a fracture, sprain, or head injury, according to a multicenter study of 9,704 older women, aged 65-99 years.

However, functional impairment is strongly predictive of mortality among both fallers and non-fallers, said co-author Molly T. Vogt, PhD, associate professor of orthopaedic surgery, University of Pittsburgh, who presented the findings Thursday in poster exhibit A 36.

"We found a two- to three-fold increased risk of dying in these women when their functional status was impaired," said Dr. Vogt.

Loss of these abilities has a profound influence on health and independence of older people.

At the beginning of the study, women completed a questionnaire regarding age, medication use, smoking, education, medical history, physical activity, functional status, and history of falling.

Thirty percent of the women reported falling during the previous year: 19 percent fell once; 11 percent, twice. "Women who fell were older, and more likely to have a history of arthritis or stroke, a lower functional status, and a fear of falling," said Dr. Vogt. These women were followed for an average of five years, during which time 751 died.

This research indicates that whether a patient dies after surgery is very strongly influenced by a number of factors beyond the control of the surgeon. For instance, the fall per se does not seem to affect the outcome, but the level of functional impairment may have a profound affect on surgical mortality.

"As a result, outcome studies of osteoporotic fracture management should include assessment of prefracture functional status, as well as other lifestyle and medical factors," said Dr. Vogt. "Right now, many people who are reporting on patient outcomes after surgery present crude mortality data without taking into account the multitude of other factors which influence the health status of the elderly.

"Especially among the elderly, researchers need to factor in the functional status variable to arrive at a more accurate assessment of whether surgical intervention has helped the patient overall. It's important that people doing outcomes research look at all the involved variables."

Co-authors of the study with Dr. Vogt are Jane Cauley, DrPH, associate professor of epidemiology, Graduate School of Public Health, University of Pittsburgh; and Michael C. Nevitt, PhD, associate professor of epidemiology and biostatistics, University of California-San Francisco.

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