INJURY AND FUNCTIONAL DECLINE IN ELDERLY FALLERS

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As recognized in the Healthy People 2000 objectives, falls and their sequelae represent common, potentially preventable sources of disability among older persons. The goal of this study, during its initial funding period, was to determine the frequency of, and risk factors for falls, serious injuries, and other fall sequelae. The goal of the study during the renewal period will be to continue these investigations the next step, namely to examine the health, functional, and cost outcomes associated with falls and their sequelae. The specific aims of this proposal are: l) to determine whether, and to what extent, falls and/or fall sequelae are independent determinants of adverse functional and health outcomes in elderly persons; and 2) to determine the health care costs associated with falling and fall sequelae. The fall sequelae to be studied include injuries, fear of falling, low fall-related efficacy, and inability to get up without help after a fall. The adverse health and functional outcomes include new onset or increased disability in physical performance, basic and instrumental activities of daily living, and advanced physical and social activities as well as increased home services and institutionalization. The proposed study, during the renewal period, is designed to supplement an existing rich dataset on a representative sample of community elderly persons with additional utilization and expenditure data. The 1,103 participants represent a probability sample of non-institutionalized New Haven, Connecticut residents who were at least 72 years of age at time of enrollment in 1989-1990 and are now a mean age of 82.4 (5.2) years old. Data already collected on participants include: 1) three interviews between 1989 and 1993 during which demographic, social, psychological, medical, physical performance, and functional data were ascertained; 2) 3 years of daily surveillance data on occurrence, circumstances, and consequences of falls; and 3) ongoing surveillance for hospitalizations and death. These data will be supplemented with: l) reviews of medical records of all cohort members to ascertain the presence of chronic diseases and occurrence of intervening medical events; 2) medical care expenditure data from HCFA; and 3) nursing home data from the Connecticut Long Term Care Registry. The planned investigations will help determine whether, and to what extent, falls and their sequelae play a role in the increased disability, dependence, and health care costs seen as persons age and whether, in turn, fall and injury prevention programs are likely to impact on the health, functioning, and health care costs of the increasing numbers of elderly persons.