Causes and Course of Falls Resulting in Hip Fracture among Elderly Thai Patients
Weerasak Muangpaisan MD, MPhil*, Sarawut Suwanpatoomlerd MD**, Varalak Srinonprasert MD, MM**, Werasak Sutipornpalangkul MD, PhD***, Asita Wongprikron MD**, Prasert Assantchai MD, FRCP (London)*
Affiliation : * Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand ** Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand *** Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Objective : To investigate causes and course of fall-related hip fractures in elderly individuals admitted to a hospital.
Material and Method: The authors collected data from older patients admitted with fall-related hip fractures. The cause
and the clinical course of falls were evaluated by consultants in geriatric medicine. All patients were followed-up until
discharge from the hospital.
Results : Falls usually occurred indoors (78.6%) during the daytime (67.5%). Only 27.5% of the falls were attributable to
purely extrinsic causes. Neurological, musculoskeletal, and visual problems along with orthostatic hypotension were the
leading causes of falls in the present study. Women demonstrated more intrinsic causes (41.9% vs. 28.9%), such as
musculoskeletal (33.9% vs. 11.1%), and visual impairment (21.0% vs. 11.1%), whereas falls involving men were more likely
to be caused by orthostatic hypotension (21.8% vs. 8.1%). Most patients received surgical treatment (92.5%). The most
common complications during the hospital stay were delirium (45%). The modified Rankin Scale of 2-5 at discharge was
noted in 46.3% of patients, and mortality was 3.8%. The median length of hospital stay was 15 days (7-75 days). The direct
costs of in-hospital care were 2,427.2 (761.9-8,348.6) US dollars for general wards, and 3,739.1 (1,333.6-11,871.7) US
dollars for special wards.
Conclusion : Intrinsic causes (pure and combined with extrinsic) lead to falls with hip fractures more often than purely
extrinsic causes. Women and men had different etiologies for falls. Hip fracture leads to a number of in-hospital complications
and significant functional impairment. Preventive strategies following the present study would likely lead to more accurate
and beneficial outcomes.
Keywords : Falls, Hip fracture, Cause, Course, Cost
