Hei-Fen Hwang1, Chui-Hsuan Cheng, Ding-Kuo Chien, Wen-Yu Yu, Mau-Roung Lin. 1. Department of Nursing, National Taipei University of Nursing and Health Science, Taipei, Taiwan (Ms Hwang); Institute of Injury Prevention and Control, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan (Ms Hwang and Dr Lin); Department of Emergency Medicine, Taichung Branch, Tzu-Chi General Hospital, Taichung, Taiwan (Dr Cheng); Department of Emergency Medicine, Mackay Memorial Hospital, Taipei, Taiwan (Dr Chien); and Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan (Dr Yu).
Abstract
OBJECTIVE: To identify risk factors for traumatic brain injuries (TBIs) during falls in older Taiwanese people. PARTICIPANTS: Case patients consisted of 113 patients aged 60 years or older with a moderate/severe TBI due to a fall. Two control groups: (1) 339 older patients with a soft-tissue injury; and (2) 113 with a mild-TBI due to a fall. Proxies were required to provide information for a considerable number of patients. DESIGN: Matched case-control study. SETTINGS: The emergency departments of 3 general hospitals. MEASURES: Sociodemographic, lifestyle behavior, chronic condition, medication use, functional abilities, and fall-related characteristics. RESULTS: When patients with a soft-tissue injury were assigned to the control group, men were 2.06-fold more likely to have a moderate/severe TBI than women. Subjects who took antiarrhythmics within 4 hours of a fall were 2.59-fold more likely to have a moderate/severe TBI than those who took none. Subjects who were negotiating stairs and getting in/out of the bed/chair were 3.12-fold and 2.97-fold, respectively, more likely to have a moderate/severe TBI than those who fell while walking. Falling backward and sideways was 4.07-fold and 2.30-fold, respectively, more likely to cause a moderate/severe TBI than falling forward. When patients with a mild-TBI were assigned to the control group, results were similar, with the exception that the effect of antiarrhythmic use became nonsignificant and subjects who took 2 or more medications were 3.07-fold more likely to have a moderate/severe TBI than those who took none. CONCLUSION: Avoiding a head impact during a backward or sideways fall, reducing unnecessary use of polypharmacy and antiarrhythmics, and maintaining safety during stair negotiation and bed/chair transfer may protect an elderly person from a severe brain injury.
OBJECTIVE: To identify risk factors for traumatic brain injuries (TBIs) during falls in older Taiwanese people. PARTICIPANTS: Case patients consisted of 113 patients aged 60 years or older with a moderate/severe TBI due to a fall. Two control groups: (1) 339 older patients with a soft-tissue injury; and (2) 113 with a mild-TBI due to a fall. Proxies were required to provide information for a considerable number of patients. DESIGN: Matched case-control study. SETTINGS: The emergency departments of 3 general hospitals. MEASURES: Sociodemographic, lifestyle behavior, chronic condition, medication use, functional abilities, and fall-related characteristics. RESULTS: When patients with a soft-tissue injury were assigned to the control group, men were 2.06-fold more likely to have a moderate/severe TBI than women. Subjects who took antiarrhythmics within 4 hours of a fall were 2.59-fold more likely to have a moderate/severe TBI than those who took none. Subjects who were negotiating stairs and getting in/out of the bed/chair were 3.12-fold and 2.97-fold, respectively, more likely to have a moderate/severe TBI than those who fell while walking. Falling backward and sideways was 4.07-fold and 2.30-fold, respectively, more likely to cause a moderate/severe TBI than falling forward. When patients with a mild-TBI were assigned to the control group, results were similar, with the exception that the effect of antiarrhythmic use became nonsignificant and subjects who took 2 or more medications were 3.07-fold more likely to have a moderate/severe TBI than those who took none. CONCLUSION: Avoiding a head impact during a backward or sideways fall, reducing unnecessary use of polypharmacy and antiarrhythmics, and maintaining safety during stair negotiation and bed/chair transfer may protect an elderly person from a severe brain injury.
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