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ARTICLE |

Predictors and Prognosis of Inability to Get Up After Falls Among Elderly Persons

Mary E. Tinetti, MD; Wen-Liang Liu, MPH; Elizabeth B. Claus, PhD
JAMA. 1993;269(1):65-70. doi:10.1001/jama.1993.03500010075035.
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Objective.  —To identify the predictors and prognosis associated with inability to get up after falling.

Design.  —Cohort study with a mean 21-month follow-up.

Setting.  —General community.

Subjects.  —1103 New Haven, Conn, residents aged 72 years and older who were able to follow simple commands and walk unassisted.

Main Outcome Measures.  —Self-reported inability to get up without help after falls not resulting in serious injury; activity restriction and hospitalization after a fall; death; and placement in a nursing home.

Results.  —Inability to get up without help was reported after 220 of 596 noninjurious falls. Of 313 noninjured fallers, 148 (47%) reported inability get up after at least one fall. Compared with nonfallers, the risk factors independently associated with inability to get up included the following: an age of at least 80 years (adjusted relative risk [RR], 1.6; 95% confidence interval [Cl], 1.2 to 2.1); depression (RR, 1.5; Cl, 1.1 to 2.0); and poor balance and gait (RR, 2.0; Cl, 1.5 to 2.7). Previous stroke (RR, 1.6; Cl, 1.0 to 2.4) and sedative use (RR, 1.5; Cl, 0.9 to 2.2) did not achieve significance. Among fallers, older age and poor balance and gait were associated marginally with inability to get up. Compared with fallers who were able to get up, fallers who were unable to get up were more likely to suffer lasting decline in activities of daily living (35% vs 26%). Fallers who were unable to get up were more likely to die, to be hospitalized, and to suffer a decline in activities of daily living for at least 3 days, and were less likely to be placed in a nursing home than were fallers who were able to get up, but these trends were not statistically significant.

Conclusions.  —The risk factors for inability to get up were similar to those for falling, although certain factors imparted a particular risk of inability to get up without help. The frequency of inability to get up and the short- and long-term morbidity associated with this inability suggest the need for preventive and treatment efforts.(JAMA. 1993;269:65-70)

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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