The need to reduce falls is driven by the need to reduce injury. If patients at risk of injury can be distinguished from the patients at risk of falls, there is the potential for a more effective fall risk management policy by targeting injury prevention measures. We conducted a prospective observational study, with blinded endpoint evaluation of 825 consecutive patients admitted to geriatric rehabilitation wards. We identified 150 fallers (18.2%) contributing 243 falls. Fifty-six patients sustained an injury contributing 73 (30.0%) injurious falls. Only five (6.8%) falls resulted in injury of major severity. We identified no significant differences in demographics between injurious and non-injurious falls. A logistic regression analyses of the independent risk factors of suffering an injurious fall were a history of falls (p=0.036), confusion (p=0.001) and an unsafe gait (p=0.03). However, we identified no significant differences in clinical characteristics between patients suffering injurious and non-injurious falls. None of the characteristics studied can identify patients prone to injury after a fall. Injury is largely unpredictable, and more research is needed to determine how injury can be prevented in patients at risk of falls.

During the 15th World Congress on Disaster and Emergency Medicine in Amsterdam, May 2007 (15WCDEM), a targeted agenda program (TAP) about the public health aspects of large-scale floods was organized. The main goal of the TAP was the establishment of an overview of issues that would help governmental decision-makers to develop policies to increase the resilience of the citizens during floods. During the meetings, it became clear that citizens have a natural resistance to evacuations. This results in death due to drowning and injuries. Recently, communication and education programs have been developed that may increase awareness that timely evacuation is important and can be life-saving. After a flood, health problems persist over prolonged periods, including increased death rates during the first year after a flood and a higher incidence of chronic illnesses that last for decades after the flood recedes. Population-based resilience (bottom-up) and governmental responsibility (top-down) must be combined to prepare regions for the health impact of evacuations and floods. More research data are needed to become better informed about the health impact and consequences of translocation of health infrastructures after evacuations. A better understanding of the consequences of floods will support governmental decision-making to mitigate the health impact. A top-10 priority action list was formulated.

This study looked at associations of tranquilliser use and falls risk in a hospital population of confused and nonconfused patients. In a prospective observational study in a rehabilitation hospital for elderly patients, we followed 1025 consecutive patients. The number of fallers, recurrent fallers and total falls was recorded. Confused patients (p < 0.0001) and patients on tranquillisers (p = 0.001) were significantly more likely to fall than nonconfused patients and patients off tranquillisers. Confused patients on tranquillisers were significantly more likely to have recurrent falls (p = 0.026) when compared with confused patients off tranquillisers. The risk was apparent from admission, persisting throughout the first 30 days of stay. This was not noted for nonconfused patients. We identified a stratification of risk for falls with nonsignificant trends for confused and nonconfused patients on tranquillisers to be fallers and to have more falls compared with patients off tranquillisers. These data are associational and do not necessarily imply causality. There is however no evidence to recommend the routine withdrawal of tranquillisers from all patients. Any future research needs to include confused patients.

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