Falls resulting in health care among older people with intellectual disability in comparison with the general population

Abstract

Background Falls are common among older people with intellectual disability (ID) and are also a major contributor to injuries in this population. Yet, fall characteristics have only been sparsely studied, and the results are inconsistent. The aim of the present study was to investigate type of falls, places where they occurred and activities that caused them, as well as health outcomes and health utilisation patterns after falls, among older people with ID in comparison with their age peers in the general population. Methods We established an administrative cohort of people with ID aged 55 years, or more, and alive at the end of 2012 (ID cohort; n = 7936). A cohort from the general population, one‐to‐one matched by sex and year of birth, was used as referents. Data regarding fall‐induced health care episodes in inpatient and outpatient specialist care were collected from the National Patient Register for the period 2002–2012. Results With the exception of falls from one level to another (i.e. fall on and from stairs and steps, ladder and scaffolding; fall from, out of or through building or structure; fall from tree or cliff and diving or jumping into water; or other fall from one level to another), people in the ID cohort were more likely to fall and fall more often than those in the general population cohort. Falls during a vital activity (e.g. attending to personal hygiene or eating) were twice as common among people with ID compared with the general population. When falling, people with ID were more likely to injure their head and legs but less likely to sustain injuries to the thorax and elbow/forearm. They were more likely to have superficial injuries, open wounds and fractures but less likely to have dislocations, sprain and strains. Fall‐related health care visits among people with ID were more likely to be in inpatient care and be unplanned. People with ID were also more likely than those in the general population to have a readmission within 30 days. Conclusions People with ID are more likely to require specialist care after a fall and also more likely to obtain injuries to the head, compared with the general population. This is important to consider when taking preventive measures to reduce falls and fall‐related injuries.

Exploring enablers and barriers to accessing health services after a fall among people with intellectual disability

“…When a fall resulted in hospitalization, rehabilitation services were provided to enable safe discharge home; however, there was neither multifactorial assessment nor periodic follow‐up as recommended in falls prevention guidelines (Moncada & Mire, ). This is problematic as it has been found that when a fall results in a hospital admission, adults with intellectual disability are more likely to be readmitted within 30 days compared to the general population (Axmon et al, ), making post‐discharge planning and follow‐up management critical in this population.…”

“…While there has been limited research investigating the best available evidence for reducing falls among people with intellectual disability, evidence suggests that exercise‐based interventions, environmental safety and caregiver education are important to reduce fall‐related injuries (Axmon, Ahlström, & Sandberg, ; Cahill, Stancliffe, Clemson, & Durvasula, ; Van Hanegem, Enkelaar, Smulders, & Weerdesteyn, ). Further large trials are required that evaluate the effects of falls prevention strategies to inform the falls management in people with intellectual disability (Finlayson, ).…”

Health care utilisation among older people with Down syndrome compared to specific medical guidelines for health surveillance: a Swedish national register study

“…Falls occurred twice as often during vital activities among people with intellectual disabilities than in the general population. After a fall, people with intellectual disabilities most often experienced head or leg injuries and were more likely to require specialist care [38]. There is a need to further investigate if osteoporosis is being underdiagnosed, if relevant treatment is provided and if older people with DS are offered resources such as fall prevention similar to those recommended with high priority in national guidelines for the population in general [46].…”

Incidence and associated risk factors for falls in adults with intellectual disability

“…People with intellectual disability (ID) experience signs of aging from 35 years old (Connolly 1998) and as such can be considered 'older adults'. A recent study that compared falls rates between people with ID and agematched peers demonstrated that people with ID have almost doubled the rate of falls (Axmon et al 2019). A recent systematic review of falls in people with ID found that the pooled proportion of people with ID who fell was 39% [95% CI (0.35-0.43)] (Ho et al 2019).…”

“…A recent systematic review of falls in people with ID found that the pooled proportion of people with ID who fell was 39% [95% CI (0.35-0.43)] (Ho et al 2019). A recent study that compared falls rates between people with ID and agematched peers demonstrated that people with ID have almost doubled the rate of falls (Axmon et al 2019).…”