Falls, fractures and function. Focus on women with a distal forearm fracture

Sammanfattning: Falls and fractures in older people are a common and increasing health problem which causes physical, social and psychological problems for the individual and is costly to society. The aims of this thesis were to investigate accidental falls of patients aged 65 - 74 who attended an orthopedic emergency ward, to investigate reliability of the modified figure of eight (MFE) and compare it with other balance performance tests, to investigate whether patients with a distal forearm fracture exhibited risk factors for new falls and fractures, and to follow physical performance and evaluate health-related quality of life in women after a distal forearm fracture. In the accidental falls, 72% led to fractures. More women than men sustained fractures and the most common fracture was a distal forearm fracture. One third were admitted to hospital. Patients who were less healthy sustained fractures more often. Information regarding risk factors for falls and fractures were often not documented in the patients’ medical files. Satisfactory documentation is a prerequisite for prevention measures for further falls and fractures. Two examiners measured balance capacity in elderly women on two occasions with one week in between. The tests were MFE, one-legged stance, tandem stance, standing on foam and walking tests. There was a high to very high inter-rater reliability for all the tests. MFE-time significantly correlated to walking speed. The MFE was highly reliable, showed satisfactory concurrent validity and can be recommended for use by different examiners and over time. Sixty-six patients with a fall-related distal forearm fracture were examined shortly after the fracture. The majority of the patients were physically active. One third reported previous falls and fall-related fractures. Half of the patients were regularly examined for chronic ailments and were on regular medication. Their physical performance was comparable to a healthy population of the same age. One year after the fracture, 43 women came for a follow-up. A significant decrease in handgrip strength and walking speed was found. Women who reported comorbidity and low physical activity scored lower in the two health-related quality of life (HRQoL) questionnaires; EQ-5D and SF-12. Besides the fracture treatment, patients with a fall-related distal forearm fracture should be screened for fall and fracture risk, and be targeted for secondary preventive measures for falls and fractures. Additional treatment aimed at maintaining physical capacity should be further explored for this patient group. Low results in HRQoL questionnaires might indicate underlying comorbidity, not captured by physical performance tests alone. Those patients should be referred to continued health care. There is a strong relationship between falls and fractures in elderly persons. Although most falls do not result in a fracture, a majority of fractures in the elderly are sustained in a fall. There is a great need for increased awareness among the caregivers concerning falls, fractures and function. Local action plans and fracture treatment protocols should include preventive measures with the focus on falls and function.