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      Ethnicity and culture: is it associated with falls?

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      Clinical Interventions in Aging

      Dove Medical Press

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          Abstract

          Dear editor We read with great interest in the last issue of Clinical Interventions in Aging the article by Vieira et al, who studied the factors associated with falls among different ethnic groups in community-dwelling older adults and revealed that Afro-Caribbeans had a lower prevalence of falls and that several associations were stronger among this ethnic group.1 On the other hand, those associated factors, including taking medications for anxiety, having incontinence, and age above 75 years, do not seem to be ethnicity-related exclusively, but rather are more attributable to the general population’s lifestyle. Also, they did not discuss the role of ethnicity in falls and differences between ethnic groups. Previous studies have suggested several culture-related factors that may be associated with falls among the elderly population, such as marital status.2,3 It has been shown that falls and hip fractures occur less frequently among married people, which can be explained by the physical and emotional support of the spouses. This explanation could be different in various cultures, due to their attitude toward marriage and family. The time pattern of hip fractures is another factor that was revealed in a study among an Iranian population, which showed a peak time in the early morning among elderly women, which may be associated with ritual customs and the Islamic religion, which requires praying in the morning before dawn.1 Carpet is another feature that has been proposed in the literature and that is commonly seen in Eastern cultures. It seems that it has two aspects. Although it could decrease impact velocity, it also itself could increase the probability of falling in the elderly, which has not been characterized well in studies.4 It seems that there are different ethnicity- and culture-related factors that could play roles in falling among different cultures and ethnic groups. Future investigations are needed in various ethnic populations, in order to characterize the associated factors in this issue and so that preventive strategies can be managed in different target groups to be ethnicity- and culture-specific.

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          Most cited references 5

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          Falls incidence, risk factors, and consequences in Chinese older people: a systematic review.

          Falls incidence in Chinese older people has been reported to be approximately half that of Caucasian populations. It is possible that the falls risk factor profile may differ significantly between Caucasian and Chinese populations, and a better understanding of this reported difference in incidence and associated risk factors may influence potential approaches to future intervention. A systematic literature review was conducted using the EMBase, Medline, Chinese Electronic Periodical Services, and WanFangdata databases to collate and evaluate the studies that have addressed the incidence and risk factors for falls in Chinese older people. Twenty-one studies conducted in China, Hong Kong, Macao, Singapore, and Taiwan met the inclusion criteria. Fall rates ranged between 14.7% and 34% per annum (median 18%). In the four prospective studies, injuries were reported by 60% to 75% of those reporting falls, with fractures constituting 6% to 8% of all injuries. One hundred thirty-two variables were identified as fall risk factors, with commonly reported factors being female sex, older age, use of multiple medications, gait instability, fear of falling, and decline in activities of daily living. The findings reveal a consistently lower incidence of self-reported falls in Chinese older people than in Caucasian older people, although the types and prevalence of risk factors were not dissimilar from those found in studies of Caucasian older people. A greater understanding of the health, behavioral, and lifestyle factors that influence fall rates in Chinese populations is required for elucidating fall prevention strategies in Chinese and non-Chinese older people. © 2011, Copyright the Authors. Journal compilation © 2011, The American Geriatrics Society.
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            Incidence and characteristics of falls leading to hip fracture in Iranian population.

            An estimated one in three adults aged 65 years or older falls each year, making falls a major health concern. Hip fractures are the most serious consequences of falls in elderly people. Identifying the characteristics of falls leading to hip fracture may provide information about high risk individuals, environment, and activities useful for the development of intervention strategies. Little is known, however, about the incidence and characteristics of falls leading to hip fracture in Middle Eastern countries. Therefore, the authors presented data from the Iranian Multicenter Study on Accidental Injuries, a prospective population-based study conducted in 9 provinces of Iran in 2003. All the hospitals serving about 9.5 million people in the study area were prospectively surveyed for any incident injury resulting from accidental events. A total of 2,186 patients (1,372 male, 814 female) were admitted due to any injurious fall events, where 572 (26.2%) of them suffered a hip fracture. Annual incidence rates of injurious fall events and related hip fractures were 116.3 and 30.4 per 100,000 person-years, respectively. These figures were 237.1 and 93.6 per 100,000 person-years for people over the age of 50 years, respectively. 71% of fall injuries and 76% of hip fractures occurred indoors. Among 450 patients with hip fractures >or=50 years of age, 61.8% arose from a fall from standing height or less. Only 1 in these 450 hip fractures occurred at the time of recreational activity. In multivariate logistic regression analysis, no factor was an independent predictor of hip fractures comparing to other fall-related injuries among younger participants (>or=20 and <50 years). For older patients, falls from standing height or loss (odds ratio (OR) = 2.67), falls during walking (OR = 1.71), and falls on stairs (OR = 1.73) were detected as risk factors of hip fracture. Married persons and those falling from a ladder or other elevations were less likely to fracture their hip in this age group. Our data suggest that modification of the factors external to the homes is less likely to prevent more than a small proportion of fall-related hip fractures in Iran. Further studies on this topic have potential applications for developing preventive strategies.
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              Circumstances around the fall in a multinational hip fracture risk study: a diverse pattern for prevention. MEDOS Study Group). Mediterranean Osteoporosis Study.

              Hip fracture is a major public health problem, but with a potential for prevention. Data from a European multicentre study on hip fracture epidemiology with a case control design, the MEDOS study, were used to describe and analyse circumstances around falls associated with hip fracture. The study includes 2185 fracture cases age > 50 years from 14 centres in southern Europe: Portugal, Spain, France, Italy, Greece and Turkey. Information was collected by a standardized and validated questionnaire translated into six languages and administered by trained interviewers. Circumstances around the fall were categorized according to: (1) place, age group and time of day; (2) functional disability; (3) drug consumption including alcohol; and (4) environmental factors. Possibilities for prevention were also analysed. High risk falls were identified using seven reasonably well-established risk factors, and similarly eight risk factors were used to identify high risk fallers. Selected trains of events were also studied. A pattern of great diversity was found both among the fallers and the environment in which they fell and fractured the hip. Those with more than one factor involved constituted only 14.7% of female and 19.7% of male fractures. A majority of cases were not physically disabled before the fall. A majority (66.5%) fell and fractured their hip indoors and only 4.3% outside in darkness. Cardiovascular and cerebrovascular comborbidity were observed with 4.9 and 7.8%, of falls respectively. Falls in a stairway comprised 11% of falls. The correlation between the number of the risk factors of the faller and in the environment was 0.07 and there was no difference between males and females. The pattern of causality behind falls that cause hip fracture and therefore of prevention comprises many sometimes small groups and intricate time sequence. The results suggest that global preventive strategies could presently not be implemented. Instead, the pattern of prevention should include different target groups and be country and site specific. For the high risk group of institutionalized patients prevention can be implemented without delay.
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                Author and article information

                Affiliations
                [1 ]Student Research Center, Babol University of Medical Sciences, Babol, Iran
                [2 ]Department of Neurology, Ayatollah Rohani Hospital, Babol University of Medical Sciences, Babol, Iran
                [1 ]Department of Physical Therapy, Florida International University, Miami, FL, USA
                [2 ]Department of Neuroscience, Florida International University, Miami, FL, USA
                [3 ]Christine E Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
                Author notes
                Correspondence: Amin Zarghami, Department of Neurology, Ayatollah Rohani Hospital, Babol University of Medical Sciences, Ganjafrouz Street, Babol, Iran, Tel +98 911 212 0205, Email aminzarghami18@ 123456yahoo.com
                Journal
                Clin Interv Aging
                Clin Interv Aging
                Clinical Interventions in Aging
                Clinical Interventions in Aging
                Dove Medical Press
                1176-9092
                1178-1998
                2015
                10 December 2015
                : 10
                : 1945-1946
                cia-10-1945
                10.2147/CIA.S101139
                4677658
                © 2015 Anissian and Zarghami. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

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                Health & Social care

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