The importance of following up older people who have had a fall: global lessons
Falls prevention, particularly in older people has been recognized as an important policy issue and public health strategies and initiatives involving health and social services, local government and the voluntary sector are prevalent in many countries (Chang et al. 2004, Todd & Skelton 2004). The consequences of falls are well documented and include injury, hospitalization, impaired mobility and even premature death. Other impacts for individuals and their families are loss of independence, social isolation, fear of falls, recurrent falls, increased care needs and impaired mental health, well-being and quality of life (Roe et al. 2009). Our knowledge of older people’s experience of falls, their perspectives, interpretation and understanding is also an emerging area of inquiry that can help inform future development, organization and delivery of services (Roe et al. 2008).
Hip fractures are associated with osteoporosis that may present as a fall. The questions arise, are hip fractures the result of osteoporosis or the fall? Or was the fall due to the osteoporosis? Either way the consequences are devastating. The study by Shyu et al. (2009) in this issue of JAN has looked at older people with hip fracture and depression in their first postoperative year. This study builds on their earlier work and provides a synthesis of internationally relevant research that informed their own research in Taiwan. Their JAN paper reports the analysis of longitudinal data over 12 months for symptoms of depression at five time points in a sample of older people, who had a hip fracture. Their study was based on the fact that prevalence rates of depression in older people following hip fracture had not been studied longitudinally in Asian countries. They found a majority of people with hip fracture were at risk of depressive symptoms. Lower emotional support was predictive of persistent depressive symptoms following discharge (P < 0·01). They advocate ongoing support of older people who have had a hip fracture, in particular women, those with poorer prefracture function and those having lower emotional-social support.
This study is important on two counts. It illustrates the importance of following older people with hip fractures or those who have had a fall over time as their health needs may alter and they require additional support or services. Falls are recurrent and can be a sign of other underlying changes or health needs that require intervention as part of falls prevention. On the second count, this study provides a good example of how a project undertaken locally can have global or international relevance and impact by incorporating the international evidence available on a subject to justify it being undertaken and inform its design and methods. The findings, conclusions and implications for practice and research are discussed in context for Asian countries and populations as well as their contribution to global evidence. These are important and distinguishing features and contributions of publications in JAN, and provides a good example of international context.