Skip to main content
Top
Published in: BMC Geriatrics 1/2024

Open Access 01-12-2024 | COVID-19 | Research

Trends in falls among older adults before and during the COVID-19 pandemic in Ontario, Canada: A retrospective observational study

Authors: Ashini Weerasinghe, Justin Thielman, Ye Li, Varsha B. Doguparty, Alexia Medeiros, Sue Keller-Olaman, Sarah Carsley, Sarah A. Richmond

Published in: BMC Geriatrics | Issue 1/2024

Login to get access

Abstract

Background

The public health measures associated with the COVID-19 pandemic may have indirectly impacted other health outcomes, such as falls among older adults. The purpose of this study was to examine trends in fall-related hospitalizations and emergency department visits among older adults before and during the COVID-19 pandemic in Ontario, Canada.

Methods

We obtained fall-related hospitalizations (N = 301,945) and emergency department visit (N = 1,150,829) data from the Canadian Institute for Health Information databases from 2015 to 2022 for adults ages 65 and older in Ontario. Fall-related injuries were obtained using International Classification of Diseases, 10th edition, Canada codes. An interrupted time series analysis was used to model the change in weekly fall-related hospitalizations and emergency department visits before (January 6, 2015-March 16, 2020) and during (March 17, 2020-December 26, 2022) the pandemic.

Results

After adjusting for seasonality and population changes, an 8% decrease in fall-related hospitalizations [Relative Rate (RR) = 0.92, 95% Confidence Interval (CI): 0.85, 1.00] and a 23% decrease in fall-related emergency department visits (RR = 0.77, 95%CI: 0.59, 1.00) were observed immediately following the onset of the pandemic, followed by increasing trends during the pandemic for both outcomes.

Conclusions

Following an abrupt decrease in hospitalizations and emergency department visits immediately following the onset of the pandemic, fall-related hospitalizations and emergency department visits have been increasing steadily and are approaching pre-pandemic levels. Further research exploring the factors contributing to these trends may inform future policies for public health emergencies that balance limiting the spread of disease among this population while supporting the physical, psychological, and social needs of this vulnerable group.
Literature
4.
go back to reference Yardley L, Smith H. A prospective study of the relationship between feared consequences of falling and avoidance of activity in community-living older people. Gerontologist. 2002;42(1):17–23.CrossRefPubMed Yardley L, Smith H. A prospective study of the relationship between feared consequences of falling and avoidance of activity in community-living older people. Gerontologist. 2002;42(1):17–23.CrossRefPubMed
9.
go back to reference Sekhon H, Lavin P, Vacaflor B, Rigas C, Cinalioglu K, Su CL, et al. Isolating together during COVID-19: results from the Telehealth intervention program for older adults. Front Med (Lausanne). 2022;9:948506.CrossRefPubMed Sekhon H, Lavin P, Vacaflor B, Rigas C, Cinalioglu K, Su CL, et al. Isolating together during COVID-19: results from the Telehealth intervention program for older adults. Front Med (Lausanne). 2022;9:948506.CrossRefPubMed
10.
go back to reference Hoffman GJ, Malani PN, Solway E, Kirch M, Singer DC, Kullgren JT. Changes in activity levels, physical functioning, and fall risk during the COVID-19 pandemic. J Am Geriatr Soc. 2022;70(1):49–59.CrossRefPubMed Hoffman GJ, Malani PN, Solway E, Kirch M, Singer DC, Kullgren JT. Changes in activity levels, physical functioning, and fall risk during the COVID-19 pandemic. J Am Geriatr Soc. 2022;70(1):49–59.CrossRefPubMed
11.
go back to reference Demangel R, Treffel L, Py G, Brioche T, Pagano AF, Bareille MP, et al. Early structural and functional signature of 3-day human skeletal muscle disuse using the dry immersion model. J Physiol. 2017;595(13):4301–15.CrossRefPubMedPubMedCentral Demangel R, Treffel L, Py G, Brioche T, Pagano AF, Bareille MP, et al. Early structural and functional signature of 3-day human skeletal muscle disuse using the dry immersion model. J Physiol. 2017;595(13):4301–15.CrossRefPubMedPubMedCentral
12.
go back to reference Rosenberg DE, Bellettiere J, Gardiner PA, Villarreal VN, Crist K, Kerr J. Independent associations between sedentary behaviors and mental, cognitive, physical, and functional health among older adults in retirement communities. J Gerontol Biol Sci Med Sci. 2016;71(1):78–83.CrossRef Rosenberg DE, Bellettiere J, Gardiner PA, Villarreal VN, Crist K, Kerr J. Independent associations between sedentary behaviors and mental, cognitive, physical, and functional health among older adults in retirement communities. J Gerontol Biol Sci Med Sci. 2016;71(1):78–83.CrossRef
13.
go back to reference Brodie MA, Okubo Y, Annegarn J, Wieching R, Lord SR, Delbaere K. Disentangling the health benefits of walking from increased exposure to falls in older people using remote gait monitoring and multi-dimensional analysis. Physiol Meas. 2017;38(1):45–62.CrossRefPubMed Brodie MA, Okubo Y, Annegarn J, Wieching R, Lord SR, Delbaere K. Disentangling the health benefits of walking from increased exposure to falls in older people using remote gait monitoring and multi-dimensional analysis. Physiol Meas. 2017;38(1):45–62.CrossRefPubMed
14.
go back to reference Steinfeld Y, Ben Natan M, Yonai Y, Berkovich Y. Hip fracture following a fall among older adults during the COVID-19 pandemic. Isr Med Assoc J. 2021;23(8):479–83.PubMed Steinfeld Y, Ben Natan M, Yonai Y, Berkovich Y. Hip fracture following a fall among older adults during the COVID-19 pandemic. Isr Med Assoc J. 2021;23(8):479–83.PubMed
15.
go back to reference Janke AT, Jain S, Hwang U, Rosenberg M, Biese K, Schneider S, et al. Emergency department visits for emergent conditions among older adults during the COVID-19 pandemic. J Am Geriatr Soc. 2021;69(7):1713–21.CrossRefPubMedPubMedCentral Janke AT, Jain S, Hwang U, Rosenberg M, Biese K, Schneider S, et al. Emergency department visits for emergent conditions among older adults during the COVID-19 pandemic. J Am Geriatr Soc. 2021;69(7):1713–21.CrossRefPubMedPubMedCentral
16.
go back to reference Dass D, Ramhamadany E, Govilkar S, Rhind JH, Ford D, Singh R, et al. How a pandemic changes trauma: epidemiology and management of trauma admissions in the UK during COVID-19 Lockdown. J Emerg Trauma Shock. 2021;14(2):75–9.CrossRefPubMedPubMedCentral Dass D, Ramhamadany E, Govilkar S, Rhind JH, Ford D, Singh R, et al. How a pandemic changes trauma: epidemiology and management of trauma admissions in the UK during COVID-19 Lockdown. J Emerg Trauma Shock. 2021;14(2):75–9.CrossRefPubMedPubMedCentral
17.
go back to reference Zahoor U, Malik C, Raja H, Ramaraju S, Sri-Ram K. Effect of COVID-19 on orthopaedic trauma admissions and operating in a London District General Hospital. Surg J (N Y). 2022;8(4):e283–289.CrossRefPubMed Zahoor U, Malik C, Raja H, Ramaraju S, Sri-Ram K. Effect of COVID-19 on orthopaedic trauma admissions and operating in a London District General Hospital. Surg J (N Y). 2022;8(4):e283–289.CrossRefPubMed
18.
go back to reference Hollinghurst R, Williams N, Pedrick-Case R, North L, Long S, Fry R, et al. Annual risk of falls resulting in emergency department and hospital attendances for older people: an observational study of 781,081 individuals living in Wales (United Kingdom) including deprivation, frailty and dementia diagnoses between 2010 and 2020. Age Ageing. 2022;51(8):afac176.CrossRefPubMed Hollinghurst R, Williams N, Pedrick-Case R, North L, Long S, Fry R, et al. Annual risk of falls resulting in emergency department and hospital attendances for older people: an observational study of 781,081 individuals living in Wales (United Kingdom) including deprivation, frailty and dementia diagnoses between 2010 and 2020. Age Ageing. 2022;51(8):afac176.CrossRefPubMed
19.
go back to reference Grimm F, Johansen A, Knight H, Brine R, Deeny SR. Indirect effect of the COVID-19 pandemic on hospital mortality in patients with hip fracture: a competing risk survival analysis using linked administrative data. BMJ Qual Saf. 2023;32(5):264–73.CrossRefPubMed Grimm F, Johansen A, Knight H, Brine R, Deeny SR. Indirect effect of the COVID-19 pandemic on hospital mortality in patients with hip fracture: a competing risk survival analysis using linked administrative data. BMJ Qual Saf. 2023;32(5):264–73.CrossRefPubMed
20.
go back to reference Dotchviri T, Pitskhelauri N, Chikhladze N, Akhobadze K, Dotchviri T, Kereselidze M. Fall related geriatric trauma trends in Georgia. Georgian Med News. 2023;336:85–90. Dotchviri T, Pitskhelauri N, Chikhladze N, Akhobadze K, Dotchviri T, Kereselidze M. Fall related geriatric trauma trends in Georgia. Georgian Med News. 2023;336:85–90.
22.
go back to reference Sultanoğlu H, Demir MC, Boğan M. Trends in geriatric trauma emergency department admissions during COVID-19. J Trauma Nurs. 2022;29(3):125–30.CrossRefPubMed Sultanoğlu H, Demir MC, Boğan M. Trends in geriatric trauma emergency department admissions during COVID-19. J Trauma Nurs. 2022;29(3):125–30.CrossRefPubMed
23.
go back to reference Chiba H, Lewis M, Benjamin ER, Jakob DA, Liasidis P, Wong MD, et al. “Safer at home”: The effect of the COVID-19 lockdown on epidemiology, resource utilization, and outcomes at a large urban trauma center. J Trauma Acute Care Surg. 2021;90(4):708–13.CrossRefPubMed Chiba H, Lewis M, Benjamin ER, Jakob DA, Liasidis P, Wong MD, et al. “Safer at home”: The effect of the COVID-19 lockdown on epidemiology, resource utilization, and outcomes at a large urban trauma center. J Trauma Acute Care Surg. 2021;90(4):708–13.CrossRefPubMed
24.
go back to reference AlRousan FM, Alkhawaldah A, Altarawneh RY, Al-Qudah AK, Almigdad AK. Impact of social distancing on geriatric hip fractures among Jordanian population during COVID-19 pandemic. Mater Sociomed. 2022;34(1):37–9.CrossRefPubMedPubMedCentral AlRousan FM, Alkhawaldah A, Altarawneh RY, Al-Qudah AK, Almigdad AK. Impact of social distancing on geriatric hip fractures among Jordanian population during COVID-19 pandemic. Mater Sociomed. 2022;34(1):37–9.CrossRefPubMedPubMedCentral
26.
go back to reference Von-Bahten LC, Zvicker AL, Silva AAD, Salviato BZ, Teixeira HM, Ando PK, et al. Influence of the COVID-19 pandemic on the epidemiological profile of the initial care of victims of falls. Rev Col Bras Cir. 2023;50:e20233422.PubMedPubMedCentral Von-Bahten LC, Zvicker AL, Silva AAD, Salviato BZ, Teixeira HM, Ando PK, et al. Influence of the COVID-19 pandemic on the epidemiological profile of the initial care of victims of falls. Rev Col Bras Cir. 2023;50:e20233422.PubMedPubMedCentral
27.
28.
go back to reference Howley F, Lavan A, Connolly E, McMahon G, Mehmood M, Briggs R. Trends in emergency department use by older people during the COVID-19 pandemic. Eur Geriatr Med. 2021;12(6):1159–67.CrossRefPubMedPubMedCentral Howley F, Lavan A, Connolly E, McMahon G, Mehmood M, Briggs R. Trends in emergency department use by older people during the COVID-19 pandemic. Eur Geriatr Med. 2021;12(6):1159–67.CrossRefPubMedPubMedCentral
31.
go back to reference Population Reporting. Population estimates County/Municipality, 1986–2020 [data file]. Ottawa ON: Statistics Canada, Government of Canada [producer]; Toronto, ON: Ontario. Ministry of Health, IntelliHealth Ontario [distributor]; [data extracted 2022 Jan 13]. Population Reporting. Population estimates County/Municipality, 1986–2020 [data file]. Ottawa ON: Statistics Canada, Government of Canada [producer]; Toronto, ON: Ontario. Ministry of Health, IntelliHealth Ontario [distributor]; [data extracted 2022 Jan 13].
32.
go back to reference Population Reporting. Population projections public health unit, 2021–2046 [data file]. Toronto ON: Ministry of Finance [producer]; Toronto, ON: Ontario. Ministry of Health, IntelliHealth Ontario [distributor]; [data extracted 2022 Jan 13]. Population Reporting. Population projections public health unit, 2021–2046 [data file]. Toronto ON: Ministry of Finance [producer]; Toronto, ON: Ontario. Ministry of Health, IntelliHealth Ontario [distributor]; [data extracted 2022 Jan 13].
33.
go back to reference Bernal JL, Cummins S, Gasparrini A. Interrupted time series regression for the evaluation of public health interventions: a tutorial. Int J Epidemiol. 2017;46(1):348–55.PubMed Bernal JL, Cummins S, Gasparrini A. Interrupted time series regression for the evaluation of public health interventions: a tutorial. Int J Epidemiol. 2017;46(1):348–55.PubMed
34.
go back to reference Hanley JA, Negassa A, Edwardes MD, Forrester JE. Statistical analysis of correlated data using generalized estimating equations: an orientation. Am J Epidemiol. 2003;157(4):364–75.CrossRefPubMed Hanley JA, Negassa A, Edwardes MD, Forrester JE. Statistical analysis of correlated data using generalized estimating equations: an orientation. Am J Epidemiol. 2003;157(4):364–75.CrossRefPubMed
35.
go back to reference Landi F, Liperoti R, Russo A, Giovannini S, Tosato M, Capoluongo E, et al. Sarcopenia as a risk factor for falls in elderly individuals: results from the ilSIRENTE study. Clin Nutr. 2012;31(5):652–8.CrossRefPubMed Landi F, Liperoti R, Russo A, Giovannini S, Tosato M, Capoluongo E, et al. Sarcopenia as a risk factor for falls in elderly individuals: results from the ilSIRENTE study. Clin Nutr. 2012;31(5):652–8.CrossRefPubMed
36.
go back to reference Xiao H, Augusto O, Wagenaar BH. Reflection on modern methods: a common error in the segmented regression parameterization of interrupted time-series analyses. Int J Epidemiol. 2021;50(3):1011–5.CrossRefPubMed Xiao H, Augusto O, Wagenaar BH. Reflection on modern methods: a common error in the segmented regression parameterization of interrupted time-series analyses. Int J Epidemiol. 2021;50(3):1011–5.CrossRefPubMed
37.
go back to reference Vongsachang H, Mihailovic A, E JY, Friedman DS, West SK, Gitlin LN, et al. The impact of weather and seasons on falls and physical activity among older adults with glaucoma: a longitudinal prospective cohort study. Sensors (Basel). 2021;21(10):3415.CrossRefPubMed Vongsachang H, Mihailovic A, E JY, Friedman DS, West SK, Gitlin LN, et al. The impact of weather and seasons on falls and physical activity among older adults with glaucoma: a longitudinal prospective cohort study. Sensors (Basel). 2021;21(10):3415.CrossRefPubMed
38.
go back to reference Caruso Soares B, Alves Costa D, de Faria Xavier J, Alamino Pereira de Viveiro L, Pedrozo Campos Antunes T, Grazielli Mendes F, et al. Social isolation due to COVID-19: impact on loneliness, sedentary behavior, and falls in older adults. Aging Ment Health. 2022;26(10):2120–7.CrossRefPubMed Caruso Soares B, Alves Costa D, de Faria Xavier J, Alamino Pereira de Viveiro L, Pedrozo Campos Antunes T, Grazielli Mendes F, et al. Social isolation due to COVID-19: impact on loneliness, sedentary behavior, and falls in older adults. Aging Ment Health. 2022;26(10):2120–7.CrossRefPubMed
39.
go back to reference Vidal E, Moreira-Filho D, Pinheiro R, Souza RC, Almeida L, Camargo K Jr, et al. Delay from fracture to hospital admission: a new risk factor for hip fracture mortality? Osteoporos Int. 2012;23(12):2847–53.CrossRefPubMed Vidal E, Moreira-Filho D, Pinheiro R, Souza RC, Almeida L, Camargo K Jr, et al. Delay from fracture to hospital admission: a new risk factor for hip fracture mortality? Osteoporos Int. 2012;23(12):2847–53.CrossRefPubMed
40.
go back to reference Walker MJ, Meggetto O, Gao J, Espino-Hernández G, Jembere N, Bravo CA, et al. Measuring the impact of the COVID-19 pandemic on organized cancer screening and diagnostic follow-up care in Ontario, Canada: a provincial, population-based study. Prev Med. 2021;151:106586.CrossRefPubMedPubMedCentral Walker MJ, Meggetto O, Gao J, Espino-Hernández G, Jembere N, Bravo CA, et al. Measuring the impact of the COVID-19 pandemic on organized cancer screening and diagnostic follow-up care in Ontario, Canada: a provincial, population-based study. Prev Med. 2021;151:106586.CrossRefPubMedPubMedCentral
Metadata
Title
Trends in falls among older adults before and during the COVID-19 pandemic in Ontario, Canada: A retrospective observational study
Authors
Ashini Weerasinghe
Justin Thielman
Ye Li
Varsha B. Doguparty
Alexia Medeiros
Sue Keller-Olaman
Sarah Carsley
Sarah A. Richmond
Publication date
01-12-2024
Publisher
BioMed Central
Keyword
COVID-19
Published in
BMC Geriatrics / Issue 1/2024
Electronic ISSN: 1471-2318
DOI
https://doi.org/10.1186/s12877-024-05032-y

Other articles of this Issue 1/2024

BMC Geriatrics 1/2024 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine