PubMed · 11198840
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H E Ganley, M Ward. 2001. Program logic. A planning and evaluation method.. https://doi.org/10.1097/00005110-200101000-00001
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In the companion paper, we have outlined how relevant risk factors for falls can be identified using a systematic approach. Once identified, the underlying diseases and pattern of (usually multiple) risk factors guides the design of an individually tailored intervention program. Such intervention programs follow one or more of the following goals: (a) to treat the underlying disease; (b) to reduce or even eliminate the number of falls; (c) to prevent or minimise the associated injuries; and (d) tertiary prevention of fall-related disability, including immobilisation, muscle weakness, reduced fitness, osteoporosis, fear of falling and mortality. The successful results of various intervention studies underscores that falls should be regarded as a potentially treatable disorder in elderly persons. Such knowledge is important for clinicians, which could apply prevention strategies to individual patients with risk factors that are strongly associated with falls. In addition, prevention is important for health policy makers who aim to reduce falls in the general population by reducing or eliminating commonly present risk factors (even if they are only weakly associated with falls).
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OBJECTIVES: To examine the nature, severity and outcomes of injuries sustained from ladder falls. DESIGN: Retrospective survey of medical records. PATIENTS AND SETTING: Patients who presented after a fall from a ladder to the emergency department of a tertiary hospital in Melbourne, Victoria, between January 1994 and December 1997. MAIN OUTCOME MEASURES: Demographic characteristics; height and mechanism of fall; injury site and Injury Severity Score (ISS); rate of hospital admissions. RESULTS: 163 patients presented after ladder falls. They were aged 2.5 to 86 years (mean age, 48 years); 83% were male, and 78% were injured in non-occupational settings. Almost half the accidents (43%) were caused by ladder instability (ladder sliding from position or tilting sideways). Most patients had mild or moderate injuries (usually of the extremities), but 13% had an ISS > or = 16 (indicating severe trauma), usually with head, chest or spinal injuries; 42% were admitted to hospital. Multiple regression analyses showed that ISS increased signficantly with height of fall and age (P< 0.05 for both), although a substantial amount of variation was not attributable to these variables. Likelihood of hospital admission increased linearly with increasing ISS to an ISS of 8 and remained high thereafter. CONCLUSIONS: Ladder falls resulted in significant morbidity, with men undertaking non-occupational activities comprising most of those injured. New strategies to encourage safe ladder use are needed.