Unintentional falls at home among young and middle-aged adults: the influence of alcohol

Abstract

Aim To investigate the epidemiology of unintentional fall-related injuries at home among young and middle-aged adults (25 to 59 years) and to investigate the contribution of alcohol to these injuries. Methods Routinely collected national fall injury data were analysed to describe the incidence and characteristics of falls at home resulting in death or hospital inpatient treatment among this age group in New Zealand. A systematic review of the published literature evaluated the epidemiological evidence quantifying the risk of falls associated with acute and usual alcohol consumption in this age group. A population-based case-control study was conducted in Auckland, New Zealand over a 12-month period. Cases were 335 people aged 25 to 59 years who were admitted to hospital or died as a result of unintentional non-occupational falls at home. Controls were 352 people randomly selected from the electoral roll from the same age group as the cases. The participants or next-of-kin completed a structured interview to ascertain data on personal and lifestyle factors including alcohol consumption. Findings The review of national injury data found that almost a third of unintentional falls resulting in an in-patient admission among working-age people were recorded as occurring at home. For every death there were about 150 in-patient hospital admissions. The systematic review identified only a small number of studies but showed an increased risk of unintentional falls in this age group with increasing exposure to alcohol use. The magnitude of this risk varied considerably across studies with most estimates being relatively imprecise. There was modest evidence of a dose-response relationship with acute alcohol use. The association between usual alcohol use and fall risk was inconclusive. The case-control study revealed that after controlling for confounding, the consumption of two or more standard alcoholic drinks in the preceding six hours relative to none is associated with a significantly increased risk of fall-related injury. Approximately 21% of unintentional non-occupational falls at home in this population was attributed to this risk. No association between hazardous drinking as a usual pattern and falls was found when the analyses were adjusted for confounders. Conclusion A significant proportion of unintentional fall-related injuries among the working-aged New Zealanders occur at home. Consuming two or more drinks in the previous six hours was strongly associated with unintentional non-occupational falls at home that result in admission to hospital or death in this age group. This largely unrecognised problem should be addressed in further research and in falls prevention programmes.