The present study is a part of larger study which mainly focussed on pattern of injuries and its socioeconomic impact in an urban community which has been described in detail elsewhere [6]. The present study focussed on to determine the prevalence of falls in an urban area and its social and economic impact on the individual and their family.

The methodology has been described in detail elsewhere [6]. The study population included all people residing at ward number 17 & 36, Mattikere, Bangalore out of which 3003 population was studied during June 2012- March 2013. Inclusion criteria consisted of any person who was residing in that area from the past 6 months and those who met with falls injury where the term “falls injury” had been described as trip, slip, stumble or fall on a level plane, from one level to another, or into a hole or other opening in a surface whether being unintentional or due to assault and self directed violence [7].

Fall of objects was also included in our study. Further the injuries were classified as mild, moderate injuries and severe injuries based on the number of days of incapacitation. Recall period of 12 months was used during data collection. Those refusing to give informed consent and those who were not willing to participate for their own reasons were excluded.

Fall from moving vehicles and fall into water i.e drowning were excluded. Information relating to moderate & severe falls injuries alone was collected in each of the households after obtaining informed consent from the participants. Mild injuries were excluded since in the pilot study it was observed that mild injuries resulted in minimal social and economic impact.

Statistical Analysis: SPSS -17software was used for analysis. The data was tabulated with respect to certain socio-demographic characters against falls injuries and their prevalence rate with 95% confidence interval was calculated. Qualitative variables were expressed in frequency and percentages. The quantitative data were summarized through descriptive measures such as mean, standard deviation, median and inter quartile range. Chi square test, Fisher exact test and Kruskal Wallis test were employed for evaluating statistical significance.

The prevalence of falls was 23/1000 population with 95% confidence interval (CI) of (18-29). In our study falls was common among extremes of age group i.e high prevalence of 48 (40-56) among children aged ≤14 years and 23 (18-29) among ≥60 years was observed which was found to be statistically significant (χ2=22.3, P<0.01). Falls was more common among males. Its prevalence was high both in upper 36 (30-43) and lower 36 (29-42) socio economic status according to modified Kuppuswamy’s classification of socioeconomic status [8]. Falls prevalence was high among Muslim community but was not significant.

Pattern of falls injuries- All the falls were of unintentional type 73 (100%). Home 28 (38.4%) was the most common place of falls followed by street 18 (24.7%), at work area 8 (11%), school 7 (9.6%), athletic and commercial areas 3 (4.1%) each and others 6 (8.1%). Fall of objects accounted to 15 (20.5%). Majority of falls occurred while playing 33 (45.2%) followed by during travelling 20 (27.4%), work related was 10 (13.7%), domestic activity 6 (8.2%) and others 4 (5.5%).

Falls resulted in fracture in 12 (16.4%) and sprain or strain in 17(23.3%) of them while 39 (53.4%) of them had cut or open wounds, 1 (1.4%) had concussion and 1 (1.4) experienced organ system injury. Lower limbs were the common site of injury 28 (38.4%) followed by head 21 (28.8%), upper limb 18 (24.7%), spinal injury 2 (2.7%), multiple sites in 4 (5.4%).

Among 73; 36 (49.3%) were severely injured resulting in partial or complete incapacitation of the injured person lasting ≥14 days (≥ 2 weeks) or resulting in permanent disability/coma/death in the past 12 months and rest of them were moderately injured 37 (50.7%).

Social impact of falls: Social impact of falls was assessed by number of days spent in hospital, working days lost by injured and care giver. Long term social impact of falls on the victim was assessed through falls resulting in loss of employment opportunity, affecting the children’s education and persistence of disability even after a month following falls.

Long term social impact of falls on the family was assessed through family breakups (i.e divorce, separation, splitting of families etc).

Among the care givers 28 of them lost working days for 2 (2-7) minimum and maximum being 1-90 days. Among the care givers 42 people’s routine activity was disrupted due to this injury for median (IQR) days of 7 (2-16), minimum and maximum days being 1-180.

Irrespective of injury severity there was no family breakups, loss of employment opportunity nor was there any education loss. But more severe the falls greater was the disability and this was found to be statistically significant (χ2 =14.892, P <0.001).

Following falls injuries 23 (31.5%) experienced impairment/activity limitation/participation restriction even after 30 days of injury.

Figure-1: Proportion of physical nature of disability following falls injuries

Among the disabled walking with a limp was the common type 11(47.8%) followed by difficulty to use hand or arm 6(26.1%), unable to use hand or arm in 5 (21.7%) and 1(4.4%) was not able to remember things

Economic impact of falls: The economic impact was assessed through the expenditure met for travel, hospital, miscellaneous charges (direct cost) and wages lost by injured and caregiver (indirect cost). In our study the total direct expenditure (due to hospital, travel, miscellaneous charges) mean (SD) and median (IQR) value was Rs 17127 (68398) and Rs1500 (600-4050). Total indirect expenditure mean (SD) and median (IQR) value incurred (due to wages lost by injured and

Majority of falls victims met their financial support through their savings 56 (76.8%), only 11 (15.1%) borrowed loan. Minimum and maximum loan amount was Rs 200-Rs 200000. Only 2 (2.7%) were covered by health insurance and another 2 (2.7%) got reimbursed while rest 2 (2.7%) of them had two or more combined sources.

Figure- 2: Bar chart showing the source of financial support to those injured by falls

Efforts to reduce information bias (occurred while collecting details of number of days being injured, expenditures met by the family following an injury) was done by cross checking the medical bills, medical records and discharge summaries. Local event calendar was used to limit recall bias.

According to Bengaluru Injury surveillance programme (BISP- 2007), falls were more common among males 83% which was also observed in our study. For non-fatal injuries, 40% occurred at home, followed by 31% in work places and 18% on roads. Head (53%) was the common site followed by upper limbs and lower limbs. Fractures were seen in 54% of cases [9].

Both genders are at risk of falls in all age groups and worldwide. While fatal falls are commonly seen among males, non-fatal falls are more among women, probable reason being high risk taking behaviour among males and increased occupational exposure [3].

Falls are more commonly seen in extremes of age group i.e in children and older people which was also observed in our study. Falls related deaths are more in elderly probably due to physical, sensory, and cognitive changes associated with ageing in combination with environment which are not adapted for an aging population [3].

Medical expenditure was 2-3 times higher for women compared to men [12]. Even in our study hospital charges accounted to 58.5% of total expenditure incurred.

Prevalence of falls was 23/1000 population with 95% CI (18-29). The prevalence was high in extreme age group (≤14years and ≥60 years), among males and also among upper and lower socio economic status. Home was the common place of falls. Majority occurred during leisure time and while playing. Following falls 16.4% met with fracture and 23.3% met with sprain/strain. Lower limbs (38.4%) were the common injury site

Median number of working days lost or school missed by children was one week and median of two week time was taken to return back to normal routine activities by the injured. More severe the falls injury greater was the disability and this was statistically significant (χ2 =14.892, P <0.001). Disability even after 30 days was present in 31.5% of cases most common being walking with a limp. A single falls costed Rs 20197, minimum and maximum expenditure being Rs 100 and Rs 5 lakhs.

The hospital charges were significantly high among elderly ≥60 years age group (P=0.04). Total cost incurred following falls was high among 15-59 year age group (P=0.005). To conclude though the prevalence of falls were high among extremes of age group, the economic impact was significantly high among 15-59 year age group and was statistically significant. Hence we would like to recommend developing preventive and control measures to prevent falls among 15-59 year age group and not just concentrating on extremes of age group.

Since home was the common place of injury there is a need to develop safety precautions to avoid falls at home; example using anti-skid tiles for flooring, using mesh or barriers on windows and balconies etc. Most of the falls among children occurred while playing; hence use of protective equipments like helmets, knee caps, shoes etc would reduce the severity of falls impact.

We would also like to recommend to develop a comprehensive health care service (includes preventive, promotive, curative and rehabilitative health care service) to reduce the burden of falls in a community.