greater decrease of QOL (Quality of Life) than men 6
months after fall (24). This is not consistent with the findings
of the current study. The present study showed that
risk of dependency due to a trauma increases with age
consistent with previous studies (6, 21). The present study
showed that most frequent geriatric trauma injuries occur
due to falls. According to Gill, about one of three people
older than 65 years falls annually; this rate increases
with advanced age (19). A serious fall injury is often a defining
event in the life of an older person, and can dramatically
affect the function of elderlies (19). Fazel et al.
reported fall as the most common cause of home-related
injury in Kashan, Iran in one-fifth of elderlies (25). Falling
could be simply a marker for the progression of ‘‘normal’’
age-related changes in vision, gait and strength. For
instance, visual impairment increases the risk of falling
for about 2.5 times (6). According to Brand et al. 49% of patients
with rheumatic disease reported one or more falls
in previous 12 months (26). In the present study, most
injuries were occurred in the morning hours around 8
AM, which could be due to a sudden rise from bed or side
effects of drugs. The elderly should be instructed to get
up from the bed slowly in the mornings, and sit on the
edge of the bed for about a minute. In total, 60% of participants
had a history of previous trauma. Individuals who
had fallen have a threefold increased risk of falling again.
Recurrent falls in an individual are frequently due to the
same previous causes (6).
In the present study, fractures (80.5%) were the main
consequences of trauma. Fractures are the most serious
consequence of falls for seniors (27). The most common
injured regions were pelvic (35%), femur (29%), upper
limb (20.5%) and knee and below knee (15.5%). Community-
dwelling older persons who survive a fracture need
special attention (14). In addition, Gill et al. reported that
47.7% of participants had hip fractures and post-fall functional
trajectories were consistently worse after a hip
fracture than other injuries (28). Hip fracture is the second
major cause of bedridden (26). Studies showed that
patients with hip fracture have poor recovery in their deficiency
in mobility might be permanent (14). In the present
study, more than three-quarters of the elderly were independent
based on ISADL before trauma, but trauma in
elderly patients had a substantial negative effect on their
ability and ADL function. In summary, our group is the
first to follow a longitudinal group of elderly adults after
trauma in Kashan, Iran and identify a significant and progressive
loss of functional ability. Clinical consequences
include increased risk of future decline, loss of independence,
and mortality. We propose that care of geriatric
patients with trauma should move beyond prevention
of death and include multidisciplinary care targeted rehabilitation
and prevention of permanent functional impairment.
The elderly patients following trauma should
be cared for by specialist nurses. Telephone counseling
could be helpful. This study had some limitations; first,
the ISADL questionnaires were completed by phone call