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Open Access Highly Accessed Research article

Emotional stress as a trigger of falls leading to hip or pelvic fracture. Results from the ToFa study – a case-crossover study among elderly people in Stockholm, Sweden

Jette Möller1*, Johan Hallqvist12, Lucie Laflamme3, Fredrik Mattsson1, Sari Ponzer4, Siv Sadigh1 and Karin Engström1

Author Affiliations

1 Karolinska Institutet, Department of Public Health Sciences, Division of Public Health Epidemiology, Stockholm, Sweden

2 Uppsala University, Department of Public Health and Caring Sciences, Uppsala, Sweden

3 Karolinska Institutet, Department of Public Health Sciences, Division of International Health, Stockholm, Sweden

4 Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset, Section of Orthopaedic Surgery, Stockholm, Sweden

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BMC Geriatrics 2009, 9:7  doi:10.1186/1471-2318-9-7

Published: 9 February 2009

Abstract

Background

Sudden emotions may interfere with mechanisms for keeping balance among the elderly. The aim of this study is to analyse if emotional stress and specifically feelings of anger, sadness, worries, anxiety or stress, can trigger falls leading to hip or pelvic fracture among autonomous older people.

Methods

The study applied the case-crossover design and was based on data gathered by face to face interviews carried out in Stockholm between November 2004 and January 2006 at the emergency wards of two hospitals. Cases (n = 137) were defined as persons aged 65 and older admitted for at least one night due to a fall-related hip or pelvic fracture (ICD10: S72 or S32) and meeting a series of selection criteria. Results are presented as relative risks with 95% confidence intervals.

Results

There was an increased risk for fall and subsequent hip or pelvic fracture for up to one hour after emotional stress. For anger there was an increased relative risk of 12.2 (95% CI 2.7–54.7), for sadness of 5.7 (95% CI 1.1–28.7), and for stress 20.6 (95% CI 4.5–93.5) compared to periods with no such feelings.

Conclusion

Emotional stress seems to have the potential to trigger falls and subsequent hip or pelvic fracture among autonomous older people. Further studies are needed to clarify how robust the findings are – as the number of exposed cases is small – and the mechanisms behind them – presumably balance and vision impairment in stress situation.