Non-occupational falls from ladders in men 50 years and over : contributing factors and impact

Background: Research into falls from ladders in older men in the non-occupational setting is limited, yet such falls are increasing. Aim: To explore non-occupational falls from ladders in older men presenting to a major trauma centre; identify factors influencing ladder climbing behaviour and explore the post fall impacts. Methods: We conducted a retrospective review of medical records of men aged 50 years and older admitted to a major trauma centre following a non-occupational ladder fall between February 2011 and December 2013. Interviews were conducted with a sample of men (and their partners where possible) after discharge from hospital. The Late Life Functional Disability Instrument-computer adaptive testing (LLFDI-CAT) was administered to determine pre-and post-fall function. Basic descriptive analysis was undertaken on medical record data. Thematic analysis was used with the socioecological (SE) model as an interpretive frame. Results: Of 86 men included in the study (range 50–85 years, mean age 64.7 years), 27% sustained severe trauma. The median length of stay was 4 days. Fourteen interviews were conducted with 19 participants (12 men, 7 spouses). The most salient pre-fall factor was a lack of assessment of risk, reflecting individual and community factors. Post fall impacts were identified in all domains of the SE model. A statistically significant decrease in self-reported post-fall compared with pre-fall LLFDI-CAT scores for interviewed men was found, despite seven having minor trauma (Injury Severity Score [ISS]<12) on admission. Conclusion: Ladder fall injuries cause marked morbidity, often with life changing impacts, even with minor trauma. Contributing factors are multifactorial. Injury prevention strategies should address these factors.