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Abstract
Background. Research into factors contributing to falls from ladders in older men in the non-occupational setting is limited, yet falls in this cohort are increasing with significant morbidity and mortality. Aim. To explore the epidemiology of non-occupational falls from ladders in older men presenting to a major trauma centre; identify key influences on older men's decisions and behaviour around ladder climbing; and explore the impact of ladder falls and participant perspectives in injury prevention strategies. Methods. A sequential mixed methods approach was used. Eligible participants included men aged 50 years and older who were admitted to hospital following a non-occupational ladder fall between February 2011 and December 2013. A retrospective review of the Trauma Registry and medical records was undertaken. Qualitative in-depth interviews were conducted with a sample of men and/or their spouses. The Late Life Functional Disability Instrument (LLFDI) was administered to men interviewed to determine pre and post fall function. Basic descriptive analysis was undertaken on the registry and medical record data. Thematic analysis of interview data was used to identify factors contributing to ladder falls and their impact using the socioecological (SE) model. Narrative analysis was used to extend the thematic analysis. Results. Eighty-six men were identified (range 50-85 years, mean age 64.7 years), 27% of whom had severe trauma (Injury Severity Score [ISS] greater than or equal to 12). Most commonly injured regions included: upper limb (37%), head (30%), lower limb (29%), and spine (27%). Median length of stay was 4 days. Fourteen interviews were conducted with 19 participants (men=12, spouses=7). Pre-fall and post fall factors were identified in the individual, interpersonal and community domains of the SE model and in the organisational domain post fall. Interviewed men demonstrated a decrease in post fall LLFDI scores at 4-27 months post event compared with self-reported pre-fall scores, despite seven having minor trauma (ISS<12) on admission. Conclusion. Ladder fall injuries cause marked morbidity even in 'minor' trauma. The impact of these injuries is extensive, affecting the individual, their interpersonal relationships and the community. Multiple strategies developed by key stakeholders aimed at the individual, family, organisations and community are needed for effective prevention.