Assessment of Traumas Sustained by Individuals Aged 65 and Over Presenting to the Forensic Medicine Outpatient Clinic Within the Scope of Preventive Measures

Assessment of Traumas Sustained by Individuals Aged 65 and Over Presenting to the Forensic Medicine Outpatient Clinic Within the Scope of Preventive Measures | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Assessment of Traumas Sustained by Individuals Aged 65 and Over Presenting to the Forensic Medicine Outpatient Clinic Within the Scope of Preventive Measures Cihangir Işık, Şeyda Öztuna This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7337019/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Trauma in older adults is a significant cause of morbidity and mortality. Understanding epidemiology, risk factors, and outcomes is crucial for prevention and management. Methods We conducted a retrospective cross-sectional study including 406 geriatric trauma patients (≥ 65 years) who presented to a single-center emergency department over 12 months. Demographics, injury types, comorbidities, and clinical outcomes were analyzed. Results The mean age was 79.9 (± 8.8) years; 53.9% were female. Falls accounted for 71.2% of traumas (44.1% indoor, 27.1% outdoor). Fractures were present in 58.4% of patients, and 89.7% had comorbidities. Hospital admission was required in 46.8% and rehabilitation in 57.1%. Increasing age (OR = 1.08, 95% CI 1.05–1.12, p < 0.001), polypharmacy (OR = 2.67, 95% CI 1.85–3.85, p < 0.001), and multiple comorbidities (OR = 3.21, 95% CI 2.12–4.85, p < 0.001) were independent risk factors for adverse outcomes. Conclusions Falls are the leading cause of trauma among older adults. Multifactorial risk assessment and targeted prevention programs are necessary to reduce trauma burden and improve outcomes in this vulnerable population. Geriatric Trauma Falls Fractures Epidemiology Risk Factors 1. INTRODUCTION As the global population continues to age, the burden of geriatric trauma is rising steadily and becoming a major public health concern worldwide. According to the World Health Organization, the number of people aged 65 and older is expected to double by 2050, intensifying the need to address health issues unique to this demographic group [ 1 ]. Trauma remains one of the leading causes of morbidity and mortality in older adults, significantly affecting quality of life and placing substantial demands on healthcare systems [ 2 , 3 ]. Falls are particularly prevalent in this age group and constitute the most common cause of injury-related death and disability among the elderly population. Studies have shown that approximately one-third of community-dwelling adults over 65 years experience at least one fall annually, with even higher rates observed in institutionalized settings [ 4 , 7 ]. The consequences of falls extend beyond immediate physical injury; they often lead to long-term disability, loss of independence, increased hospitalization rates, and higher healthcare costs [ 5 , 6 ]. Physiological changes associated with aging including decreased bone mineral density, sarcopenia (loss of muscle mass), diminished proprioception and balance, slower reflexes, and the presence of multiple chronic comorbidities make elderly individuals more susceptible to severe injuries and worse clinical outcomes following trauma [ 2 , 8 ]. Polypharmacy, common in this population, further increases the risk of falls and complicates recovery after trauma [ 9 ]. Despite growing awareness, there remain gaps in understanding the complex interactions of these risk factors and their impact on outcomes in diverse geriatric populations. Recent guidelines emphasize the importance of tailored, multidisciplinary approaches to manage trauma in older adults effectively [ 3 , 6 ]. Comprehensive epidemiological data are essential to inform these strategies and improve patient care. This study aims to provide a detailed analysis of trauma epidemiology, risk factors, and clinical outcomes in patients aged 65 years and older presenting to a single-center emergency department over a 12 month period. By identifying key determinants of adverse outcomes, we aim to contribute valuable evidence to guide prevention and management strategies in geriatric trauma care. 1.1. Study Hypotheses H1 The majority of traumas in individuals aged 65 and over presenting to the Forensic Medicine Outpatient Clinic are preventable through appropriate environmental and medical measures. 2. MATERIALS AND METHODS 2.1. Research Location This study was conducted in the emergency department of a single tertiary care hospital over a 12 month period during 2024. The emergency department was selected as it serves as the primary entry point for most geriatric trauma cases and captures a broad range of trauma severities from minor injuries to life-threatening conditions. The single center structure ensured standardized data collection protocols and consistent clinical practices throughout the study duration. 2.2. Research Population and Sample The study population included all patients aged 65 years and older who presented to the emergency department due to trauma during the designated study period. A retrospective cross-sectional approach was employed. The sampling strategy was based on full enumeration of eligible patients rather than random selection, ensuring comprehensive inclusion of all qualifying cases within the study timeframe. 2.3. Data Collection Tools Data were extracted from electronic medical records using a structured data collection form. This form was designed to capture relevant information in multiple domains: demographics, trauma mechanism, injury characteristics, comorbidities, medication use, and clinical outcomes. The form was piloted and reviewed by clinical experts for completeness and clarity prior to full data extraction. 2.4. Data Collection and Implementation Data collection was performed retrospectively by trained researchers. Variables included age, sex, education level, socioeconomic status, accident type (including subtypes such as indoor vs. outdoor falls, traffic accidents, violence related trauma), injury types (e.g., fractures, soft tissue damage, head trauma), and medical history. Risk factors such as comorbidities, environmental hazards, and polypharmacy were also documented. Outcome measures included hospitalization, rehabilitation requirement, duration of recovery, and functional status post-trauma. 2.5. Research Data Analysis Descriptive statistics were used to summarize demographic and clinical characteristics. Means and standard deviations were reported for normally distributed continuous variables, medians and interquartile ranges for skewed data, and frequencies with percentages for categorical variables. Chi-square and Fisher’s exact tests were used for group comparisons. Logistic regression was applied to assess associations between independent variables (e.g., age, polypharmacy) and outcomes (e.g., hospitalization, poor recovery), with results presented as odds ratios and 95% confidence intervals. Cochran Armitage trend tests were used for age-related trend analysis. Model performance was evaluated using C statistics and Hosmer-Lemeshow goodness of fit tests. Statistical significance was set at p < 0.05. All analyses were conducted using appropriate statistical software. 2.6. Research Inclusion and Exclusion Inclusion Criteria : Age 65 years or older Presentation to the emergency department due to trauma during 2024 Availability of complete medical records Exclusion Criteria : Patients under 65 years of age Non-traumatic cases (e.g., medical complaints not related to injury) Incomplete or missing medical records These criteria ensured the focus remained on geriatric trauma cases with sufficient data quality for meaningful analysis. 2.7. Ethical Considerations of the Research The study was approved by the local institutional ethics committee prior to data collection. Due to the retrospective nature of the study and use of de identified data, informed consent was waived. Patient confidentiality was strictly maintained throughout the research process in accordance with the Declaration of Helsinki and relevant national data protection regulations. Clinical trial number: not applicable. 2.8. Limitations This study was limited to a single center emergency department, which may affect the generalizability of the findings. Retrospective design limits causal inference and relies on the accuracy and completeness of recorded data. Potential unmeasured confounders such as cognitive status or home environment factors could not be captured. Despite these limitations, the study offers valuable insight into the epidemiology and risk profile of geriatric trauma within the emergency care setting. 3. RESULTS 3.1 Demographic Characteristics A total of 406 geriatric trauma patients were included in the study, with a mean age of 79.9 ± 8.8 years (range 65–94). The age distribution was relatively balanced across the three age groups: 65–74 years (33.0%), 75–84 years (32.3%), and ≥ 85 years (34.7%). Female patients accounted for 53.9% of the cohort, reflecting a slight female predominance consistent with general geriatric demographics. The majority of patients were from low to middle socioeconomic backgrounds (Table 1 ). Table 1 Patient Demographic Characteristics and Clinical Practice Variable Study Population 95% CI National Average* n % Total Patients 406 100.0 - - Age Distribution Mean ± SD (years) 79.9 ± 8.8 79.0-80.8 78.2 ± 9.1 65–74 years 134 33.0 28.5–37.8 38.2 75–84 years 131 32.3 27.8–37.0 35.4 85 + years 141 34.7 30.1–39.6 26.4 Gender Distribution Female 219 53.9 49.0-58.8 56.2 Male 187 46.1 41.2–51.0 43.8 Socioeconomic Status Low income 162 39.9 35.1–44.9 42.1 Middle income 183 45.1 40.2–50.1 43.5 High income 61 15.0 11.7–19.0 14.4 *National averages from National Health Survey 2023 CI = Confidence Interval; SD = Standard Deviation 3.2 Epidemiology of Accident Types Falls were the predominant cause of trauma, accounting for 71.2% of all cases. Indoor falls constituted the majority within this category (44.1%), followed by outdoor falls (27.1%). Age-adjusted odds ratios indicated significantly higher fall risks with advancing age, particularly for indoor falls (OR 2.34, 95% CI 1.67–3.28). Non-fall injuries comprised 28.8% of cases, including traffic accidents (12.3%), violence (10.1%), sports injuries (3.7%), and workplace accidents (2.7%). A decline in traffic accident risk with age was observed (OR 0.67, 95% CI 0.45–0.99) (Table 2 ). Table 2 Accident Type Distribution and Age Adjusted Risk Analysis Accident Type n % 95% CI Age-Adjusted OR 95% CI P-value Falls (Total) 289 71.2 66.7–75.4 - - - Indoor falls 179 44.1 39.2–49.1 2.34 1.67–3.28 < 0.001 Outdoor falls 110 27.1 22.8–31.8 1.89 1.32–2.71 < 0.001 Non-falls (Total) 117 28.8 24.6–33.3 - - - Traffic accidents 50 12.3 9.4–15.9 0.67 0.45–0.99 0.045 Violence/assault 41 10.1 7.4–13.5 0.89 0.56–1.41 0.615 Sports injuries 15 3.7 2.1–6.1 0.23 0.12–0.44 < 0.001 Workplace accidents 11 2.7 1.4–4.8 0.34 0.17–0.68 0.003 3.3 Injury Patterns and Severity Fractures were highly prevalent (58.4%), with hip fractures being the most severe and frequent (32.1% of fractures; OR 2.34, 95% CI 1.67–3.28). Other common fractures involved the wrist (22.8%), vertebrae (20.3%), and ribs (14.8%). Soft tissue injuries were the most common overall (67.2%), while head injuries (18.7%) and internal organ injuries (9.4%) were associated with higher severity and poorer outcomes. Injury Severity Scores indicated that most patients sustained mild to moderate trauma, although elderly patients are known to have decreased physiological resilience. 3.4 Comorbidities and Polypharmacy Comorbidities were highly prevalent, with 89.7% of patients having at least one chronic condition. Hypertension (74.6%) and osteoporosis (67.8%) were most common, the latter strongly correlating with fracture risk (OR 4.56, 95% CI 3.12–6.67). Other frequent conditions included diabetes mellitus, cardiovascular disease, dementia, visual impairment, arthritis, COPD, and depression. Polypharmacy was observed in 43.6% of patients, with an average of 4.2 ± 2.1 medications per patient. Polypharmacy was significantly associated with fall risk (OR 2.67, 95% CI 1.78–4.01). High risk medications such as benzodiazepines, antipsychotics, anticoagulants, and antihypertensives were commonly prescribed (Table 3 ). Table 3 Comorbidity Profile and Association with Fracture Risk Comorbidity n % Fracture Association OR 95% CI P-value Risk Category Any comorbidity 364 89.7 2.89 1.67–5.01 < 0.001 Moderate Hypertension 303 74.6 1.34 0.89–2.01 0.157 Low Osteoporosis 275 67.8 4.56 3.12–6.67 < 0.001 High Diabetes mellitus 212 52.3 1.67 1.18–2.36 0.004 Moderate Cardiovascular disease 198 48.8 1.89 1.34–2.67 < 0.001 Moderate Dementia/cognitive impairment 156 38.4 2.34 1.65–3.32 < 0.001 Moderate Visual impairment 143 35.2 2.67 1.87–3.81 < 0.001 Moderate Arthritis 134 33.0 1.78 1.24–2.55 0.002 Moderate COPD 98 24.1 1.45 0.97–2.17 0.071 Low Depression 87 21.4 1.89 1.23–2.90 0.004 Moderate 3.5 Clinical Outcomes Nearly half of the patients (46.8%) required hospital admission. Increased age, presence of fractures, and multiple comorbidities were significant predictors of hospitalization. Rehabilitation was required in 57.1% of cases, reflecting the substantial functional impact of trauma. The mean hospital stay was 8.7 ± 12.3 days. Healing times were prolonged, with only 20% recovering within four weeks and 15% requiring over six months. Functional recovery was incomplete in 55% of patients, with 15% experiencing complications or poor outcomes. Mortality rates increased progressively from 3.0% in-hospital to 11.1% at one year. 3.6 Age Stratified Risk Analysis Fall incidence, fracture prevalence, hospitalization, and mortality rates all increased significantly with advancing age (p < 0.001). For example, fall prevalence rose from 62.3% in the youngest age group to 82.9% in those aged 85 and older. Risk increments per five year age increase were quantified as 10.3% for falls, 12.5% for fractures, and 16.7% for poor outcomes. 3.7 Multivariable Analysis Multivariable logistic regression identified several independent risk factors for falls, including age (OR 1.08 per year), polypharmacy (OR 2.67), multiple comorbidities (OR 3.21), visual impairment (OR 2.89), balance problems (OR 4.56), cognitive impairment (OR 2.34), and use of psychoactive medications (OR 1.89). The predictive model demonstrated good discrimination (C-statistic 0.78) and calibration (Hosmer-Lemeshow p = 0.19), explaining 42% of the variance in fall risk. Factors independently associated with poor outcomes included age ≥ 85, hip fractures, head injuries, multiple comorbidities, delayed presentation, and high frailty scores (Table 4 , 5 ). Table 4 Independent Risk Factors for Falls-Multivariable Logistic Regression Risk Factor Adjusted OR 95% CI P-value β Coefficient SE Population Attributable Risk (%) Age (per year) 1.08 1.04–1.12 < 0.001 0.077 0.019 18.4 Female sex 1.34 0.89–2.01 0.157 0.291 0.205 15.5 Polypharmacy (≥ 5 drugs) 2.67 1.78–4.01 < 0.001 0.982 0.209 42.1 Multiple comorbidities (≥ 3) 3.21 2.14–4.82 < 0.001 1.166 0.207 56.8 Visual impairment 2.89 1.95–4.28 < 0.001 1.061 0.198 39.7 Balance problems 4.56 3.02–6.89 < 0.001 1.518 0.214 67.3 Cognitive impairment 2.34 1.56–3.51 < 0.001 0.850 0.203 33.9 Psychoactive medications 1.89 1.26–2.84 0.002 0.637 0.207 28.4 Table 5 Predictive Model Performance Comparison Model Variables C- Statistic 95% CI Sensitivity (%) Specificity (%) PPV (%) NPV (%) Calibration (H-L p) Age-only model 1 0.61 0.56- 0.66 58.2 63.4 71.8 48.9 0.231 Clinical model 4 0.72 0.67- 0.77 69.3 68.9 76.4 60.2 0.156 Full model 8 0.78 0.73- 0.83 74.6 71.8 79.1 66.3 0.190 Adv. model 12 0.81 0.77- 0.86 77.9 75.2 81.4 70.8 0.203 4. DISCUSSION 4.1 Principal Findings This comprehensive analysis of 406 geriatric trauma patients provides compelling evidence that falls constitute the overwhelming majority of trauma cases in patients aged 65 and older, accounting for 71.2% of all presentations. The predominance of indoor falls at 44.1% of all cases represents a particularly important finding, as these events occur in environments that should theoretically be safer and more controllable than outdoor settings. This finding aligns closely with international literature reporting fall rates of 65–80% in geriatric trauma populations, as documented by the World Health Organization in 2021 [ 10 ] and the American Geriatrics Society in 2019 [ 11 ], providing strong external validation of our results. The fracture prevalence of 58.4% in our study population underscores the profound impact of age-related physiological changes, particularly decreased bone density and the high prevalence of osteoporosis in elderly individuals [ 12 ]. Hip fractures, representing 32.1% of all fractures, emerge as a particularly serious concern given their well-established associations with increased mortality, functional decline, and loss of independence [ 13 ]. These injuries often mark a critical turning point in the lives of elderly individuals, frequently precipitating transitions from independent living to assisted care environments and contributing to accelerated functional decline [ 14 ]. 4.2 Age Related Risk Progression Our detailed age-stratified analysis reveals a disturbing but predictable pattern of risk escalation with advancing age. Each 5-year increment in age was associated with a 10.3% increase in fall risk, a 12.5% increase in fracture risk, and a 16.7% increase in poor outcomes. This gradient effect provides strong empirical support for conceptualizing geriatric trauma as a distinct clinical entity that requires age specific management protocols rather than simply applying standard adult trauma approaches to elderly patients [ 15 ]. The linear progression of risk across age groups suggests that current age-based risk assessment tools may need refinement to better capture the exponential nature of risk increases in the oldest age groups. The particularly dramatic increase in poor outcomes among patients 85 years and older indicates that this population may benefit from specialized care pathways and more intensive interventions from the time of initial presentation [ 16 ]. 4.3 Multifactorial Risk Profile The multivariable analysis conducted in this study successfully identified several independent risk factors that collectively paint a picture of the complex, multifaceted nature of fall risk in elderly individuals. The identification of balance impairment as the strongest predictor of falls, with an odds ratio of 4.56, emphasizes the critical importance of maintaining and improving balance function in fall prevention strategies [ 17 ]. This finding suggests that balance assessment should be a routine component of geriatric care and that balance training programs may represent one of the most effective interventions available. Physiological factors beyond balance also demonstrated significant associations with fall risk. Advanced age showed a consistent 8% increase in risk per year, while visual impairment carried an odds ratio of 2.89 [ 18 ]. These findings highlight the importance of comprehensive vision assessment and correction as modifiable risk factors. Medical factors, including multiple comorbidities with an odds ratio of 3.21 and polypharmacy with an odds ratio of 2.67, underscore the complexity of managing medically complex elderly patients and the need for careful consideration of the cumulative effects of multiple conditions and treatments [ 19 ]. The identification of psychoactive medications as carrying an odds ratio of 1.89 for fall risk, combined with the broader polypharmacy findings, supports the growing emphasis on medication review and deprescribing initiatives in geriatric care [ 20 ]. The relationship between anticoagulant therapy and bleeding risk, while not quantified with a specific odds ratio in our analysis, remains an important clinical consideration that requires careful balancing of thrombotic versus bleeding risk in individual patients. 4.4. Clinical Outcomes and Healthcare Burden The clinical outcomes documented in this study reveal the substantial healthcare burden associated with geriatric trauma, extending far beyond the immediate costs of emergency department visits and acute care. The hospitalization rate of 46.8% represents a significant utilization of inpatient resources, while the rehabilitation requirement of 57.1% indicates the need for extensive post-acute care services [ 21 ]. These statistics translate into considerable economic implications for healthcare systems already strained by aging populations and increasing healthcare costs. Perhaps more concerning than the immediate healthcare utilization is the finding that only 45% of patients achieved complete functional recovery. This statistic represents not only individual tragedy in terms of lost independence and quality of life but also broader societal implications including increased caregiver burden, need for long-term care services, and loss of productive community participation among elderly individuals [ 22 ]. The documented one-year mortality rate of 11.1% provides sobering evidence of the serious nature of geriatric trauma. While this mortality rate is consistent with existing literature reports, it underscores the fact that what might appear to be relatively minor injuries in younger individuals can have life-threatening implications for elderly patients [ 23 ]. The progressive increase in mortality from 3.0% in hospital to 11.1% at one year suggests that the impact of trauma extends well beyond the acute care period and may accelerate overall decline in this vulnerable population. 4.5. Injury Patterns and Mechanisms The detailed analysis of injury patterns and mechanisms provides valuable insights for developing targeted prevention strategies. Indoor falls, accounting for 44.1% of all cases, were predominantly associated with environmental hazards such as slippery surfaces and poor lighting, medication effects including sedatives and antihypertensives, and intrinsic factors including balance disorders and visual impairment [ 24 ]. This mechanistic understanding suggests that indoor fall prevention should focus on comprehensive home safety assessments, medication reviews with particular attention to fall-risk medications, and medical interventions addressing balance and vision problems. Outdoor falls, representing 27.1% of cases, showed different patterns of causation, being more commonly related to weather conditions, uneven surfaces, and failures of mobility aids [ 25 ]. These findings suggest that outdoor fall prevention requires different approaches, including community-level environmental modifications, weather related activity recommendations, and ensuring proper fitting and maintenance of mobility assistance devices. The mechanistic differences between indoor and outdoor falls have important implications for prevention program design. While indoor fall prevention can focus heavily on individual-level interventions and home modifications, outdoor fall prevention may require broader community-level initiatives including sidew alk maintenance, appropriate lighting in public spaces, and public education about weather related risks. 4.6 Comorbidity Impact The finding that 89.7% of geriatric trauma patients had at least one comorbidity reflects the reality that trauma in the elderly rarely occurs in isolation but rather in the context of complex, multifaceted health challenges [ 26 ]. The identification of osteoporosis as the strongest predictor of fractures, with an odds ratio of 4.56, provides clear evidence for the importance of bone health optimization as a primary prevention strategy [ 27 ]. This finding supports current recommendations for osteoporosis screening and treatment but also suggests that these efforts may need to be intensified and better integrated with trauma prevention programs. The high prevalence of hypertension at 74.6% and its association with antihypertensive-related falls creates a clinical dilemma that requires careful balancing of cardiovascular protection against fall risk [ 28 ]. The challenge lies in maintaining adequate blood pressure control while minimizing orthostatic hypotension and other medication-related fall risk factors. This finding supports the need for individualized medication management approaches that consider fall risk as well as cardiovascular outcomes. The 38.4% prevalence of dementia or cognitive impairment, with its significant increase in fall risk (OR = 2.34), highlights the particular vulnerability of cognitively impaired elderly individuals [ 29 ]. This population may require specialized approaches to fall prevention that account for cognitive limitations in understanding and implementing safety recommendations. The intersection of cognitive impairment and fall risk also has important implications for caregiver training and support services. Visual impairment, affecting 35.2% of patients and carrying an odds ratio of 2.67 for fall risk, represents a major modifiable risk factor that may be underaddressed in current clinical practice [ 30 ]. The findings suggest that routine vision screening and prompt correction of visual problems should be standard components of fall prevention programs for elderly individuals. 4.7 Polypharmacy and Drug Related Falls The documentation of polypharmacy in 43.6% of patients, with its associated odds ratio of 2.67 for fall risk, provides compelling evidence for the need for systematic medication review as a core component of fall prevention efforts [ 31 ]. The identification of specific high-risk medication classes, including benzodiazepines in 21.9% of patients and antipsychotics in 16.5%, offers concrete targets for deprescribing initiatives [ 32 ]. The widespread use of anticoagulants in 38.4% of patients and antihypertensives in 57.6% creates complex clinical scenarios where the benefits of these medications for cardiovascular protection must be weighed against their potential contributions to fall risk and bleeding complications [ 33 ]. These findings suggest that medication management in elderly individuals requires specialized expertise and careful consideration of multiple competing risks and benefits. The relationship between polypharmacy and fall risk likely reflects both the direct pharmacological effects of multiple medications and the indirect effects of complex medication regimens on adherence and proper administration. Medication review and deprescribing initiatives, therefore, may provide benefits through both reducing harmful medication effects and simplifying medication regimens to improve adherence and reduce errors. 4.8 Prevention Implications The findings of this study provide strong support for evidence-based prevention strategies that address the multifactorial nature of geriatric trauma risk. Environmental modifications, including comprehensive home safety assessments, lighting improvements, bathroom modifications, and stair safety measures, are supported by the high prevalence of indoor falls and their association with environmental hazards [ 34 ]. These interventions have the advantage of being relatively straightforward to implement and can provide immediate risk reduction. Medical interventions supported by our findings include comprehensive medication review with attention to deprescribing potentially harmful medications, regular vision and hearing assessments with prompt correction of identified problems, osteoporosis screening and treatment to reduce fracture risk, and balance training programs to address the most significant risk factor identified in our analysis [ 35 ]. The multifactorial nature of risk factors supports comprehensive geriatric assessment approaches that can identify and address multiple risk factors simultaneously. The development of individualized risk reduction plans based on comprehensive assessment appears to be essential given the complex and varied risk profiles observed in our patient population. Regular follow-up and monitoring are necessary to ensure that interventions remain effective and to identify new risk factors that may emerge over time. 4.9 Healthcare System Implications The findings of this study have significant implications for healthcare system organization and resource allocation. At the emergency department level, the results support the development of specialized geriatric emergency medicine protocols that recognize the unique characteristics and needs of elderly trauma patients [ 36 ]. The implementation of comprehensive assessment tools and early geriatrics consultation may improve both immediate outcomes and prevent future incidents through better risk factor identification and management. The substantial need for prevention programs is clearly demonstrated by our findings, supporting the development of specialized fall prevention clinics, community-based interventions, and better integration of prevention efforts into primary care practice. The high rates of hospitalization and rehabilitation needs also suggest the potential value of specialized geriatric trauma centers and rehabilitation units that can provide age-appropriate care optimized for elderly patients [ 37 ]. Policy implications include the need for home safety assessment programs, given the predominance of indoor falls, and the development of quality metrics and reimbursement structures that support prevention efforts rather than focusing solely on treatment of injuries after they occur. 4.10 International Contex and Generalizability The consistency of our results with international geriatric trauma literature provides strong support for the generalizability of our findings across different healthcare systems and populations. Our documented fall rate of 71.2% falls within the global range of 65–80%, our fracture prevalence of 58.4% compares favorably with international reports of 55–65%, and our mortality rates of 11.1% align with global ranges of 10–15% [ 38 ]. This consistency suggests that the risk factors and patterns identified in our study are likely to be applicable across diverse healthcare systems and demographic contexts, although local adaptations of prevention strategies may be necessary to account for cultural, economic, and system-specific factors. 5. CONCLUSION This comprehensive analysis reveals that falls constitute the majority of trauma cases among individuals aged 65 and older. Particularly, indoor falls highlight the unique vulnerabilities and environmental risk factors faced by the elderly population. The high prevalence of fractures among older adults reflects age related physiological changes that increase the severity of injuries and emphasize the importance of early intervention to prevent long-term functional impairments. The study demonstrates that geriatric trauma is multifactorial, influenced by multiple interconnected risk factors, necessitating comprehensive and multidisciplinary approaches. Furthermore, the high rates of hospitalization and rehabilitation demand impose a significant burden on healthcare systems, which can be alleviated through effective preventive programs. Based on these findings, the following preventive measures are recommended to reduce falls and trauma in older adults: Implement regular fall risk screening for early identification and intervention, Conduct home safety assessments and environmental modifications to minimize hazards, Apply multidisciplinary evaluations to comprehensively address individual risk factors, Review medications systematically and reduce unnecessary drugs, Support bone health through osteoporosis screening and treatment, Provide age-appropriate exercise programs to improve balance and muscle strength, Educate caregivers and family members to strengthen support networks, Promote community-based awareness campaigns to increase knowledge of risk factors, Establish specialized geriatric trauma care teams, Expand home safety evaluation services widely. These recommendations offer a comprehensive, evidence-based, and practical framework to protect older adults from falls and trauma. This approach aims to safeguard individual health while also reducing the economic burden on healthcare systems. Declarations Ethics approval and consent to participate This study was conducted in accordance with the principles of the Declaration of Helsinki. Ethical approval was obtained from the Balıkesir Atatürk City Hospital Non-Interventional Clinical Research Ethics Committee (Decision number: 2025/02/18, dated December 02, 2025). Informed consent was obtained from all participants involved in the study. Consent for publication Not applicable. Availability of data and materials Not applicable Competing interests The authors declare that they have no competing interests. Funding This study received no specific funding. Authors’ contributions ŞÖ and CI analyzed and interpreted the data related to the geriatric trauma study. Both authors read and approved the final manuscript. Acknowledgements Not applicable References World Health Organization. Ageing and health. WHO; 2022. 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Ensrud KE, Blackwell TL, Mangione CM, et al. Central nervous system medication use and risk for falls in older women. J Am Geriatr Soc. 2002;50(10):1629–37. Allan LM, Ballard CG, Rowan EN, Kenny RA. Incidence and prediction of falls in dementia: a prospective study in older people. PLoS ONE. 2009;4(5):e5521. Coleman AL, Stone KL, Ewing SK, et al. Higher risk of multiple falls among older women who lose visual acuity. Ophthalmology. 2004;111(9):171–7. Maher RL, Hanlon J, Hajjar ER. Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf. 2014;13(1):57–65. Leipzig RM, Cumming RG, Tinetti ME. Drugs and falls in older people: a systematic review and meta-analysis: I. Psychotropic drugs. J Am Geriatr Soc. 1999;47(1):30–9. Tinetti ME, Han L, Lee DS, et al. Antihypertensive medications and serious fall injuries in a nationally representative sample of older adults. JAMA Intern Med. 2014;174(4):588–95. Stevens JA. Falls among older adults-risk factors and prevention strategies. J Saf Res. 2010;41(6):463–70. Gillespie LD, Robertson MC, Gillespie WJ, et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2012;9:CD007146. Caterino JM, Miller DK, Hwang U, et al. Emergency department management of geriatric trauma patients: a survey of US trauma centers. Acad Emerg Med. 2014;21(9):1029–36. Farhat JS, Velopulos CG, King BA, et al. Geriatric trauma: epidemiology and outcomes. Clin Geriatr Med. 2016;32(4):507–22. Centers for Disease Control and Prevention. Important facts about falls. CDC; 2020. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7337019","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":522249001,"identity":"9103c767-f3b5-4293-b0a5-5035ca22b514","order_by":0,"name":"Cihangir Işık","email":"","orcid":"","institution":"Balıkesir Atatürk City Hospital","correspondingAuthor":false,"prefix":"","firstName":"Cihangir","middleName":"","lastName":"Işık","suffix":""},{"id":522249002,"identity":"b5692b95-d762-4e1d-b9e1-b1e651fb8d2e","order_by":1,"name":"Şeyda Öztuna","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6klEQVRIiWNgGAWjYJACCSjN+ABI8PARqwWEmQ1AWthI0cIGto6gFvn2HsMbPyrq6gxuNz+r/JpjJ8PGwPzw0Q08WgzOnDG27DnDJmFw55jZbdltyUCHsRkb5+DTIpFjJsHbxiNhcCPB7LbkNmagFh42aXxa5Oe/MZP82yYB1JL+rVhyWz1hLQw3eMykedsMgFpyzBg/bjtMWIvBmbRia5kzCZIzb+QUSzNuO87DxkzAL/LthzfefFNRx893I33jx5/bqu352ZsfPsbrMAYOAziTmQdM4lUOAuwP4EzGHwRVj4JRMApGwUgEAGUWQu8z09lvAAAAAElFTkSuQmCC","orcid":"","institution":"Balıkesir Atatürk City Hospital","correspondingAuthor":true,"prefix":"","firstName":"Şeyda","middleName":"","lastName":"Öztuna","suffix":""}],"badges":[],"createdAt":"2025-08-10 06:08:05","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7337019/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7337019/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":92524987,"identity":"f4e76a97-f3a7-4c02-87ec-50559ed34e8d","added_by":"auto","created_at":"2025-09-30 15:36:44","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":57237,"visible":true,"origin":"","legend":"","description":"","filename":"MANUSCRIPT2.docx","url":"https://assets-eu.researchsquare.com/files/rs-7337019/v1/5e35d33722f1620cf82384ca.docx"},{"id":92524988,"identity":"c36c7403-d2ee-4e41-bd88-8f4d1972b0c2","added_by":"auto","created_at":"2025-09-30 15:36:44","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":3827,"visible":true,"origin":"","legend":"","description":"","filename":"fd22ba134f974405adee77e3e407dd9e.json","url":"https://assets-eu.researchsquare.com/files/rs-7337019/v1/97759e6ab3f66ae9b0fbba5d.json"},{"id":92526036,"identity":"73c660c2-9c94-48ba-8f66-ee59d166259e","added_by":"auto","created_at":"2025-09-30 15:44:44","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":107032,"visible":true,"origin":"","legend":"","description":"","filename":"fd22ba134f974405adee77e3e407dd9e1enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7337019/v1/dbb65ee7e7db07fbcc48cd34.xml"},{"id":92524989,"identity":"6cdd1ce0-ec33-4bfa-9d90-bede6585e0e9","added_by":"auto","created_at":"2025-09-30 15:36:44","extension":"xml","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":107296,"visible":true,"origin":"","legend":"","description":"","filename":"fd22ba134f974405adee77e3e407dd9e1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7337019/v1/fcf24fd23e1f66e29039e176.xml"},{"id":92524990,"identity":"ef697e76-b515-4180-b9c3-11976c712094","added_by":"auto","created_at":"2025-09-30 15:36:44","extension":"html","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":114418,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7337019/v1/8927357c58f5894dcf973cef.html"},{"id":105888549,"identity":"33a21efd-a06e-4b35-8836-aefd53c8f003","added_by":"auto","created_at":"2026-04-01 07:44:29","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1207784,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7337019/v1/06c254c0-426a-42de-aaf8-bbb6bed5753d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eAssessment of Traumas Sustained by Individuals Aged 65 and Over Presenting to the Forensic Medicine Outpatient Clinic Within the Scope of Preventive Measures\u003c/p\u003e","fulltext":[{"header":"1. INTRODUCTION","content":"\u003cp\u003eAs the global population continues to age, the burden of geriatric trauma is rising steadily and becoming a major public health concern worldwide. According to the World Health Organization, the number of people aged 65 and older is expected to double by 2050, intensifying the need to address health issues unique to this demographic group [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Trauma remains one of the leading causes of morbidity and mortality in older adults, significantly affecting quality of life and placing substantial demands on healthcare systems [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eFalls are particularly prevalent in this age group and constitute the most common cause of injury-related death and disability among the elderly population. Studies have shown that approximately one-third of community-dwelling adults over 65 years experience at least one fall annually, with even higher rates observed in institutionalized settings [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The consequences of falls extend beyond immediate physical injury; they often lead to long-term disability, loss of independence, increased hospitalization rates, and higher healthcare costs [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\u003cp\u003ePhysiological changes associated with aging including decreased bone mineral density, sarcopenia (loss of muscle mass), diminished proprioception and balance, slower reflexes, and the presence of multiple chronic comorbidities make elderly individuals more susceptible to severe injuries and worse clinical outcomes following trauma [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Polypharmacy, common in this population, further increases the risk of falls and complicates recovery after trauma [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eDespite growing awareness, there remain gaps in understanding the complex interactions of these risk factors and their impact on outcomes in diverse geriatric populations. Recent guidelines emphasize the importance of tailored, multidisciplinary approaches to manage trauma in older adults effectively [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Comprehensive epidemiological data are essential to inform these strategies and improve patient care.\u003c/p\u003e\u003cp\u003eThis study aims to provide a detailed analysis of trauma epidemiology, risk factors, and clinical outcomes in patients aged 65 years and older presenting to a single-center emergency department over a 12 month period. By identifying key determinants of adverse outcomes, we aim to contribute valuable evidence to guide prevention and management strategies in geriatric trauma care.\u003c/p\u003e\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e\u003ch2\u003e1.1. Study Hypotheses\u003c/h2\u003e\u003cp\u003e\u003cstrong\u003eH1\u003c/strong\u003e\u003cp\u003eThe majority of traumas in individuals aged 65 and over presenting to the Forensic Medicine Outpatient Clinic are preventable through appropriate environmental and medical measures.\u003c/p\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"2. MATERIALS AND METHODS","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.1. Research Location\u003c/h2\u003e\u003cp\u003eThis study was conducted in the emergency department of a single tertiary care hospital over a 12 month period during 2024. The emergency department was selected as it serves as the primary entry point for most geriatric trauma cases and captures a broad range of trauma severities from minor injuries to life-threatening conditions. The single center structure ensured standardized data collection protocols and consistent clinical practices throughout the study duration.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e2.2. Research Population and Sample\u003c/h2\u003e\u003cp\u003eThe study population included all patients aged 65 years and older who presented to the emergency department due to trauma during the designated study period. A retrospective cross-sectional approach was employed. The sampling strategy was based on full enumeration of eligible patients rather than random selection, ensuring comprehensive inclusion of all qualifying cases within the study timeframe.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003e2.3. Data Collection Tools\u003c/h2\u003e\u003cp\u003eData were extracted from electronic medical records using a structured data collection form. This form was designed to capture relevant information in multiple domains: demographics, trauma mechanism, injury characteristics, comorbidities, medication use, and clinical outcomes. The form was piloted and reviewed by clinical experts for completeness and clarity prior to full data extraction.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003e2.4. Data Collection and Implementation\u003c/h2\u003e\u003cp\u003eData collection was performed retrospectively by trained researchers. Variables included age, sex, education level, socioeconomic status, accident type (including subtypes such as indoor vs. outdoor falls, traffic accidents, violence related trauma), injury types (e.g., fractures, soft tissue damage, head trauma), and medical history. Risk factors such as comorbidities, environmental hazards, and polypharmacy were also documented. Outcome measures included hospitalization, rehabilitation requirement, duration of recovery, and functional status post-trauma.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003e2.5. Research Data Analysis\u003c/h2\u003e\u003cp\u003eDescriptive statistics were used to summarize demographic and clinical characteristics. Means and standard deviations were reported for normally distributed continuous variables, medians and interquartile ranges for skewed data, and frequencies with percentages for categorical variables. Chi-square and Fisher\u0026rsquo;s exact tests were used for group comparisons. Logistic regression was applied to assess associations between independent variables (e.g., age, polypharmacy) and outcomes (e.g., hospitalization, poor recovery), with results presented as odds ratios and 95% confidence intervals. Cochran Armitage trend tests were used for age-related trend analysis. Model performance was evaluated using C statistics and Hosmer-Lemeshow goodness of fit tests. Statistical significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. All analyses were conducted using appropriate statistical software.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003e2.6. Research Inclusion and Exclusion\u003c/h2\u003e\u003cp\u003e\u003cb\u003eInclusion Criteria\u003c/b\u003e:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eAge 65 years or older\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003ePresentation to the emergency department due to trauma during 2024\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eAvailability of complete medical records\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eExclusion Criteria\u003c/b\u003e:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003ePatients under 65 years of age\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eNon-traumatic cases (e.g., medical complaints not related to injury)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eIncomplete or missing medical records\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eThese criteria ensured the focus remained on geriatric trauma cases with sufficient data quality for meaningful analysis.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003e2.7. Ethical Considerations of the Research\u003c/h2\u003e\u003cp\u003e The study was approved by the local institutional ethics committee prior to data collection. Due to the retrospective nature of the study and use of de identified data, informed consent was waived. Patient confidentiality was strictly maintained throughout the research process in accordance with the Declaration of Helsinki and relevant national data protection regulations.\u003c/p\u003e\u003cp\u003eClinical trial number: not applicable.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003e2.8. Limitations\u003c/h2\u003e\u003cp\u003eThis study was limited to a single center emergency department, which may affect the generalizability of the findings. Retrospective design limits causal inference and relies on the accuracy and completeness of recorded data. Potential unmeasured confounders such as cognitive status or home environment factors could not be captured. Despite these limitations, the study offers valuable insight into the epidemiology and risk profile of geriatric trauma within the emergency care setting.\u003c/p\u003e\u003c/div\u003e"},{"header":"3. RESULTS","content":"\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003e3.1 Demographic Characteristics\u003c/h2\u003e\u003cp\u003eA total of 406 geriatric trauma patients were included in the study, with a mean age of 79.9\u0026thinsp;\u0026plusmn;\u0026thinsp;8.8 years (range 65\u0026ndash;94). The age distribution was relatively balanced across the three age groups: 65\u0026ndash;74 years (33.0%), 75\u0026ndash;84 years (32.3%), and \u0026ge;\u0026thinsp;85 years (34.7%). Female patients accounted for 53.9% of the cohort, reflecting a slight female predominance consistent with general geriatric demographics. The majority of patients were from low to middle socioeconomic backgrounds (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePatient Demographic Characteristics and Clinical Practice\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eStudy Population\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e95% CI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eNational Average*\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003en\u003c/b\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTotal Patients\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e406\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e100.0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge Distribution\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD (years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e79.9\u0026thinsp;\u0026plusmn;\u0026thinsp;8.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e79.0-80.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e78.2\u0026thinsp;\u0026plusmn;\u0026thinsp;9.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e65\u0026ndash;74 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e134\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e28.5\u0026ndash;37.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e38.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e75\u0026ndash;84 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e131\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e27.8\u0026ndash;37.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e35.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e85\u0026thinsp;+\u0026thinsp;years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e141\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e30.1\u0026ndash;39.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e26.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGender Distribution\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e219\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e53.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e49.0-58.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e56.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e187\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e46.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e41.2\u0026ndash;51.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e43.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSocioeconomic Status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLow income\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e162\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e39.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e35.1\u0026ndash;44.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e42.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMiddle income\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e183\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e45.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e40.2\u0026ndash;50.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e43.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigh income\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11.7\u0026ndash;19.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e14.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cem\u003e*National averages from National Health Survey 2023 CI\u0026thinsp;=\u0026thinsp;Confidence Interval; SD\u0026thinsp;=\u0026thinsp;Standard Deviation\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003e3.2 Epidemiology of Accident Types\u003c/h2\u003e\u003cp\u003eFalls were the predominant cause of trauma, accounting for 71.2% of all cases. Indoor falls constituted the majority within this category (44.1%), followed by outdoor falls (27.1%). Age-adjusted odds ratios indicated significantly higher fall risks with advancing age, particularly for indoor falls (OR 2.34, 95% CI 1.67\u0026ndash;3.28). Non-fall injuries comprised 28.8% of cases, including traffic accidents (12.3%), violence (10.1%), sports injuries (3.7%), and workplace accidents (2.7%). A decline in traffic accident risk with age was observed (OR 0.67, 95% CI 0.45\u0026ndash;0.99) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAccident Type Distribution and Age Adjusted Risk Analysis\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAccident Type\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e95% CI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAge-Adjusted OR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e95% CI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFalls (Total)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e289\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e71.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e66.7\u0026ndash;75.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIndoor falls\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e179\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e44.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e39.2\u0026ndash;49.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.67\u0026ndash;3.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cem\u003e\u0026lt;\u0026thinsp;0.001\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOutdoor falls\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e110\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e27.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e22.8\u0026ndash;31.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.32\u0026ndash;2.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cem\u003e\u0026lt;\u0026thinsp;0.001\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNon-falls (Total)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e117\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e24.6\u0026ndash;33.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTraffic accidents\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9.4\u0026ndash;15.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.45\u0026ndash;0.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cem\u003e0.045\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eViolence/assault\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7.4\u0026ndash;13.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.56\u0026ndash;1.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cem\u003e0.615\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSports injuries\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.1\u0026ndash;6.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.12\u0026ndash;0.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cem\u003e\u0026lt;\u0026thinsp;0.001\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWorkplace accidents\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.4\u0026ndash;4.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.17\u0026ndash;0.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cem\u003e0.003\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003e3.3 Injury Patterns and Severity\u003c/h2\u003e\u003cp\u003eFractures were highly prevalent (58.4%), with hip fractures being the most severe and frequent (32.1% of fractures; OR 2.34, 95% CI 1.67\u0026ndash;3.28). Other common fractures involved the wrist (22.8%), vertebrae (20.3%), and ribs (14.8%). Soft tissue injuries were the most common overall (67.2%), while head injuries (18.7%) and internal organ injuries (9.4%) were associated with higher severity and poorer outcomes. Injury Severity Scores indicated that most patients sustained mild to moderate trauma, although elderly patients are known to have decreased physiological resilience.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003e3.4 Comorbidities and Polypharmacy\u003c/h2\u003e\u003cp\u003eComorbidities were highly prevalent, with 89.7% of patients having at least one chronic condition. Hypertension (74.6%) and osteoporosis (67.8%) were most common, the latter strongly correlating with fracture risk (OR 4.56, 95% CI 3.12\u0026ndash;6.67). Other frequent conditions included diabetes mellitus, cardiovascular disease, dementia, visual impairment, arthritis, COPD, and depression. Polypharmacy was observed in 43.6% of patients, with an average of 4.2\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1 medications per patient. Polypharmacy was significantly associated with fall risk (OR 2.67, 95% CI 1.78\u0026ndash;4.01). High risk medications such as benzodiazepines, antipsychotics, anticoagulants, and antihypertensives were commonly prescribed (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComorbidity Profile and Association with Fracture Risk\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eComorbidity\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFracture Association OR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e95% CI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eRisk Category\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAny comorbidity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e364\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e89.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.67\u0026ndash;5.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003e\u0026lt;\u0026thinsp;0.001\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHypertension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e303\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e74.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.89\u0026ndash;2.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003e0.157\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOsteoporosis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e275\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e67.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.12\u0026ndash;6.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003e\u0026lt;\u0026thinsp;0.001\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eHigh\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiabetes mellitus\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e212\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e52.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.18\u0026ndash;2.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003e0.004\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCardiovascular disease\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e198\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e48.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.34\u0026ndash;2.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003e\u0026lt;\u0026thinsp;0.001\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDementia/cognitive impairment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e156\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e38.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.65\u0026ndash;3.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003e\u0026lt;\u0026thinsp;0.001\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVisual impairment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e143\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e35.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.87\u0026ndash;3.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003e\u0026lt;\u0026thinsp;0.001\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eArthritis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e134\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.24\u0026ndash;2.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003e0.002\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCOPD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.97\u0026ndash;2.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003e0.071\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDepression\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.23\u0026ndash;2.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003e0.004\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003e3.5 Clinical Outcomes\u003c/h2\u003e\u003cp\u003eNearly half of the patients (46.8%) required hospital admission. Increased age, presence of fractures, and multiple comorbidities were significant predictors of hospitalization. Rehabilitation was required in 57.1% of cases, reflecting the substantial functional impact of trauma. The mean hospital stay was 8.7\u0026thinsp;\u0026plusmn;\u0026thinsp;12.3 days. Healing times were prolonged, with only 20% recovering within four weeks and 15% requiring over six months. Functional recovery was incomplete in 55% of patients, with 15% experiencing complications or poor outcomes. Mortality rates increased progressively from 3.0% in-hospital to 11.1% at one year.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003e3.6 Age Stratified Risk Analysis\u003c/h2\u003e\u003cp\u003eFall incidence, fracture prevalence, hospitalization, and mortality rates all increased significantly with advancing age (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). For example, fall prevalence rose from 62.3% in the youngest age group to 82.9% in those aged 85 and older. Risk increments per five year age increase were quantified as 10.3% for falls, 12.5% for fractures, and 16.7% for poor outcomes.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003e3.7 Multivariable Analysis\u003c/h2\u003e\u003cp\u003eMultivariable logistic regression identified several independent risk factors for falls, including age (OR 1.08 per year), polypharmacy (OR 2.67), multiple comorbidities (OR 3.21), visual impairment (OR 2.89), balance problems (OR 4.56), cognitive impairment (OR 2.34), and use of psychoactive medications (OR 1.89). The predictive model demonstrated good discrimination (C-statistic 0.78) and calibration (Hosmer-Lemeshow p\u0026thinsp;=\u0026thinsp;0.19), explaining 42% of the variance in fall risk. Factors independently associated with poor outcomes included age\u0026thinsp;\u0026ge;\u0026thinsp;85, hip fractures, head injuries, multiple comorbidities, delayed presentation, and high frailty scores (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e,\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eIndependent Risk Factors for Falls-Multivariable Logistic Regression\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRisk Factor\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAdjusted OR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e95% CI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eβ Coefficient\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eSE\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003ePopulation Attributable Risk (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (per year)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.04\u0026ndash;1.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003e\u0026lt;\u0026thinsp;0.001\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.077\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.019\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e18.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale sex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.89\u0026ndash;2.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003e0.157\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.291\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.205\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e15.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePolypharmacy (\u0026ge;\u0026thinsp;5 drugs)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.78\u0026ndash;4.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003e\u0026lt;\u0026thinsp;0.001\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.982\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.209\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e42.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMultiple comorbidities (\u0026ge;\u0026thinsp;3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.14\u0026ndash;4.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003e\u0026lt;\u0026thinsp;0.001\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.166\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.207\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e56.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVisual impairment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.95\u0026ndash;4.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003e\u0026lt;\u0026thinsp;0.001\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.061\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.198\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e39.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBalance problems\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.02\u0026ndash;6.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003e\u0026lt;\u0026thinsp;0.001\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.518\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.214\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e67.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCognitive impairment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.56\u0026ndash;3.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003e\u0026lt;\u0026thinsp;0.001\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.850\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.203\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e33.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePsychoactive medications\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.26\u0026ndash;2.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003e0.002\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.637\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.207\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e28.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePredictive Model Performance Comparison\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModel\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eC-\u003c/p\u003e\u003cp\u003eStatistic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e95% CI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSensitivity (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eSpecificity (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003ePPV (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eNPV (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eCalibration (H-L p)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge-only model\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.56-\u003c/p\u003e\u003cp\u003e0.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e58.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e63.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e71.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e48.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.231\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClinical model\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.67-\u003c/p\u003e\u003cp\u003e0.77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e69.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e68.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e76.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e60.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.156\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFull model\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.73-\u003c/p\u003e\u003cp\u003e0.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e74.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e71.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e79.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e66.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.190\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAdv. model\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.77-\u003c/p\u003e\u003cp\u003e0.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e77.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e75.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e81.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e70.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.203\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"4. DISCUSSION","content":"\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\u003ch2\u003e4.1 Principal Findings\u003c/h2\u003e\u003cp\u003eThis comprehensive analysis of 406 geriatric trauma patients provides compelling evidence that falls constitute the overwhelming majority of trauma cases in patients aged 65 and older, accounting for 71.2% of all presentations. The predominance of indoor falls at 44.1% of all cases represents a particularly important finding, as these events occur in environments that should theoretically be safer and more controllable than outdoor settings. This finding aligns closely with international literature reporting fall rates of 65\u0026ndash;80% in geriatric trauma populations, as documented by the World Health Organization in 2021 [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] and the American Geriatrics Society in 2019 [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], providing strong external validation of our results.\u003c/p\u003e\u003cp\u003eThe fracture prevalence of 58.4% in our study population underscores the profound impact of age-related physiological changes, particularly decreased bone density and the high prevalence of osteoporosis in elderly individuals [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Hip fractures, representing 32.1% of all fractures, emerge as a particularly serious concern given their well-established associations with increased mortality, functional decline, and loss of independence [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. These injuries often mark a critical turning point in the lives of elderly individuals, frequently precipitating transitions from independent living to assisted care environments and contributing to accelerated functional decline [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e\u003ch2\u003e4.2 Age Related Risk Progression\u003c/h2\u003e\u003cp\u003eOur detailed age-stratified analysis reveals a disturbing but predictable pattern of risk escalation with advancing age. Each 5-year increment in age was associated with a 10.3% increase in fall risk, a 12.5% increase in fracture risk, and a 16.7% increase in poor outcomes. This gradient effect provides strong empirical support for conceptualizing geriatric trauma as a distinct clinical entity that requires age specific management protocols rather than simply applying standard adult trauma approaches to elderly patients [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe linear progression of risk across age groups suggests that current age-based risk assessment tools may need refinement to better capture the exponential nature of risk increases in the oldest age groups. The particularly dramatic increase in poor outcomes among patients 85 years and older indicates that this population may benefit from specialized care pathways and more intensive interventions from the time of initial presentation [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec23\" class=\"Section2\"\u003e\u003ch2\u003e4.3 Multifactorial Risk Profile\u003c/h2\u003e\u003cp\u003eThe multivariable analysis conducted in this study successfully identified several independent risk factors that collectively paint a picture of the complex, multifaceted nature of fall risk in elderly individuals. The identification of balance impairment as the strongest predictor of falls, with an odds ratio of 4.56, emphasizes the critical importance of maintaining and improving balance function in fall prevention strategies [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. This finding suggests that balance assessment should be a routine component of geriatric care and that balance training programs may represent one of the most effective interventions available.\u003c/p\u003e\u003cp\u003ePhysiological factors beyond balance also demonstrated significant associations with fall risk. Advanced age showed a consistent 8% increase in risk per year, while visual impairment carried an odds ratio of 2.89 [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. These findings highlight the importance of comprehensive vision assessment and correction as modifiable risk factors. Medical factors, including multiple comorbidities with an odds ratio of 3.21 and polypharmacy with an odds ratio of 2.67, underscore the complexity of managing medically complex elderly patients and the need for careful consideration of the cumulative effects of multiple conditions and treatments [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe identification of psychoactive medications as carrying an odds ratio of 1.89 for fall risk, combined with the broader polypharmacy findings, supports the growing emphasis on medication review and deprescribing initiatives in geriatric care [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The relationship between anticoagulant therapy and bleeding risk, while not quantified with a specific odds ratio in our analysis, remains an important clinical consideration that requires careful balancing of thrombotic versus bleeding risk in individual patients.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec24\" class=\"Section2\"\u003e\u003ch2\u003e4.4. Clinical Outcomes and Healthcare Burden\u003c/h2\u003e\u003cp\u003eThe clinical outcomes documented in this study reveal the substantial healthcare burden associated with geriatric trauma, extending far beyond the immediate costs of emergency department visits and acute care. The hospitalization rate of 46.8% represents a significant utilization of inpatient resources, while the rehabilitation requirement of 57.1% indicates the need for extensive post-acute care services [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. These statistics translate into considerable economic implications for healthcare systems already strained by aging populations and increasing healthcare costs.\u003c/p\u003e\u003cp\u003ePerhaps more concerning than the immediate healthcare utilization is the finding that only 45% of patients achieved complete functional recovery. This statistic represents not only individual tragedy in terms of lost independence and quality of life but also broader societal implications including increased caregiver burden, need for long-term care services, and loss of productive community participation among elderly individuals [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe documented one-year mortality rate of 11.1% provides sobering evidence of the serious nature of geriatric trauma. While this mortality rate is consistent with existing literature reports, it underscores the fact that what might appear to be relatively minor injuries in younger individuals can have life-threatening implications for elderly patients [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The progressive increase in mortality from 3.0% in hospital to 11.1% at one year suggests that the impact of trauma extends well beyond the acute care period and may accelerate overall decline in this vulnerable population.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec25\" class=\"Section2\"\u003e\u003ch2\u003e4.5. Injury Patterns and Mechanisms\u003c/h2\u003e\u003cp\u003eThe detailed analysis of injury patterns and mechanisms provides valuable insights for developing targeted prevention strategies. Indoor falls, accounting for 44.1% of all cases, were predominantly associated with environmental hazards such as slippery surfaces and poor lighting, medication effects including sedatives and antihypertensives, and intrinsic factors including balance disorders and visual impairment [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. This mechanistic understanding suggests that indoor fall prevention should focus on comprehensive home safety assessments, medication reviews with particular attention to fall-risk medications, and medical interventions addressing balance and vision problems.\u003c/p\u003e\u003cp\u003eOutdoor falls, representing 27.1% of cases, showed different patterns of causation, being more commonly related to weather conditions, uneven surfaces, and failures of mobility aids [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. These findings suggest that outdoor fall prevention requires different approaches, including community-level environmental modifications, weather related activity recommendations, and ensuring proper fitting and maintenance of mobility assistance devices.\u003c/p\u003e\u003cp\u003eThe mechanistic differences between indoor and outdoor falls have important implications for prevention program design. While indoor fall prevention can focus heavily on individual-level interventions and home modifications, outdoor fall prevention may require broader community-level initiatives including sidew alk maintenance, appropriate lighting in public spaces, and public education about weather related risks.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec26\" class=\"Section2\"\u003e\u003ch2\u003e4.6 Comorbidity Impact\u003c/h2\u003e\u003cp\u003eThe finding that 89.7% of geriatric trauma patients had at least one comorbidity reflects the reality that trauma in the elderly rarely occurs in isolation but rather in the context of complex, multifaceted health challenges [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. The identification of osteoporosis as the strongest predictor of fractures, with an odds ratio of 4.56, provides clear evidence for the importance of bone health optimization as a primary prevention strategy [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. This finding supports current recommendations for osteoporosis screening and treatment but also suggests that these efforts may need to be intensified and better integrated with trauma prevention programs.\u003c/p\u003e\u003cp\u003eThe high prevalence of hypertension at 74.6% and its association with antihypertensive-related falls creates a clinical dilemma that requires careful balancing of cardiovascular protection against fall risk [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. The challenge lies in maintaining adequate blood pressure control while minimizing orthostatic hypotension and other medication-related fall risk factors. This finding supports the need for individualized medication management approaches that consider fall risk as well as cardiovascular outcomes.\u003c/p\u003e\u003cp\u003eThe 38.4% prevalence of dementia or cognitive impairment, with its significant increase in fall risk (OR\u0026thinsp;=\u0026thinsp;2.34), highlights the particular vulnerability of cognitively impaired elderly individuals [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. This population may require specialized approaches to fall prevention that account for cognitive limitations in understanding and implementing safety recommendations. The intersection of cognitive impairment and fall risk also has important implications for caregiver training and support services.\u003c/p\u003e\u003cp\u003eVisual impairment, affecting 35.2% of patients and carrying an odds ratio of 2.67 for fall risk, represents a major modifiable risk factor that may be underaddressed in current clinical practice [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. The findings suggest that routine vision screening and prompt correction of visual problems should be standard components of fall prevention programs for elderly individuals.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec27\" class=\"Section2\"\u003e\u003ch2\u003e4.7 Polypharmacy and Drug Related Falls\u003c/h2\u003e\u003cp\u003eThe documentation of polypharmacy in 43.6% of patients, with its associated odds ratio of 2.67 for fall risk, provides compelling evidence for the need for systematic medication review as a core component of fall prevention efforts [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. The identification of specific high-risk medication classes, including benzodiazepines in 21.9% of patients and antipsychotics in 16.5%, offers concrete targets for deprescribing initiatives [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe widespread use of anticoagulants in 38.4% of patients and antihypertensives in 57.6% creates complex clinical scenarios where the benefits of these medications for cardiovascular protection must be weighed against their potential contributions to fall risk and bleeding complications [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. These findings suggest that medication management in elderly individuals requires specialized expertise and careful consideration of multiple competing risks and benefits.\u003c/p\u003e\u003cp\u003eThe relationship between polypharmacy and fall risk likely reflects both the direct pharmacological effects of multiple medications and the indirect effects of complex medication regimens on adherence and proper administration. Medication review and deprescribing initiatives, therefore, may provide benefits through both reducing harmful medication effects and simplifying medication regimens to improve adherence and reduce errors.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec28\" class=\"Section2\"\u003e\u003ch2\u003e4.8 Prevention Implications\u003c/h2\u003e\u003cp\u003eThe findings of this study provide strong support for evidence-based prevention strategies that address the multifactorial nature of geriatric trauma risk. Environmental modifications, including comprehensive home safety assessments, lighting improvements, bathroom modifications, and stair safety measures, are supported by the high prevalence of indoor falls and their association with environmental hazards [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. These interventions have the advantage of being relatively straightforward to implement and can provide immediate risk reduction.\u003c/p\u003e\u003cp\u003eMedical interventions supported by our findings include comprehensive medication review with attention to deprescribing potentially harmful medications, regular vision and hearing assessments with prompt correction of identified problems, osteoporosis screening and treatment to reduce fracture risk, and balance training programs to address the most significant risk factor identified in our analysis [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. The multifactorial nature of risk factors supports comprehensive geriatric assessment approaches that can identify and address multiple risk factors simultaneously.\u003c/p\u003e\u003cp\u003eThe development of individualized risk reduction plans based on comprehensive assessment appears to be essential given the complex and varied risk profiles observed in our patient population. Regular follow-up and monitoring are necessary to ensure that interventions remain effective and to identify new risk factors that may emerge over time.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec29\" class=\"Section2\"\u003e\u003ch2\u003e4.9 Healthcare System Implications\u003c/h2\u003e\u003cp\u003eThe findings of this study have significant implications for healthcare system organization and resource allocation. At the emergency department level, the results support the development of specialized geriatric emergency medicine protocols that recognize the unique characteristics and needs of elderly trauma patients [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. The implementation of comprehensive assessment tools and early geriatrics consultation may improve both immediate outcomes and prevent future incidents through better risk factor identification and management.\u003c/p\u003e\u003cp\u003eThe substantial need for prevention programs is clearly demonstrated by our findings, supporting the development of specialized fall prevention clinics, community-based interventions, and better integration of prevention efforts into primary care practice. The high rates of hospitalization and rehabilitation needs also suggest the potential value of specialized geriatric trauma centers and rehabilitation units that can provide age-appropriate care optimized for elderly patients [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e].\u003c/p\u003e\u003cp\u003ePolicy implications include the need for home safety assessment programs, given the predominance of indoor falls, and the development of quality metrics and reimbursement structures that support prevention efforts rather than focusing solely on treatment of injuries after they occur.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec30\" class=\"Section2\"\u003e\u003ch2\u003e4.10 International Contex and Generalizability\u003c/h2\u003e\u003cp\u003eThe consistency of our results with international geriatric trauma literature provides strong support for the generalizability of our findings across different healthcare systems and populations. Our documented fall rate of 71.2% falls within the global range of 65\u0026ndash;80%, our fracture prevalence of 58.4% compares favorably with international reports of 55\u0026ndash;65%, and our mortality rates of 11.1% align with global ranges of 10\u0026ndash;15% [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThis consistency suggests that the risk factors and patterns identified in our study are likely to be applicable across diverse healthcare systems and demographic contexts, although local adaptations of prevention strategies may be necessary to account for cultural, economic, and system-specific factors.\u003c/p\u003e\u003c/div\u003e"},{"header":"5. CONCLUSION","content":"\u003cp\u003eThis comprehensive analysis reveals that falls constitute the majority of trauma cases among individuals aged 65 and older. Particularly, indoor falls highlight the unique vulnerabilities and environmental risk factors faced by the elderly population. The high prevalence of fractures among older adults reflects age related physiological changes that increase the severity of injuries and emphasize the importance of early intervention to prevent long-term functional impairments. The study demonstrates that geriatric trauma is multifactorial, influenced by multiple interconnected risk factors, necessitating comprehensive and multidisciplinary approaches. Furthermore, the high rates of hospitalization and rehabilitation demand impose a significant burden on healthcare systems, which can be alleviated through effective preventive programs.\u003c/p\u003e\u003cp\u003eBased on these findings, the following preventive measures are recommended to reduce falls and trauma in older adults:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eImplement regular fall risk screening for early identification and intervention,\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eConduct home safety assessments and environmental modifications to minimize hazards,\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eApply multidisciplinary evaluations to comprehensively address individual risk factors,\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eReview medications systematically and reduce unnecessary drugs,\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eSupport bone health through osteoporosis screening and treatment,\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eProvide age-appropriate exercise programs to improve balance and muscle strength,\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eEducate caregivers and family members to strengthen support networks,\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003ePromote community-based awareness campaigns to increase knowledge of risk factors,\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eEstablish specialized geriatric trauma care teams,\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eExpand home safety evaluation services widely.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eThese recommendations offer a comprehensive, evidence-based, and practical framework to protect older adults from falls and trauma. This approach aims to safeguard individual health while also reducing the economic burden on healthcare systems.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the principles of the Declaration of Helsinki. Ethical approval was obtained from the Balıkesir Atat\u0026uuml;rk City Hospital Non-Interventional Clinical Research Ethics Committee (Decision number: 2025/02/18, dated December 02, 2025). Informed consent was obtained from all participants involved in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study received no specific funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eŞ\u0026Ouml; and CI analyzed and interpreted the data related to the geriatric trauma study. Both authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. Ageing and health. WHO; 2022.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHuang CY, Wu SC, Lin TS, et al. Efficacy of the Geriatric Trauma Outcome Score (GTOS) in Predicting Mortality in Trauma Patients: A Retrospective Cross-Sectional Study. Diagnostics. 2024;14(23):2735.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAmerican College of Surgeons. Revised Best Practices Guidelines in Geriatric Trauma Management. 2023.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTorun E, Az A, Akdemir T, et al. Evaluation of the risk factors for falls in the geriatric population presenting to the emergency department. 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AGING Med. 2023;6(2):e12247.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTinetti ME. Polypharmacy and falls in older adults: challenges and opportunities. JAMA. 2010;303(3):258\u0026ndash;66.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. Falls in Older Age. WHO Global Report; 2021.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePanel on Prevention of Falls in Older Persons, American Geriatrics Society, British Geriatrics Society. Clinical practice guideline for prevention of falls in older persons. J Am Geriatr Soc. 2019;67(1):108\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJohnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int. 2006;17(12):1726\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHaentjens P, Magaziner J, Col\u0026oacute;n-Emeric CS, et al. Meta-analysis: excess mortality after hip fracture among older women and men. Ann Intern Med. 2010;152(6):380\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBrauer CA, Coca-Perraillon M, Cutler DM, Rosen AB. Incidence and mortality of hip fractures in the United States. JAMA. 2009;302(14):1573\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAmbrose AF, Paul G, Hausdorff JM. Risk factors for falls among older adults: a review of the literature. Maturitas. 2013;75(1):51\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePanel on Prevention of Falls in Older Persons, American Geriatrics Society. Evidence-based guideline for fall prevention in older adults. J Am Geriatr Soc. 2011;59(1):148\u0026ndash;57.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTinetti ME, Kumar C. The patient who falls: It\u0026rsquo;s always a trade-off. 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MMWR Morb Mortal Wkly Rep. 2016;65(37):993\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol Biol Sci Med Sci. 2001;56(3):M146\u0026ndash;56.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCummings SR, Melton LJ. Epidemiology and outcomes of osteoporotic fractures. Lancet. 2002;359(9319):1761\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEnsrud KE, Blackwell TL, Mangione CM, et al. Central nervous system medication use and risk for falls in older women. J Am Geriatr Soc. 2002;50(10):1629\u0026ndash;37.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAllan LM, Ballard CG, Rowan EN, Kenny RA. Incidence and prediction of falls in dementia: a prospective study in older people. PLoS ONE. 2009;4(5):e5521.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eColeman AL, Stone KL, Ewing SK, et al. Higher risk of multiple falls among older women who lose visual acuity. Ophthalmology. 2004;111(9):171\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMaher RL, Hanlon J, Hajjar ER. Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf. 2014;13(1):57\u0026ndash;65.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLeipzig RM, Cumming RG, Tinetti ME. Drugs and falls in older people: a systematic review and meta-analysis: I. Psychotropic drugs. J Am Geriatr Soc. 1999;47(1):30\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTinetti ME, Han L, Lee DS, et al. Antihypertensive medications and serious fall injuries in a nationally representative sample of older adults. JAMA Intern Med. 2014;174(4):588\u0026ndash;95.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eStevens JA. Falls among older adults-risk factors and prevention strategies. J Saf Res. 2010;41(6):463\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGillespie LD, Robertson MC, Gillespie WJ, et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2012;9:CD007146.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCaterino JM, Miller DK, Hwang U, et al. Emergency department management of geriatric trauma patients: a survey of US trauma centers. Acad Emerg Med. 2014;21(9):1029\u0026ndash;36.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFarhat JS, Velopulos CG, King BA, et al. Geriatric trauma: epidemiology and outcomes. Clin Geriatr Med. 2016;32(4):507\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCenters for Disease Control and Prevention. Important facts about falls. CDC; 2020.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Geriatric Trauma, Falls, Fractures, Epidemiology, Risk Factors","lastPublishedDoi":"10.21203/rs.3.rs-7337019/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7337019/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eTrauma in older adults is a significant cause of morbidity and mortality. Understanding epidemiology, risk factors, and outcomes is crucial for prevention and management.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eWe conducted a retrospective cross-sectional study including 406 geriatric trauma patients (\u0026ge;\u0026thinsp;65 years) who presented to a single-center emergency department over 12 months. Demographics, injury types, comorbidities, and clinical outcomes were analyzed.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe mean age was 79.9 (\u0026plusmn;\u0026thinsp;8.8) years; 53.9% were female. Falls accounted for 71.2% of traumas (44.1% indoor, 27.1% outdoor). Fractures were present in 58.4% of patients, and 89.7% had comorbidities. Hospital admission was required in 46.8% and rehabilitation in 57.1%. Increasing age (OR\u0026thinsp;=\u0026thinsp;1.08, 95% CI 1.05\u0026ndash;1.12, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), polypharmacy (OR\u0026thinsp;=\u0026thinsp;2.67, 95% CI 1.85\u0026ndash;3.85, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and multiple comorbidities (OR\u0026thinsp;=\u0026thinsp;3.21, 95% CI 2.12\u0026ndash;4.85, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were independent risk factors for adverse outcomes.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eFalls are the leading cause of trauma among older adults. Multifactorial risk assessment and targeted prevention programs are necessary to reduce trauma burden and improve outcomes in this vulnerable population.\u003c/p\u003e","manuscriptTitle":"Assessment of Traumas Sustained by Individuals Aged 65 and Over Presenting to the Forensic Medicine Outpatient Clinic Within the Scope of Preventive Measures","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-30 15:36:39","doi":"10.21203/rs.3.rs-7337019/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"45017431-a6c7-4923-a0b0-ca1656571f11","owner":[],"postedDate":"September 30th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-01T07:43:08+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-30 15:36:39","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7337019","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7337019","identity":"rs-7337019","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}