, Volume 81, Issue 1, pp 23–36 | Cite as

The regional ecology of elderly falls in Sweden

  • Roya Bamzar
  • Vania Ceccato


The study assesses exploratory the geography of the elderly fall in Sweden in relation to the ecology of the socio-demographic characteristics of the Swedes older population. Kendall Test is used to measure the association between elderly fall rates and demographic, socio-economic characteristics of the population, costs of elderly care and accessibility measures at county level. Results show a number of significant associations: high rates of the elderly fall are associated with high cost of the elderly care but also low rate of elderly fall and good accessibility to basic services (e.g., grocery store, health care and cash machines). The articles finalizes with reflections of the results and suggestions for future research.


Ecology of fall Elderly fall Socio demographic variations Geography of fall 



We would like to express our particular appreciation to Lars Erik Lundberg Scholarship Foundation for funding the study.


  1. Andersen, R. M. (2008). National health surveys and the behavioral model of health services use. Medical Care, 46(7), 647–653.CrossRefGoogle Scholar
  2. Bailey, C., Convery, I., Mort, M., & Baxter, J. (2006). Different public health geographies of the 2001 foot and mouth disease epidemic: ‘Citizen’ versus ‘professional’ epidemiology. Health & Place, 12(2), 157–166.CrossRefGoogle Scholar
  3. Bamzar, R., & Ceccato, V. (2014). The nature and the geography of elderly injuries in Sweden. GeoJournal. doi: 10.1007/s10708-014-9552-z.Google Scholar
  4. Bjorgul, K., & Reikeras, O. (2007). Incidence of hip fracture in southeastern Norway: A study of 1,730 cervical and trochanteric fractures. International Orthopaedics, 31(5), 665–669.CrossRefGoogle Scholar
  5. Bleijlevens, M. H., Diederiks, J. P., Hendriks, M. R., van Haastregt, J. C., Crebolder, H. F., & van Eijk, J. T. (2010). Relationship between location and activity in injurious falls: An exploratory study. BMC Geriatrics. doi: 10.1186/1471-2318-10-40.Google Scholar
  6. Bradley, J. E., Kirby, A. M., & Taylor, P. J. (1978). Distance decay and dental decay: A study of dental health among primary school children in Newcastle upon Tyne. Regional Studies, 12(5), 529–540.CrossRefGoogle Scholar
  7. Burnett, A. (2005). In the right place accessibility, local services and older people. Help the Aged. ISBN, 1904528937, 9781904528937.Google Scholar
  8. Cakar, E., Durmus, O., Dincer, U., Kiralp, M. Z., & Soydan, F. C. (2011). The effect of marital status on health quality and fall risk of elderly people. Turkish Journal of Geriatrics, 14(4), 331–336.Google Scholar
  9. Campbell, A. J., Reinken, J., Allan, B. C., & Martinez, G. S. (1981). Falls in old age: A study of frequency and related clinical factors. Age and Ageing, 10(4), 264–270.CrossRefGoogle Scholar
  10. Cauley, J. A. (2011). Defining ethnic and racial differences in osteoporosis and fragility fractures. Clinical Orthopaedics and Related Research, 469(7), 1891–1899.CrossRefGoogle Scholar
  11. Chan, W., Law, J., & Seliske, P. (2011). Bayesian spatial methods for small-area injury analysis: A study of geographical variation of falls in older people in the Wellington-Dufferin-Guelph health region of Ontario, Canada. Injury Prevention, 18(5), 303–308.CrossRefGoogle Scholar
  12. Chris, P. (2009). Medical geography. In D. Gregory, R. Johnston, & G. Pratt (Eds.), The dictionary of human geography (5th ed., pp. 451–453). Oxford: Blackwell.Google Scholar
  13. Dhanwal, D. K., Cooper, C., & Dennison, E. M. (2010). Geographic variation in osteoporotic hip fracture incidence: The growing importance of Asian influences in coming decades. Journal of Osteoporosis. doi: 10.4061/2010/757102.Google Scholar
  14. Dhanwal, D., Dennison, E., Harvey, N., & Cooper, C. (2011). Epidemiology of hip fracture: Worldwide geographic variation. Indian Journal of Orthopaedics, 45(1), 15–22.CrossRefGoogle Scholar
  15. Falch, J. A., Kaastad, T. S., Bohler, G., Espeland, J., & Sundsvold, O. J. (1993). Secular increase and geographical differences in hip fracture incidence in Norway. Bone, 14(4), 643–645.CrossRefGoogle Scholar
  16. Finsen, V., Johnsen, L. G., Trano, G., Hansen, B., & Sneve, K. S. (2004). Hip fracture incidence in central Norway: A follow up study. Clinical Orthopaedics and Related Research. doi: 10.1097/00003086-200402000-00028.CrossRefGoogle Scholar
  17. Furugren, L., & Laflamme, L. (2007). Hip fractures among the elderly in a Swedish urban setting: Different perspectives on the significance of country of birth. Scandinavian Journal of Public Health, 35(1), 11–16.CrossRefGoogle Scholar
  18. Galizia, G., Testa, G., Mazzella, F., Cacciatore, F., Ungar, A., Masotti, G., et al. (2008). Multidisciplinary approach to “accidental” falls in the elderly: A case report. Geriatrics & Gerontology International, 8(2), 130–132.CrossRefGoogle Scholar
  19. Giuliano, G., Hu, H. & Lee, K. (2003). Travel patterns of the elderly: The role of land use. (Metrans Project 00-8). California, US. School of Policy, Planning, and Development, University of Southern California.Google Scholar
  20. Graham, J. E., Chang, P. F., Berges, I. M., Granger, C. V., & Ottenbacher, K. J. (2008). Race/ethnicity and outcomes following inpatient rehabilitation for hip fracture. Biological Sciences and Medical Sciences, 63(8), 860–866.CrossRefGoogle Scholar
  21. Haan, M., Kaplan, G. A., & Camacho, T. (1987). Poverty and health. Prospective evidence from the Alameda County Study. American Journal of Epidemiology, 125(6), 989–998.Google Scholar
  22. Haining, R. (2012). The ecological analysis of offence and offender data’. In V. Ceccato (Ed.), The Urban Fabric of Crime and Fear (pp. 141–163). Dordrecht: Springer.Google Scholar
  23. Hokby, A., Reimers, A., & Laflamme, L. (2003). Hip fractures among older people: Do marital status and type of residence matter? Public Health, 117(3), 196–201.CrossRefGoogle Scholar
  24. Jacobsen, S. J., Goldberg, J., Miles, T. P., Brody, J. A., Stiers, W., & Rimm, A. A. (1992). Race and sex differences in mortality following fracture of the hip. American Journal of Public Health, 82(8), 1147–1150.CrossRefGoogle Scholar
  25. Jäntti, P. O., Pyykkö, V. I., & Hervonen, A. L. (1993). Falls among elderly nursing home residents. Public Health, 107(2), 89–96.CrossRefGoogle Scholar
  26. Johnel, O., Melton, L. J., Atkinson, E. F., O’Fallon, W. M., & Kurland, L. T. (1992). Fracture risk in patients with Parkinsonism: A population-based study in Olmstead County. Minnesota. Age and Ageing, 21(1), 32–38.CrossRefGoogle Scholar
  27. Jones, K., & Moon, G. (1993). Medical geography: Taking space seriously. Progress in Human Geography, 17(4), 515–524.CrossRefGoogle Scholar
  28. Kannus, P., Parkkari, J., Koskinen, S., Niemi, S., Palvanen, M., Järvinen, M., et al. (1999). Fall-induced injuries and deaths among older adults. JAMA: The Journal of the American Medical Association, 281(20), 1895–1899.CrossRefGoogle Scholar
  29. Kearns, R. (1993). Place and health: Toward a reformed medical geography. Professional Geographer, 45(2), 139–147.CrossRefGoogle Scholar
  30. Kearns, R., & Joseph, A. (1993). Space in it’s place—Developing the link in medical geography. Social Science and Medicine, 37(6), 711–717.CrossRefGoogle Scholar
  31. Kehusmaa, S., Autti-Ramo, I., Helenius, H., Hinkka, K., Valaste, M., & Rissanen, P. (2012). Factors associated with the utilization and costs of health and social services in frail elderly patients. BMC Health Services Research. doi: 10.1186/1472-6963-12-204.Google Scholar
  32. Landi, F., Onder, G., Russo, A., Tabaccanti, S., Rollo, R., Federici, S., et al. (2001). A new model of integrated home care for the elderly: Impact on hospital use. Journal of Clinical Epidemiology, 54(9), 968–970.CrossRefGoogle Scholar
  33. Lopata, H. Z. (1982). Lifestyles of American widows and widowers in Urban America. Educational Horizen, 60(4), 184–190.Google Scholar
  34. Luukinen, H., Koski, K., Kivela, S. L., & Laippala, P. (1996). Social status, life changes, housing conditions, health, functional abilities and life-style as risk factors for recurrent falls among the home-dwelling elderly. Public Health, 110(2), 115–118.CrossRefGoogle Scholar
  35. Macintyre, S., McIver, S., & Sooman, A. (1993). Area, class and health: Should we be focusing on people or places? Journal of Social Policy, 22(2), 213–234.CrossRefGoogle Scholar
  36. Megyesi, M. S., Hunt, L. M., & Brody, H. (2011). A critical review of racial/ethnic variables in osteoporosis and bone density research. Osteoporosis International, 22(6), 1669–1679.CrossRefGoogle Scholar
  37. Neutel, C. I., Hirdes, J. P., Maxwell, C. J., & Patten, S. B. (1996). New evidence on benzodiazepine use and falls: The time factor. Age and Ageing, 25(4), 273–278.CrossRefGoogle Scholar
  38. Nguyen-Oghalai, T. U., Ottenbacher, K. J., Kuo, Y. F., Wu, H., Grecula, M., Eschbach, K., et al. (2009). Disparities in utilization of outpatient rehabilitative care following hip fracture hospitalization with respect to race and ethnicity. Archives of Physical Medicine and Rehabilitation, 90(4), 560–563.CrossRefGoogle Scholar
  39. O’Loughlin, J. L., Robitaille, Y., Boivin, J. F., & Suissa, S. (1993). Incidence of and risk factors for falls and injurious falls among community-dwelling elderly. Journal of Epidemiology and Community Health, 137(3), 342–354.Google Scholar
  40. Penrod, J. D., Litke, A., Hawkes, W. G., Magaziner, J., Doucette, J. T., Koval, K. J., et al. (2008). The association of race, gender, and comorbidity with mortality and function after hip fracture. Biological Sciences and Medical Sciences, 63(8), 867–872.CrossRefGoogle Scholar
  41. Prudham, D., & Grimley-Evans, J. (1981). Factors associated with falls in the elderly: A community study. Age and Ageing, 10(3), 141–146.CrossRefGoogle Scholar
  42. Reimers, A., & Laflamme, L. (2007). Hip fractures among elderly: Personal and contextual social factors that matter. The Journal of Trauma, 62(2), 365–369.CrossRefGoogle Scholar
  43. Rubenstein, L. Z., & Josephson, K. R. (2002). The epidemiology of falls and syncope. Clinics in Geriatric Medicine, 18(2), 141–158.CrossRefGoogle Scholar
  44. Sandberg, M., Kristensson, J., Midlov, P., Fagerstrom, C., & Jakobsson, U. (2012). Prevalence and predictors of healthcare utilization among older people (60+): Focusing on ADL dependency and risk of depression. Archives of Gerontology and Geriatrics, 54(3), e349–e363.CrossRefGoogle Scholar
  45. Sattin, R. W., Lambert-Huber, D. A., DeVito, C. A., Rodriguez, J. G., et al. (1990). The incidence of fall injury events among the elderly in a defined population. American Journal of Epidemiology, 131(6), 1028–1037.Google Scholar
  46. Smoyer, K. E. (1998). Putting risk in its place: Methodological considerations for investigating extreme event health risk. Social Science and Medicine, 47(11), 1809–1824.CrossRefGoogle Scholar
  47. Tinetti, M., Speechley, M., & Ginter, S. (1988). Risk factors for falls among elderly persons living in the community. The New England Journal of Medicine, 319(26), 1701–1707.CrossRefGoogle Scholar
  48. Trujillo, A. J., Puvanachandra, P., & Hyder, A. A. (2011). Individual income and falls among the elderly in Latin America. Geriatrics & Gerontology International, 11(2), 180–190.CrossRefGoogle Scholar
  49. Van Rossum, C. T., van de Mheen, H., Mackenbach, J. P., & Grobbee, D. E. (2000). Socioeconomic status and mortality in Dutch elderly people. European Journal of Public Health, 10(4), 255–261.CrossRefGoogle Scholar
  50. Wågert, P., Gustafson, Y., Kallin, K., Jensen, J., & Lundin-Olsson, L. (2009). Falls in very old people: The population-based Umeå 85+ Study in Sweden. Archives of Gerontology and Geriatrics, 49(3), 390–396.CrossRefGoogle Scholar
  51. Wild, D., Nayak, U. S. L., & Isaacs, B. (1981). How dangerous are falls in old people at home? British Medical Journal, 282(24), 266–268.CrossRefGoogle Scholar
  52. Yiannakoulias, N., Rowe, B. H., Svenson, L. W., Schopflocher, D. P., Kelly, K., & Voaklander, D. C. (2003). Zones of prevention: The geography of fall injuries in the elderly. Social Science and Medicine, 57(11), 2065–2073.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2014

Authors and Affiliations

  1. 1.Royal Institute of TechnologyStockholmSweden

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