| Sumario: | Purpose Hip fractures are life-threatening injuries in older adults, and more than 95% of cases are due to a fall. Since consequences of hip fractures are debilitating, prevention is important. Development of effective prevention strategies requires sound knowledge on the injury mechanisms during a fall, and research studies to date provide several pieces of information (i.e., risk factors, injury mechanisms) to suggest prevention strategies (i.e., exercise programs, hip protectors, safe landing strategies, and so on). However, the problem doesn't seem to be solved yet, and fall-death rates in older adults has continuously increased over the past decades, anticipating seven fall deaths every hour by 2030 (CDC, 2017; Burns and Kakara, 2018). This indicates that current intervention strategies are ineffective in fast growing aged population. Method We reviewed literatures to summarize current biomechanical understandings and prevention strategies of falls and hip fractures in older adults to help guide a future direction on research and application. Results and Discussion (1) While falls are a number one cause of hip fracture in older adults, not all falls result in hip fracture, leaving more than 98% of falls non-injurious (Tinetti et al., 1988; Sattin, 1992). This forces us to think of factors that differentiate injurious versus non-injurious falls, and circumstances that lead to hip fractures. (2) Research evidence suggests that the injurious falls are determined with various biomechanical factors, including but not limited to, falling velocity, body mass, soft tissue stiffness, muscle pulling force, knee position at the time of hip impact, hip impact angle, fall direction, body mass index, age, femur geometry, and bone density. While effects of each individual factor have well been documented, combining effects and correlation and causation among the risk factors are poorly understood. (3) The fall-related hip fractures in older adults may be addressed by reducing individuals' fall risk during activities of daily living, or decreasing fracture risk in the event of a fall, and the fall prevention interventions include exercise, vision correction, vitamin D intake and environment modification. Whereas, the fracture prevention strategies include use of hip protectors, compliant flooring, and safe landing strategies, vitamin D intake and exercise (Choi et al., 2021). (4) While fall risk assessments have well been established and widely used in clinics and research, injury (fracture) risk assessments are relatively under-developed. (5) Development of fracture risk assessment techniques or tools along with better understanding on the correlation and causation among risk factors of falls and hip fractures in older adults, are necessary to establish more effective intervention models for fall-related hip fractures in older adults.
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