Fall-risk screening test: a prospective study on predictors for falls in community-dwelling elderly

This large prospective cohort study was undertaken to construct a fall-risk model for elderly. The emphasis of the study rests on easily measurable predictors for any falls and recurrent falls. The occurrence of falls among 1285 community-dwelling elderly aged 65 years and over was followed during 1 year by means of a "fall calendar." Physical, cognitive, emotional and social functioning preceding the registration of falls were studied as potential predictors of fall-risk. Previous falls, visual impairment, urinary incontinence and use of benzodiazepines were the strongest predictors identified in the risk profile model for any falls (area under the curve [AUC] = 0.65), whereas previous falls, visual impairment, urinary incontinence and functional limitations proved to be the strongest predictors in the model for recurrent falls (AUC = 0.71). The probability of recurrent falls for subsequent scores of the screening test ranged from 4.7% (95% Confidence Interval [CI]: 4.0-5.4%) to 46.8% (95% CI: 43.0-50.6%). Our study provides a fall-risk screening test based on four easily measurable predictors that can be used for fall-risk stratification in community-dwelling elderly.     

Fall-related factors in a cohort of elderly community residents

OBJECTIVE: To identify factors associated to fall and recurrent fall episodes among elderly living in a community, and to determine the relative risk of each factor as a fall predictor. METHODS: A two-year follow-up study with two segments of multi-dimensional household surveys (1991-1992 and 1994-1995) was carried out in a cohort of 1,667 elderly, aged 65 or older, living in a community in the city of S?o Paulo, Brazil. The instrument used for data collection was the BOMFAQ, the Brazilian version of the Multidimensional Functional Assessment Questionnaire (OARS). A stepwise logistic regression analysis was conducted with p<0.05 and 95% CI. RESULTS: About 31% of the elderly referred a fall episode and around 11% referred two or more fall episodes in the previous year of the first survey. After follow-up, 53.4% didn't refer any fall episodes, 32.7% referred a fall episode either in the first survey or in the second one and almost 14% referred fall episodes in both surveys. The predictive model of recurrent falls was composed by the following variables: absence of a spouse (OR=1.59 95% CI 1.00-2.52), not having a reading habit (OR= 1.56 95% CI 1.03-2.37), history of fractures (OR=4.6 95% CI 2.23-9.69 difficulty to perform one to three activities of daily life (OR=2.37 95% CI 1.49-3.78), difficulty to perform four or more activities of daily life (OR=3.31 95%CI 1.58-6.93) and among those whose sight is most impaired (OR=1.53 95%CI 1.00-2.34). CONCLUSIONS: Population ageing and increase in life expectancy demand preventive and rehabilitation actions in order to reduce risk factors for falls, such as impaired functional capacity, impaired eye sight and lack of cognitive stimulation.     

Balance and mobility performance as treatable risk factors for recurrent falling in older persons

BACKGROUND AND OBJECTIVES: The purpose of this study was to examine whether easily measurable measures for balance and muscle strength predicted recurrent falling as well as sophisticated measurements, and to examine which of the modifiable risk factors were strongest associated with recurrent falling. METHODS: The study was performed in a subsample (n=439, aged 69-92 years) of the Longitudinal Aging Study Amsterdam (LASA). Balance, muscle strength, physical activity, and performance tests were assessed. Falls were recorded during 1 year. The outcome measure was recurrent falls (>/=2 falls within 1 year). RESULTS: The area under the curve (AUC) of mediolateral sway (AUC=0.67; 95% CI:0.57-0.77), tandem stand (AUC=0.61; 95% CI:0.49-0.73), leg extension strength (AUC=0.58; 95% CI:0.51-0.64), and handgrip strength (AUC=0.57; 95% CI:0.51-0.64) for recurrent falling were not significantly different. In a multivariate model, mediolateral sway (OR=2.8; 95% CI:1.1-6.9), tandem stand (OR=2.1; 95% CI:1.1-3.8), and walking test (OR=2.2; 95% CI:1.1-4.1) were significantly associated with recurrent falling. CONCLUSIONS: The easily measurable tandem stand and handgrip strength predicted recurrent falling as well as the sophisticated measures. Mediolateral sway was strongest associated with recurrent falling.     

河南省老年人能力状况对跌倒的影响

目的 了解河南省老年人跌倒发生情况,并探讨老年人能力状况与跌倒之间的关系。方法 采用分阶段抽样的方法,对河南省60岁及以上的老年人进行问卷调查。采用二元logistic回归模型分析日常生活能力、精神状态能力、感知觉与沟通能力、社会参与能力对老年人跌倒的影响。结果 共调查5 570例老年人,其中496例老年人发生了跌倒,发生率为8.9%。Logistic回归分析表明,全人群中日常生活能力受损（OR = 3.060,95%CI = 2.418～3.872）、感知觉与沟通能力受损（OR = 1.449,95%CI = 1.128～1.861）、社会参与能力受损（OR = 1.438,95%CI = 1.100～1.880）是河南省老年人跌倒的危险因素。根据性别进行分层后无论对于男性（OR = 3.542,95%CI = 2.445～5.130）还是女性（OR = 2.826,95%CI = 2.075～3.848）,跌倒都受日常生活能力受损的影响。除此之外,感知觉与沟通能力受损（OR = 1.543,95%CI = 1.118～2.130）和社会参与能力受损（OR = 1.480,95%CI = 1.045～2.096）也是女性老年人跌倒的危险因素。结论 能力状况受损是老年人跌倒的危险因素,其中男性跌倒主要受日常生活能力的影响,女性跌倒受日常生活能力、感知觉与沟通能力、社会参与能力的影响。     

重庆市老年人多次跌倒发生率及相关因素分析

目的 了解重庆市65岁及以上老年人过去1年多次跌倒发生率及相关因素,为开展干预工作提供建议.方法 在4个区县采用多阶段分层整群随机抽样抽取65岁及以上老年人进行问卷调查.多次跌倒发生率的比较采用x2检验,多次跌倒发生的相关因素采用多因素logistic回归分析.结果 共计调查1607人,平均年龄(72.36±6.27)...     

The construction of a patient record-based risk model for recurrent falls among elderly people living in the community

BACKGROUND: Predictive models of fall risk in the elderly living in the community may contribute to the identification of elderly at risk for recurrent falling. OBJECTIVES: Our aim was to investigate occurrence, determinants and health consequences of falls in a community-dwelling elderly population and the contribution of data from patient records to a risk model of recurrent falls. METHODS: A population survey was carried out using a postal questionnaire. The questionnaire on occurrence, determinants and health consequences of falls was sent to 2744 elderly persons of 70 years and over, registered in four general practices (n = 27 000). Data were analysed by bivariate techniques and logistic regression. RESULTS: A total of 1660 (60%) responded. Falls (> or =1 fall) in the previous year were reported by 44%: one-off falls by 25% and recurrent falls (> or =2 falls) by 19%. Women had significantly more falls than men. Major injury was reported by 8% of the fallers; minor injury by 49%. Treatment of injuries was by the GP in 67% of cases. From logistic regression, a risk model for recurrent falls, consisting of the risk factors female gender, age 80 years or over, presence of a chronic neurological disorder, use of antidepressants, problems of balance and sense organs and complaints of muscles and joints was developed. The model predicted recurrent falls with a sensitivity of 64%, a specificity of 71%, a positive predictive value of 42% and a negative predictive value of 86%. CONCLUSION: A risk model consisting of six variables usually known to the GP from the patient records may be a useful tool in the identification of elderly people living in the community at risk for recurrent falls.     

苏州市某社区居家老年人跌倒危险因素分析

目的 探讨苏州市某社区居家老年人跌倒现状及危险因素,为社区跌倒预防工作提供参考.方法 采用方便抽样的方法,于2018年4—7月选取苏州市某社区60岁及以上居家养老的375名老年人为研究对象,采用Logistic回归模型分析跌倒的危险因素.结果 65名居家老年人在一年内发生过跌倒,发生率为17.33％,午饭后到晚饭间是老...     

Clinical history and biologic age predicted falls better than objective functional tests

OBJECTIVE: Fall risk assessment is important because the consequences, such as a fracture, may be devastating. The objective of this study was to find the test or tests that best predicted falls in a population-based sample of elderly women. STUDY DESIGN AND SETTING: The fall-predictive ability of a questionnaire, a subjective estimate of biologic age and objective functional tests (gait, balance [Romberg and sway test], thigh muscle strength, and visual acuity) were compared in 984 randomly selected women, all 75 years of age. RESULTS: A recalled fall was the most important predictor for future falls. Only recalled falls and intake of psycho-active drugs independently predicted future falls. Women with at least five of the most important fall predictors (previous falls, conditions affecting the balance, tendency to fall, intake of psychoactive medication, inability to stand on one leg, high biologic age) had an odds ratio of 11.27 (95% confidence interval 4.61-27.60) for a fall (sensitivity 70%, specificity 79%). CONCLUSION: The more time-consuming objective functional tests were of limited importance for fall prediction. A simple clinical history, the inability to stand on one leg, and a subjective estimate of biologic age were more important as part of the fall risk assessment.     

Demenz, Depressionen und Aktivit?ten des t?glichen Lebens als Risikofaktoren von Stürzen bei Betagten

OBJECTIVES: Falls among elderly are a well-recognised public health problem. The purpose of the present study was to explore the relation between dementia, number of depressive symptoms, activities of daily living, setting, and risk of falling. METHODS: Data for the analysis came from a cross-sectional study about dementia, depression, and disabilities, carried out 1995/96 in Zurich and Geneva. The random sample stratified, by age and gender consisted of 921 subjects aged 65 and more. The interview was conducted by means of the Canberra interview for the Elderly, extended by short questionnaire. The subject was classified as a faller if the subject and/or the informant had reported a fall within the last 12 months prior to the interview. Logistic-regression analysis was used to determine the independent impact of dementia, depressive symptoms, and ADL-score on risk of falling. RESULTS: The stepwise logistic regression analysis has revealed a statistically significant association between dementia (OR 2.14, 95% CI 1.15-3.96), two resp. three depressive symptoms (OR 1.64, 95% CI 1.04-2.60) as well as four or more depressive symptoms (OR 2.64, 95% CI 1.39-5.02) and the risk of falling. There was no statistically significant relationship between studied risk factors and the risk of being one-time faller. However, we found a strong positive association between dementia (OR 3.92, 95% CI 1.75-8.79), four or more depressive symptoms (OR 3.90, 95% CI 1.55-9.83) and the risk of being recurrent faller. Moreover, residents of nursing homes (OR 8.50, 95% CI 2.18-33.22) and elderly aged 85 or more (OR 2.29, 95% CI 1.08-4.87) were under statistically significant higher risk of sustaining recurrent falls. CONCLUSIONS: The results of the present study confirm that dementia and depression substantially increase the risk of falling.     

Validation of the LASA fall risk profile for recurrent falling in older recent fallers

ObjectivesThe fall risk profile developed in the Longitudinal Aging Study Amsterdam (LASA) identifies community-dwelling elderly at high risk for recurrent falling. This study assessed the predictive validity of this profile in older persons seeking care after a fall.Study Design and SettingThe LASA fall risk profile was completed for 408 persons of 65 years and older who consulted the emergency department or general practitioner after a fall. Falls were prospectively reported with a calendar during 1 year. Recurrent falling was defined as ≥2 falls within a period of 6 months.ResultsDuring 1 year of followup, 76 (18.6%) participants became recurrent fallers. The area under the receiver operating characteristic curve was 0.65 (95% confidence interval [95% CI]: 0.58–0.72). At a cutoff value of 8, the sensitivity was 56.6% (CI: 51.8–61.4), the specificity was 71.4% (CI: 67.0–75.8), the positive predictive value was 34.1% (CI: 29.5–38.7), and the negative predictive value was 85.6% (CI: 82.2–89.0).ConclusionThe discriminative ability of the LASA fall risk profile was moderate. The predictive validity of the LASA fall risk profile to identify recurrent fallers is limited among older persons who consulted the emergency department or general practitioner after a fall.     

湖北省抽样点老年人跌倒风险状况及其影响因素研究

目的研究湖北省抽样点老年人群跌倒风险情况及其相关影响因素,为采取针对性的预防措施提供理论依据。方法于2018年1-12月采取多阶段分层整群随机抽样的方法,在湖北省抽取1个区和1个县作为研究点。将符合纳入标准的2970名年龄≥60岁老年人作为研究对象,以标准化问卷进行调查,并进行身体测量和跌倒风险评估。用SPSS22.0统计软件进行χ²检验,采用多因素logistic回归模型分析老年人跌倒风险的影响因素。结果2970名老年人中存在跌倒风险的人数为1703人(57.34%),1年内摔倒1、2和3次及以上的比例分别为5.42%,0.88%和0.40%。多因素logistic回归分析结果显示,女性(OR=1.681,95%CI:1.431~1.975),高龄(70~74岁OR=1.925,95%CI:1.338~2.669,75~79岁OR=2.698,95%CI:1.883~3.886,≥80岁OR=5.014,95%CI:3.327~7.556),无配偶(OR=1.305,95%CI:1.054~1.615),跌倒相关药物服药史(OR=1.440,95%CI:1.215~1.707),日常生活活动能力受损(OR=3.238,95%CI:2.104~4.984)及患有眼疾(OR=2.844,95%CI:1.711~4.729)的湖北省抽样点老年人群跌倒风险较高,居住在农村(OR=0.515,95%CI:0.429~0.620)、每天进行体育锻炼(OR=0.715,95%CI:0.555~0.921)的湖北省抽样点老年人群跌倒风险较低。结论湖北省抽样点老年人群跌倒风险较高,且呈现影响因素多样化,个体跌倒影响因素叠加等现象,应重点关注女性、高龄独居和日常生活活动能力受损的老年人,通过社会、家庭和个体3个维度的综合性干预措施来降低老年跌倒风险。     

中国老年人不同严重程度跌倒风险与慢性病和睡眠的关联研究

目的 探索老年人慢性疾病和睡眠状况与不同严重程度跌倒风险之间的关联,为老年人跌倒所致伤害的预防和干预提供线索.方法 采用病例对照研究发生风险,以"中国健康与养老追踪调查项目"数据为基础,利用2011-2015年抽样调查数据,运用多因素Logistic回归分析模型分析慢性疾病和睡眠的暴露与中国老年人普通跌倒和跌倒就医发生...     

北京市某城市社区老年人跌倒与慢性病关系的研究

目的 探讨老年人跌倒的发生情况与慢性病的关系,为老年人跌倒的预防提供科学依据.方法 采用分层整群抽样的方法抽取北京市某城市社区60岁及以上的老年人,以面对面询问方式进行入户调查,对可能与跌倒有关的慢性病进行单因素和多因素logistic回归分析,以寻找跌倒的危险因素.结果 被调查的1512名老年人中,272人在过去的1年中发生跌倒,跌倒发生率为18.0%,其中男性92人,女性180人,男、女性跌倒发生率分别为14.9%、20.1%.单因素分析表明糖尿病(OR=1.62)、体位性低血压(OR=1.84)、高血压(OR=1.48)、脑梗死(OR=1.98)、白内障(OR=1.56)、骨关节炎(OR=1.50)、痴呆(OR=5.34)、抑郁症(OR=4.61)8种疾病的分布经χ2检验后差异有统计学意义.多因素logistic回归分析表明与跌倒有关的慢性病因素有痴呆(OR=4.82)、抑郁症(OR=4.27)、体位性低血压(OR=1.92)、患多种慢性病(OR=1.36)等.结论 北京市城市社区老年人跌倒发生率高,其中患有痴呆和抑郁症的老年人发生跌倒的危险性最高,并且跌倒的危险性随着患慢性病总数的增加而增加.     

Falls among institutionalized elderly in Alexandria

Falls are a common geriatric problem causing considerable morbidity, mortality, and affecting the quality of life of many elderly people. A cross sectional study was conducted to determine the prevalence and risk factors of falls among elderly people living in geriatric institutions in Alexandria. The total sample included 103 elderly females and 62 elderly males from six institutions. All participants were subjected to interviewing questionnaire to collect data about history, circumstances, outcome of falls, previous falls and history of diseases and drug intake It included also data about activities of daily living. Anthropometric measurements, blood pressure, postural hypotension assessment, complete physical examination and Tinetti scale for balance and gait could be completed for a sub-sample. The prevalence of falls was 32.1%. Most of the falls occurred during the daytime (77.4%), mainly in the bedroom or in the way from bed to bathroom (37.7% each). The most likely causes were slip/trip (41.5%) followed by dizziness/vertigo (32.1%). Fractures occurred in 20.8% of falls. Advanced age (70-79, 80 years and above), history of three or more falls, history of disability from previous falls, history of visual problem, history of cardiac and antihypertensive drug use, and mild impairment of balance and gait were significant risk factors for falls in the univariate analysis. All these factors except for the impairment of balance and gait were also significant predictors of falls in the multivariate analysis.     

Nutritional Status,Body Mass Index,and the Risk of Falls in Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis

ObjectivesTo evaluate the association between nutritional status, defined on the basis of a multidimensional evaluation, and body mass index (BMI) with the risk of falls and recurrent falls in community-dwelling older people.DesignSystematic literature review and meta-analysis.Setting and ParticipantsCommunity-dwelling older adults.MeasuresA systematic literature review was conducted on prospective studies identified through electronic and hand searches until October 2017. A random effects meta-analysis was used to evaluate the relative risk (RR) of experiencing falls and recurrent falls (≥2 falls within at least 6 months) on the basis of nutritional status, defined by multidimensional scores. A random effects dose-response meta-analysis was used to evaluate the association between BMI and the risk of falls and recurrent falls.ResultsPeople who were malnourished or those at risk for malnutrition had a pooled 45% higher risk of experiencing at least 1 fall than were those well-nourished (9510 subjects). Increased falls risk was observed in subjects malnourished versus well-nourished [RR 1.64, 95% confidence interval (CI) 1.18-2.28; 3 studies, 8379 subjects], whereas no substantial results were observed for risk of recurrent falls. A U-shaped association was detected between BMI and the risk for falls (P < .001), with the nadir between 24.5 and 30 (144,934 subjects). Taking a BMI of 23.5 as reference, the pooled RR of falling ranged between 1.09 (95% CI 1.04-1.15) for a BMI of 17, to 1.07 (95% CI 0.92-1.24) for a BMI of 37.5. No associations were observed between BMI and recurrent falls (120,185 subjects).Conclusions/ImplicationsThe results of our work suggest therefore that nutritional status and BMI should be evaluated when assessing the risk for falls in older age.     

The physical environment as a fall risk factor in older adults: Systematic review and meta-analysis of cross-sectional and cohort studies

Background/aim:  Evidence that the physical environment is a fall risk factor in older adults is inconsistent. The study evaluated and summarised evidence of the physical environment as a fall risk factor.
Methods:  Eight databases (1985–2006) were searched. Investigators evaluated quality of two categories (cross-sectional and cohort) of studies, extracted and analysed data.
Results:  Cross-sectional: falls occur in a variety of environments; gait aids were present in approximately 30% of falls.
Cohort:  Home hazards increased fall risk (odds ratio (OR) = 1.15; 95% confidence interval (CI): 0.97–1.36) although not significantly. When only the high quality studies were included, the OR = 1.38 (95% CI: 1.03–1.87), which was statistically significant. Use of mobility aids significantly increased fall risk in community (OR = 2.07; 95% CI: 1.59–2.71) and institutional (OR = 1.77; 95% CI: 1.66–1.89) settings.
Conclusions:  Home hazards appear to be a significant risk factor in older community-dwelling adults, although they may present the greatest risk for persons who fall repeatedly. Future research should examine relationships between mobility impairments, use of mobility aids and falls.     

Understanding risk of falls in people with cognitive impairment living in residential care

ObjectivesTo better understand fall risk factors in older adults with cognitive impairment living in residential care.DesignA prospective observational cohort study.SettingResidential care homes in South London, UK.ParticipantsResidents older than 60, with cognitive impairment who had a life expectancy of at least 6 months and were not bedbound or recently discharged from hospital.MeasurementsBaseline assessments were undertaken in domains of demographics, medical history, medication use, behavior, affect, gait, balance, sensorimotor performance and neuropsychological function. Participants were followed for 6 months for falls using care home reporting systems.ResultsA total of 109 participants completed baseline assessment and had adequate falls follow-up. Fallers took more medications, were more likely to be taking antidepressants, had more functional impairment, poorer balance and gait, were more impulsive and anxious, exhibited more dementia-related behaviors, and performed worse on cognitive tests involving attention and orientation, memory, and fluency. Logistic regression analysis identified 4 significant and independent predictors of falls: poor attention and orientation, increased postural sway with eyes closed, anxiety, and antidepressant use. The AUC for this model was 0.84 (95% CI 0.76–0.91).ConclusionsThis study identified important risk factors for falls potentially amenable to intervention in older people with cognitive impairment living in residential care. This information may be useful in designing effective approaches to fall prevention in this high-risk population.     

Correlates of falling during 24 h among elderly Danish community residents

OBJECTIVES: To identify dietary, medical, and environmental correlates of falling during the last 24 h among elderly community residents. The limited accuracy of recall of falls in the elderly in previous studies was the reason for a 24-h time frame. METHODS: The study composes 4281 community residents aged 66+ years. The statistical analyses included Pearson's chi(2) test and multiple logistic regression. RESULTS: Mutually independent correlates of falls were a family history of fracture (OR, 3.0; 95% CI: 1.3-7.1); osteoarthrosis of the knee (OR, 2.9; 95% CI: 1.3-6.2); dizziness (OR, 4.1; 95% CI: 1.9-8.9); a diet not including sour dairy products (OR, 3.0; 95% CI: 1.4-6.3) or fish (OR, 3.4; 95% CI: 1.5-7.5); drinking tea (OR, 5.8; 95% CI 2.15-15.30); needing help for shopping (OR, 3.9; 95% CI: 1.6-9.3); and for administration of medicine (OR, 9.0; 95% CI: 2.0-40.6). Independent environmental correlates were vinyl on the floor in the bathroom (OR, 6.6; 95% CI: 2.1-20.9) and using indoor footwear without soles (OR, 5.5; 95% CI: 2.3-13.4). CONCLUSION: The present analyses suggest that several factors are associated to the risk of falling among elderly community residents. It appears relevant for further studies to test if modifications of the potential risk factors identified may reduce falls among community dwelling older persons.