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.     

农村敬老院老人跌倒的危险因素探讨——条件logistic回归模型

作者对 18所农村敬老院 60岁以上老年人 154例跌倒病例按 1∶1配对 ,用条件logistic回归模型进行病例对照研究。结果表明 ,老年人无配偶、体能状况差、步态异常、患慢性病、高血压病、中风后遗症、服抗高血压药物以及静力平衡和步行试验异常等九个因素是跌倒的主要危险因素 ,并提出防制措施的建议。     

Production of a fall prevention exercise programme considering suggestions from community-dwelling elderly

OBJECTIVES: A fall prevention exercise programme, which elderly persons could undertake in their home alone to maintain and improve leg muscle strength, body balance ability and flexibility, was developed. The programme consisted of number of movements from which the best were selected on the basis of participant evaluation. The purpose of this report is to document the actual contents and an examination of the effects of this exercise programme in elderly people. METHODS: A total of 551 elderly persons, aged 75 years and over, not needing the support of elderly care insurance in S town, Miyagi Japan, were the subjects of this study. An intervention area and a non-intervention area were set in the study region. In the intervention area, 85 elderly people of high-risk for falls were selected to perform a longitudinal intervention study for one year. The selection criteria were as follows: 1) Maximum walking speed slower than median value, 2) Falls had been experienced in the past year. Forty elderly persons (15 men and 25 women) participated in the class. Thirty movements designed to improve flexibility, leg muscle strength, and body balance, and to prevent tripping were executed and evaluated. Effects of this intervention on participants in the fall prevention class were examined using a follow-up survey one year after the baseline survey. The outcome of the fall prevention exercise programme was measured in terms of incidence of falls. RESULTS: A final fall prevention exercise programme consisting of ten movements was produced by the intervention. In addition, seven movements using a chair were part of the exercise programme. METS of the exercise programme for students, leaders, and elderly persons were 3.41 +/- 0.37, 3.16 +/- 0.47, and 3.08 +/- 0.4, respectively. The incidence of falls over one year of the participants in the class significantly decreased from 48.4% at baseline survey to 25.8% at follow-up survey, but that of non-participants did not change. One-leg standing times with eyes open of the female participants significantly extended from the baseline survey to the follow-up survey, but not that of non-participants. CONCLUSIONS: This result of intervention suggested that incidence of falls was decreased by the execution of the exercise programme in twelve sessions of fall prevention class and at home.     

Incidence, risk factors and consequences of falls among elderly subjects living in the community: A criteria-based analysis

In order to obtain an overview of the incidences, risk factorsand health consequences of falls among elderly persons livingin the community from the available literature, a Medline computersearch of publications over the period 1981–1994 was carriedout. Fourteen studies met the following inclusion criteria:i) the study is an original investigation of falls among theelderly, ii) the study deals with the incidence, risk factorsand/or consequences of falls among the elderly and iii) thestudy refers to a population at risk consisting of persons aged60 years or over belonging to a population relevant to generalpractice. The selected studies were subjected to a methodologicalassessment on the basis of 10 methodological criteria. All thestudies were independently assessed by 1 author and 1 assistantto obtain a methodological consensus. The relevant outcomesof these studies are reported. Pooling of data was not performedbecause of relevant differences between the studies. Two studiesmet all methodological criteria and 2 other studies were secondbest. These 4 studies were given preference. Approximately 30%of subjects older than 65 years fall at least once a year andapproximately 15% fall recurrently. The main risk factors forfalls among the elderly belong to the intrinsic (patient-related)risk factors: cognitive impairment, balance and gait disorders,use of sedatives and hypnotics, a history of stroke, advancedage, arthritis of the knee and a high level of dependence. Extrinsic(environment-related) risk factors did not play a significantrole in any of the studies. Not all studies dealt with the healthconsequences of falls among the elderly. Major injuries werereported in 0.5–9% and fractures in 3–14%.     

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.     

广东省老年人跌倒及其影响因素和平衡能力受损现况

  目的  调查广东省社区老年人跌倒和平衡能力受损现状及跌倒影响因素。  方法  采用多阶段分层整群随机抽样的方法进行抽样调查,共有5 503名≥60岁老年人纳入分析。采用χ2检验分析老年人跌倒发生率和平衡能力受损率在不同特征老年人之间的差异,采用多因素Logistic回归分析模型分析跌倒的影响因素。  结果  本研究中老年人过去1年的跌倒发生率为11.90%,平衡能力受损率为58.37%。跌倒和平衡能力受损情况在女性、农村、文盲、无配偶和独居的老年人中较为常见(均有P＜0.05)。多因素分析显示,女性跌倒的危险性较男性高,跌倒发生情况随年龄的增加而愈发严重。农村老年人跌倒危险性高于城市老年人。老年人在家走动或做家务时最常发生跌倒(35.11%),因跌倒造成擦伤/挫伤、骨折、扭伤/拉伤、脑震荡/脑挫裂伤和其他受伤类型的比例分别为55.77%、22.22%、17.09%、1.07%和3.85%。  结论  广东省社区老年人在过去1年内发生跌倒的情况较多,平衡能力受损现状严重,应加强对老年人的防跌倒健康宣教和以家庭防护为主的综合干预措施。     

老年人在家中跌倒的流行病学特征及其危险因素研究

目的了解上海市长宁区社区老年人家中跌倒发生情况及其危险因素。方法采用分层随机抽样的方法选择居住在上海市长宁区的I〉60岁常住居民2250人,应用自行设计的调查表对研究对象过去1年在家中跌倒的情况及相关因素进行调查。结果调查对象中男性1075人（47．8％）,女性1175人（52．2％）。207位老年人过去1年至少发生1次家中跌倒,跌倒发生率为9．2％。多因素非条件Logistic回归分析显示,平衡能力、居住状态和家居环境与老年人发生家中跌倒相关。平衡能力差、家居环境中致跌危险因素多、独居是老年人发生家中跌倒的危险因素。结论老年人家中跌倒的发生与多维度因素有关。提高老人的平衡能力,减少其家居环境的致跌危险因素,加强对独居老人的日常照顾是预防家中跌倒的主要措施。     

Preventive strategy of fall for the prevention of fractures in older people: a review of the evidence

This review aims to examine the effectiveness of fall-related strategies for fracture prevention among elderly population. Previous studies were reviewed using PubMed and Japan Centra Revuo Medicina databases. Our five research questions concerned prediction of fracture using history of accidental falls, fracture risk management, and effectiveness of exercise programs, home modification and usage of hip protector. We used "accidental falls" and "fractures" as search strategies. Obtained results were as follows: a) History of falls predicts future hip fracture. b) Exercise programs including balance training have positive effects for fracture prevention. c) Fracture risk evaluation and management reduce the number of hip fractures among elderly population. d) Environmental hazard assessment and necessary home modification are effective in preventing fractures especially among elderly population with the history of falls. e) The hip protector is a beneficial device for the prevention of hip fractures among elderly people at high risk of falling.     

Outcomes of coordinated and integrated interventions targeting frail elderly people: a systematic review of randomised controlled trials

The aim of this study was to review randomised controlled trials on integrated and coordinated interventions targeting frail elderly people living in the community, their outcome measurements and their effects on the client, the caregiver and healthcare utilisation. A literature search of PubMed, AgeLine, Cinahl and AMED was carried out with the following inclusion criteria: original article; integrated intervention including case management or equivalent coordinated organisation; frail elderly people living in the community; randomised controlled trials; in the English language, and published in refereed journals between 1997 and July 2007. The final review included nine articles, each describing one original integrated intervention study. Of these, one was from Italy, three from the USA and five from Canada. Seven studies reported at least one outcome measurement significantly in favour of the intervention, one reported no difference and one was in favour of the control. Five of the studies reported at least one outcome on client level in favour of the intervention. Only two studies reported caregiver outcomes, both in favour of the intervention for caregiver satisfaction, but with no effect on caregiver burden. Outcomes focusing on healthcare utilisation were significantly in favour of the intervention in five of the studies. Five of the studies used outcome measurements with unclear psychometric properties and four used disease-specific measurements. This review provides some evidence that integrated and coordinated care is beneficial for the population of frail elderly people and reduces health care utilisation. There is a lack of knowledge about how integrated and coordinated care affects the caregiver. This review pinpoints the importance of using valid outcome measurements and describing both the content and implementation of the intervention.     

A multivariate regression model predicted falls in residents living in intermediate hostel care

BACKGROUND AND OBJECTIVE: To evaluate whether individual falls risk could be predicted in a frail elderly population. STUDY DESIGN AND SETTING: We developed and tested an assessment tool and falls risk score for predicting falls based on a multivariate regression model in a prospective cohort study of intermediate care residents. RESULTS: During the follow-up period, 1,736 falls by 1,107 subjects were recorded with an average of 170 falls per 100 person-years. Fifty percent of the study population had at least one fall within a year. Significant independent risk factors were poor balance, cognitive impairment, incontinence, higher illness severity rating, and older age. Twenty-two percent of participants with a falls risk score > or =7 accounted for 42% of the total falls, with a falls rate of 317 per 100 person-years. This rate was a sixfold increase from the falls rate of 52 per 100 person-years observed in participants with a score < 3. A high score (> or =7) indicated almost a 2 in 3 chance of falling, while a low score (<3) indicated approximately a 1 in 7 chance of falling within 6 months. CONCLUSION: The assessment tool and falls risk score could identify individuals in this frail elderly population at high risk of falls.