老年人衰弱综合征与不良结局风险的前瞻性队列研究

目的探讨老年人衰弱综合征对老年人日常生活能力及不良结局风险的影响。方法采用中国健康与养老追踪调查全国开放数据, 应用年龄60岁及以上社区老年人的一般信息、健康危险因素、慢性疾病、各种能力评估及Fried衰弱评估标准资料, 以2011年作为基线调查, 进行随访资料分析, 使用经协变量调整的Logistic回归模型对衰弱综合征与不良结局风险进行分析。结果 2011年基线人群5 630例老年人中无衰弱、衰弱前期和衰弱者分别占34.9%(1 963例)、57.4%(3 236例)和7.7%(431例)。第3、5和8年随访结果显示, 衰弱人群组跌倒、髋骨骨折、住院以及死亡发生率均高于衰弱前期和无衰弱人群。随访至2015年, 研究人群经协变量校正后Logistic回归分析结果显示, 衰弱组比非衰弱组的跌倒风险(OR=1.738, 95%CI:1.292～2.338, P<0.001), 髋骨骨折风险(OR=2.672, 95%CI:1.365～5.233, P=0.004), 住院风险(OR=1.670, 95%CI:1.224～2.277, P=0.001), 死亡风险(OR=1.599,...     

老年人跌倒危险因素的Meta分析

目的 运用Meta分析探讨老年人跌倒的危险因素,为预防老年人跌倒提供循证依据。方法 计算机检索PubMed等数据库2018年1月1日至2023年1月1日发表的与老年人跌倒相关的文献。由2名研究者独自筛选文献、提取文献内容、采用NOS量表及AHRQ评价标准进行质量评价。提取数据采用RevMan5.4进行Meta分析。结果 本研究共纳入15篇文献,总样本量为26141例,涉及18个相关影响因素。Meta分析结果显示：既往跌倒史(OR=17.85,95%CI 4.83～66.02)、自评健康状况不佳(OR=3.18,95%CI 1.87～5.41;OR=1.36,95%CI 1.16～1.59)、姿势控制能力降低(OR=2.90,95%CI 1.49～5.65)、伴有跌倒相关慢性病(OR=2.77,95%CI 2.20～3.50)、骨质疏松(OR=2.70,95%CI 2.15～3.37)、静动态平衡能力降低(OR=2.65,95%CI 1.49～4.73)、饮酒(OR=2.16,95%CI 1.61～2.90)、害怕跌倒(OR=2.09,95%CI 1.33～3.27)、患关节炎(OR=2...     

秦皇岛市城市社区老年人跌倒的危险因素

目的探讨秦皇岛市城市社区老年人跌倒的发生情况及主要危险因素。方法用分层随机抽样的方法抽取居住在秦皇岛市城市社区的老年人1 600例,用自行设计的调查表,调查过去1年的跌倒和跌倒的相关因素。结果过去1年跌倒发生率为9.8%。多因素Logistic回归分析显示,既往跌倒史(OR=9.488,95%CI:6.544~13.757,P=0.000)、文盲或半文盲(OR=1.825,95%CI:1.034~3.221,P=0.038)和平衡能力差为跌倒独立危险因素。平衡能力受到较大削弱和平衡能力较差的老年人跌倒发生率分别是平衡能力很好老年人的1.950倍(95%CI:1.152~3.299,P=0.013)和3.167倍(95%CI:1.366~7.346,P=0.007)。结论秦皇岛市城市社区老年人跌倒发生率较高,可以采取针对危险因素的综合性措施预防老年人跌倒。     

老年人跌倒损伤发生现状及危险因素分析

目的 利用我国广西壮族自治区南宁市的跌倒老年人调查数据,描述社区年龄在60岁及以上的老年人跌倒损伤的流行特征,分析社区老年人跌倒损伤的风险因素,为预防老年人跌倒损伤提供理论依据。方法 选取广西南宁市作为调查单位。采用整群抽样的方法,调查对象是在广西南宁的社区中抽取年龄在60岁及以上的老年人,于2014年7月到2015年6月间通过问卷采集调查对象的个人信息、日常生活活动能力、老年人跌倒风险评分。最终得到有完整跌倒损伤信息的样本1188例。通过秩和检验及χ²检验初步分析各因素与跌倒损伤之间的关系,并通过Logistic回归方法进一步分析被调查人群跌倒损伤可能的风险因素。结果 跌倒损伤的发生率为33.9%,发生损伤人群与未发生损伤人群相比,有统计学意义的危险因素包括衰老、文化程度低、长期居住于城市、失能、使用助行器、饮酒、缺乏户外运动、运动持续时间低于1小时、运动频率减少。同时不同跌倒风险评估等级的人群之间跌倒损伤率的差异也具有统计学意义。将上述危险因素进行logistic回归分析,长期居住地为城市(OR=1.399,95%CI 1.127～1.736)、饮酒(OR=1...     

脑卒中患者康复期间跌倒的特点及危险因素分析

目的探讨脑卒中患者康复期间跌倒的特点及危险因素。方法对95例脑卒中患者康复期间根据是否跌倒分为跌倒组及非跌倒组,分析跌倒的特点,对可能影响卒中跌倒的危险因素进行多因素Logistic回归分析。结果 95例中跌倒者21例(22.1%)。首次跌倒时间:入院1个月14例(66.7%),1~2个月5例(23.8%),2个月~出院2例(9.5%)。白天跌倒14例(66.7%),夜间跌倒7例(33.3%)。跌倒地点:床边10例(47.6%),走廊7例(33.3%),卫生间4例(19.0%)。反复跌倒5例(23.8%)。严重程度:无异常2例(9.5%),软组织损伤16例(76.2%),骨折3例(14.3%)。跌倒组Barthel生活指数(BI)评分在入院及出院均低于非跌倒组(U=11.224、12.344,均P0.05)。单因素分析显示年龄、既往跌倒史、肢体偏瘫、意识障碍、谵妄、视力损害、感觉障碍、失用、单侧空间忽略、小便障碍、大便障碍、使用精神药物、独立行走、长谷川痴呆量表(HDS-R)评分下降以及住院时间长为跌倒的危险因素。多因素Logistic回归分析示既往跌倒史(OR=1.85,95%CI:1.26~2.81)、偏瘫(右侧OR=2.37,95%CI:1.62~4.59;左侧OR=2.47,95%CI:1.46~4.78)、视力损害(OR=2.31,95%CI:1.31~5.02)、感觉障碍(OR=2.38,95%CI:1.42~4.68)、单侧空间忽略(OR=3.44,95%CI:2.82~5.38)、使用精神药物(OR=1.36,95%CI:1.01~1.72)、独立行走(OR=1.36,95%CI:1.62~2.36)以及HDS-R评分低(OR=3.02,95%CI:1.08~7.47)为跌倒的独立危险因素。结论跌倒在脑卒中患者康复期间常见,既往跌倒史、偏瘫、视力损害、感觉障碍、单侧空间忽略、使用精神药物、独立行走以及HDS-R评分低为跌倒的独立危险因素。     

衰弱离退休老干部跌倒发生现状及影响因素

目的 探讨衰弱离退休老干部跌倒发生现状,明确跌倒发生的影响因素。方法 选取2019年2月至10月于中国人民解放军总医院第一医学中心住院的离退休老干部442名作为研究对象,根据过去12个月内是否发生跌倒将衰弱前期或衰弱老干部分为2组。比较2组老干部一般资料,身体功能情况。采用SPSS 22.0软件进行数据分析。根据数据类型,组间比较分别采用t检验、秩和检验及χ²检验。采用Fried衰弱量表进行衰弱筛查,采用logistic回归分析衰弱老干部跌倒发生的危险因素。结果 最终共纳入322例(72.0%)衰弱前期及衰弱离退休老干部为研究对象,年龄63～98(76.91±9.23)岁。跌倒组患者60例,未跌倒组262例。单因素方差分析结果显示:衰弱评分、年龄、体质量指数、情绪状态、简易身体功能测试得分、串联站立测试得分、起坐测试得分对老干部是否发生跌倒有显著影响(P<0.05);logistic回归分析结果显示:年龄(OR=1.043,95%CI 1.003~1.085)、体质量指数＜18.5kg/m²(OR=3.704,95%CI 1.024~13.391)为衰弱老干部跌倒发生的主要影响因素(P<0.05)。结论 衰弱离退休老干部跌倒发生率较高,应加强该类人群跌倒风险的评估与筛查,针对跌倒高风险人群,制定有效预防措施。     

高龄老年人体位性血压改变与动脉粥样硬化的相关性

目的探讨高龄老年人体位性血压变化与动脉粥样硬化的相关性。方法连续收集2014年6月~2015年12月在新疆医科大学第一附属医院住院的高龄老年人227例。按照体位性血压的改变分为正常组151例,体位性低血压组52例和体位性高血压组24例。所有入选者均进行四肢血流多普勒超声测定。比较3组体位性血压变化与肱踝脉搏波传导速度(baPWV)和踝臂指数(ABI)的关系。结果与正常组比较,体位性高血压组年龄明显增高[(83.93±2.99)岁vs(82.32±3.15)岁,P0.05],体位性低血压组跌倒评分明显增高[(57.40±17.92)分vs(49.37±17.25)分,P0.01];右侧ABI和左侧ABI明显降低(0.97±0.14 vs 1.18±0.09,P0.01;0.89±0.21vs 1.15±0.12,P0.01)。经多因素非条件logistic回归分析显示,ABI降低是发生体位性低血压的独立危险因素之一(OR=20.776,95%CI:7.449~57.947,P=0.000)。跌倒评分升高发生体位性低血压风险是正常人群的1.035倍(95%CI:1.013~1.057,P=0.002)。年龄是导致体位性高血压发生的独立危险因素之一(OR=1.169,95%CI:1.014~1.348,P=0.031)。结论 ABI降低是高龄老年人发生体位性低血压的独立危险因素之一。年龄是导致体位性高血压发生的独立危险因素之一。跌倒评分值可能预测体位性低血压的发生风险。     

深圳市罗湖区老年人发生认知功能障碍的饮食习惯影响因素分析

目的探讨深圳市罗湖区老年人发生认知功能障碍的饮食习惯影响因素。方法采用自制调查问卷对深圳市罗湖区60岁及以上老年人进行调查,根据简易智力状态评估量表(Mini-Cog)和简易精神状态检查量表(MMSE)筛选出249例认知功能障碍患者作为病例组。按照年龄±3岁、性别相同原则进行1∶1匹配对照组249例。收集两组对象的饮食习惯,运用多因素条件logistic回归分析导致老年人认知功能障碍的饮食习惯影响因素。结果单因素分析发现,大米、新鲜蔬菜、新鲜水果的食用频次和是否食用海水鱼等饮食习惯是老年人认知功能障碍的影响因素(P均<0.05)。logistic回归分析结果显示,每月进食新鲜蔬菜>60次(OR=0.639,95%CI:0.465~0.879)、30~60次(OR=0.598,95%CI:0.412~0.790)、食用海水鱼(OR=0.634,95%CI:0.418~0.960)是老年人认知功能障碍的保护因素。结论经常进食新鲜蔬菜(≥30次/月)和食用海水鱼的饮食习惯是深圳市老年人认知功能障碍的保护因素。     

老年胃癌患者术后化疗依从性危险因素观察

目的观察老年胃癌患者术后化疗依从性的影响因素。方法纳入2015年10月至2018年10月于我院收治的120例老年胃癌患者为研究对象,开展回顾性分析。统计患者一般资料,分析患者术后化疗依从情况,并采用多因素Logistic回归分析法分析老年胃癌患者术后化疗依从性的独立影响因素。结果 120例老年胃癌患者中,有48例患者依从性好,占40.00%; 72例患者依从性差,占60.00%。多因素Logistic回归分析显示,文化程度(OR=8.148,95%CI=1.280～51.854)、手术方式(OR=6.952,95%CI=0.831～58.173)、抑郁(OR=6.145,95%CI=1.109～34.041)、术后康复锻炼(OR=0.010,95%CI=0.001～0.078)、医疗支付方式(OR=12.586,95%CI=3.277～48.342)、家庭关系(OR=24.439,95%CI=3.173～188.222)是老年胃癌患者术后化疗依从性的独立影响因素(P0.05)。结论老年胃癌患者术后化疗依从性影响因素较多,包括手术方式、医疗支付方式等,临床上应引起足够重视。     

慢性乙型肝炎肝硬化患者并发肾功能衰竭的预测模型建立及研究

目的研究慢性乙肝肝硬化患者并发急性肾衰竭的危险因素。方法纳入2016年12月至2018年12月于我院收治的215例慢性乙肝肝硬化患者为对象,开展回顾性分析。统计患者一般资料,分析慢性乙肝肝硬化患者急性肾衰竭发生情况,并采用多因素Logistic回归分析法分析慢性乙肝肝硬化患者并发急性肾衰竭的独立影响因素。结果 215例慢性乙肝肝硬化患者中,有42例出现急性肾衰竭,占19.53%;173例未发生急性肾衰竭,占80.47%。多因素Logistic回归分析显示,肝硬化分期(OR=2.125,95%CI=1.273～3.546)、Child-Pugh分级(OR=5.238,95%CI=1.995～13.756)、肝性脑病(OR=3.347,95%CI=2.364～4.738)、血钠(OR=0.755,95%CI=0.615～0.927)、腹水(OR=3.570,95%CI=1.638～7.782)、总胆红素(OR=1.192,95%CI=1.016～1.398)、凝血酶原活动度(OR=0.918,95%CI=0.865～0.974)、血氨(OR=1.278,95%CI=1.238～1.319)是慢性乙肝肝硬化患者并发急性肾衰竭的独立影响因素(P0.05)。结论肝硬化失代偿期、Child-Pugh分级、肝性脑病、大量腹水、低钠血症、高胆红素血症、低血浆凝血酶原活动度、高血氨症可能是诱发慢性乙肝肝硬化患者并发急性肾衰竭的危险因素,临床需引起足够重视。     

老年综合征对老年患者非计划再入院的影响

目的了解住院老年共病患者非计划再入院的发生情况,探讨老年综合征对非计划再入院的影响。方法选取2015年1月至2017年12月于成都市第五人民医院老年病科住院的老年共病患者443例。通过老年综合评估筛查老年综合征,记录出院后2年内非计划再入院情况,并分析老年综合征对非计划再入院的影响。采用SPSS 24.0软件进行统计分析,多因素logistic回归分析筛选出独立的危险因素。结果在2年随访期内,199例(44.92%)患者存在非计划再入院。位于前5位的老年综合征分别为日常生活活动能力(ADL)依赖(n=269,60.72%)、营养不良风险(n=256,57.79%)、跌倒高风险(n=246,55.53%)、多重用药(n=237,53.50%)和衰弱(n=231,52.14%)。经多因素logistic回归对患者非计划再入院进行分析发现,营养不良(OR=1.522,95%CI 1.081~2.145;P=0.016)、跌倒高风险(OR=1.855,95%CI 1.219~2.825;P=0.004)、ADL受损(OR=1.649,95%CI 1.074~2.533;P=0.022)、多重用药(OR=1.597,95%CI 1.068~2.388;P=0.023)是影响患者2年内再入院的独立危险因素。结论老年共病患者非计划再入院率高,不同的老年综合征对再入院的时间及次数产生影响。     

养老机构老年人跌倒现状及影响因素分析

目的 探讨昆明市养老机构老年人跌倒现状,并分析其影响因素。方法 采用分层随机整群抽样法,选取昆明市6所养老机构223名老年人,采用自制问卷对老年人进行面对面问卷调查,调查内容包括一般人口社会学特征、生活行为方式、既往病史与用药史、心理状况和跌倒史,分析跌倒现状,单因素和多因素分析跌倒影响因素。结果 223名老年人跌倒发生率为36.8%。年龄70～74岁(OR=3.385)、年龄75～79岁(OR=3.059)、患有关节炎(OR=1.220)、长期服用镇静催眠药(OR=1.049)是老年男性发生跌倒的危险因素,经常参加体育锻炼(OR=2.085)是老年男性发生跌倒的保护性因素,长期服用止痛药(OR=1.446)是老年女性发生跌倒的危险因素。结论 养老机构老年人跌倒发生率较高,应全方面分析老年人情况,进行疾病管理和用药管理,同时鼓励其积极参与体育锻炼加强自身体质健康,从而预防跌倒。     

History and mobility exam index to identify community-dwelling elderly persons at risk of falling

BACKGROUND: Falls are common in community-dwelling elderly persons and are a frequent source of morbidity. Simple indices to prospectively stratify people into categories at different fall-risk would be useful to health care practitioners. Our goal was to develop a fall-risk index that discriminated between people at high and low risk of falling. METHODS: We evaluated the risk of falling over a one-year period in 557 elderly persons (mean age 81.6) living in a retirement community. On the baseline interview, we asked subjects if they had fallen in the previous year and evaluated risk factors in six additional conceptual categories. On the follow-up interview one year later, we again asked subjects if they had fallen in the prior year. We evaluated risk factors in the different conceptual categories and used logistic regression to determine the independent predictors of falling over a one-year period. We used these independent predictors to create a fall-risk index. We compared the ability of a prior falls history with other risk factors and with the combination of a falls history and other risk factors to discriminate fallers from nonfallers. RESULTS: A fall in the previous year (OR = 2.42, 95% CI = 1.49-3.93), a symptom of either balance difficulty or dizziness (OR = 1.83, 95% CI = 1.16-2.89), or an abnormal mobility exam (OR = 2.64, 95% CI = 1.64-4.26) were independent predictors of falling over the subsequent year. These three risk factors together (c statistic =.71) discriminated fallers from nonfallers better than previous history of falls alone (c statistic =.61) or the symptomatic and exam risk factors alone (c statistic =.68). When combined into a risk index, the three independent risk factors stratify people into groups whose risk for falling over the subsequent year ranges from 10% to 51%. CONCLUSION: A history of falling over the prior year, a risk factor that can be obtained from a clinical history (balance difficulty or dizziness), and a risk factor that can be obtained from a physical exam (mobility difficulty) stratify people into groups at low and high risk of falling over the subsequent year. This risk index may provide a simple method of assessing fall risk in community-dwelling elderly persons. However, it requires validation in other subjects before it can be recommended for widespread use.     

Risk factors for falls in older disabled women with diabetes: the women's health and aging study

BACKGROUND: The aim of this study was to determine whether older disabled women with diabetes have an increased risk of falls compared to women without diabetes and to identify fall risk factors among this high-risk subgroup of patients. METHODS: Data are from the Women's Health and Aging Study I (n = 1002, age > or = 65 years), a prospective, population-based cohort study of the one third most disabled women in the Baltimore (MD) urban community-dwelling population. Participants were followed semiannually for 3 years. Falls were ascertained at each interview. Diabetes was ascertained by means of a standardized algorithm using multiple sources of information. RESULTS: Baseline prevalence of diabetes was 15.5%. Of the 878 women who participated in at least one follow-up visit and were able to walk at baseline, 64.9% fell at least once during the study and 29.6% experienced two or more falls during a follow-up interval. After adjustment for traditional risk factors, women with diabetes had a higher probability of any fall (odds ratio [OR] 1.38; 95% confidence interval [CI], 1.04-1.81) and of falling two or more times during a follow-up interval (OR 1.69; CI, 1.18-2.43), compared with women without diabetes. Among diabetic women, presence of widespread musculoskeletal pain (OR 5.58; CI, 1.89-16.5), insulin therapy (OR 2.02; CI, 1.10-3.71), overweight (OR 3.50; CI, 1.21-10.1), and poor lower-extremity performance (OR 7.76; CI, 1.03-58.8) were independently associated with increased likelihood of recurrent falls, after adjusting for major risk factors. There were synergistic effects of diabetes and lower-extremity pain and also diabetes and body mass index levels on the risk of falling (p for interactions <.05). CONCLUSION: Even among disabled older women diabetes is associated with an increased risk of falling, independent of established fall risk factors. In this specific group of older women, pain, high body mass index, and poor lower-extremity performance are powerful predictors of falling.     

Agreement and predictive power of six fall risk assessment methods in community-dwelling older adults

A large number of fall risk assessment methods are available with a variety of performances for screening the risk of falling in older adults, but their agreement for assessing the risk of falling remains unknown. This observational prospective cohort study describes the agreement and predictive power of methods to classify the risk of falling in older adults using prospective data and published cut-off values. Fifty-two participants aged 74 years (interquartile range 69–80) were assessed using the Berg Balance Scale, polypharmacy, Falls Risk Assessment Score, Fall Risk Assessment Tool, Fall Efficiency Scale, and Posturography. Nine participants (17 %) reported at least one fall after six months. Cochran’s test showed different proportions of participants classified as at high risk of falling among all methods (Q = 69.560, p < 0.001). A slightly better-then-chance agreement was estimated between all FRA methods (Light’s κ = 0.074, 95%CI [0.021; 0.142]). We found both global and pairwise agreement levels that question the agreement among fall risk assessment methods for screening community-dwelling older adults.     

Consequences of falling in older men and women and risk factors for health service use and functional decline

OBJECTIVES: (1) to examine consequences of falls in older men and women and (2) to examine risk factors for health service use and functional decline among older fallers. METHODS: the study was performed within the Longitudinal Aging Study Amsterdam. In 1998/1999, potential risk factors were assessed during the third data collection. In 1999/2000, 204 community-dwelling persons (> or =65 years) who reported at least one fall in the year before the interview, were asked about consequences of their last fall, including physical injury, health service use, treatment and functional decline (i.e. decline in functional status, social and physical activities). RESULTS: as a consequence of falling, respondents reported physical injury (68.1%), major injury (5.9%), health service use (23.5%), treatment (17.2%), and decline in functional status (35.3%), and social (16.7%) and physical activities (15.2%). Using multivariate logistic regression, specific risk factors for health service use after falling could not be identified. Female gender (OR = 2.8, 95% CI = 1.5-5.1), higher medication use (OR = 1.5, 95% CI = 1.0-2.2) and depressive symptoms (OR = 1.9, 95% CI = 1.3-2.8) were independently associated with functional decline after falling. Depressive symptoms (OR = 2.0, 95% CI = 1.2-3.3) and falls inside (OR = 2.6, 95% CI = 1.1-6.5) were risk factors for decline in social activities, while female gender (OR = 2.7, 95% CI = 1.1-7.0) and depressive symptoms (OR = 1.9, 95% CI = 1.2-3.0) were risk factors for decline in physical activities after falling. CONCLUSIONS: almost 70% of the respondents suffered physical injury, almost one-quarter used health services and more than one-third suffered functional decline after falling. No risk factors were found for health service use needed after falling. Female gender, higher medication use, depressive symptoms and falls inside were risk factors for functional decline after falling.     

Risk of falls in 85-year-olds is associated with functional and cognitive status: the Octabaix Study

Falls are a source of morbidity and mortality in the oldest old. The purpose of this study was to describe the prevalence of falls among community-dwelling 85-year-olds and to study the factors associated with falling. A cross-sectional study, including geriatric assessment, was conducted within the framework of the Octabaix Study. Functional status was measured with Barthel Index (BI) and Lawton Index (LI), cognitive impairment was assessed with the Mini-Mental State Examination (MMSE), the Spanish version of which is called MEC, Comorbidity by Charlson Index (CCI), and data were gathered on nutritional risk, social risk, falls, and drugs. The fall prevalence among the 328 octogenarians studied was 28.4%. A bivariate analysis revealed an association with being female (p=0.017) and poorer functional status according to BI (p=0.027). Logistic analysis showed an association with female gender (OR=1.96; 95%CI=1.15-3.33; p=0.014), BI (OR=0.98; 95%CI=0.97-0.99; p=0.007) and MEC (OR=1.05; 95%CI=1.01-1.09; p=0.027). The prevalence of falls among 85-year-olds is high and similar to that described in those aged 65 or over. The analyses show that being female, a degree of disability and a good score on cognitive status were independent risk factors for falls among these community-dwelling.     

Preclinical disability as a risk factor for falls in community-dwelling older adults

BACKGROUND: Falls are common and serious problems in older adults. The goal of this study was to examine whether preclinical disability predicts incident falls in a European population of community-dwelling older adults. METHODS: Secondary data analysis was performed on a population-based longitudinal study of 1644 community-dwelling older adults living in London, U.K.; Hamburg, Germany; Solothurn, Switzerland. Data were collected at baseline and 1-year follow-up using a self-administered multidimensional health risk appraisal questionnaire, including validated questions on falls, mobility disability status (high function, preclinical disability, task difficulty), and demographic and health-related characteristics. Associations were evaluated using bivariate and multivariate logistic regression analyses. RESULTS: Overall incidence of falls was 24%, and increased by worsening mobility disability status: high function (17%), preclinical disability (32%), task difficulty (40%), test-of-trend p <.003. In multivariate analysis adjusting for other fall risk factors, preclinical disability (odds ratio [OR] = 1.7, 95% confidence interval [CI], 1.1-2.5), task difficulty (OR = 1.7, 95% CI, 1.1-2.6) and history of falls (OR = 4.7, 95% CI, 3.5-6.3) were the strongest significant predictors of falls. In stratified multivariate analyses, preclinical disability equally predicted falls in participants with (OR = 1.7, 95% CI, 1.0-3.0) and without history of falls (OR = 1.8, 95% CI, 1.1-3.0). CONCLUSIONS: This study provides longitudinal evidence that self-reported preclinical disability predicts incident falls at 1-year follow-up independent of other self-reported fall risk factors. Multidimensional geriatric assessment that includes preclinical disability may provide a unique early warning system as well as potential targets for intervention.     

The prevalence and impact of falls in elderly dialysis patients: Frail elderly Patient Outcomes on Dialysis (FEPOD) study

BackgroundAs the numbers of older patients on dialysis rise, geriatric problems such as falling become more prevalent. We aimed to assess the prevalence of falls and the impact on mortality and quality of life in frail elderly patients on assisted PD (aPD) and hemodialysis (HD) from the FEPOD Study.MethodsData on falls and quality of life were collected with questionnaires at baseline and every six months during 2-year follow-up. Multiple regression analysis was used to evaluate factors associated with falls. Additionally, we performed a review of literature concerning the relation between falls and poor outcome.ResultsBaseline fall data were available for 203 patients and follow-up data for 114 patients. Dialysis modality was equally distributed (49% HD and 51% aPD). Mean (SD) age was 75 ± 7 years. Fall rate was 1.00 falls/patient year, comparable in HD and aPD. Falls led to fear of falling, resulting in less activities in 68% vs 42% (p < 0.01) and leaving the house less in 59% vs 31% (p < 0.01) of patients. Patients with diabetes mellitus were twice as likely to report falls at baseline (OR 1.91 [95%CI 1.00–3.63], p = 0.05) and falls at baseline were associated with falls during follow-up (OR 2.53 [95%CI 1.06–6.04] p = 0.03). Literature revealed frailty was a strong risk factor for falling and falling results in a higher mortality and hospitalization rate.ConclusionFalls were frequent in older dialysis patients and have a negative impact on quality of life. Fall incidence is comparable between aPD and HD.     

Prevalence and risk factors for falls in an older community-dwelling population

BACKGROUND: Falls are responsible for considerable morbidity, immobility, and mortality among elderly people. The aim of this study was to determine the prevalence of falls and related intrinsic and extrinsic risk factors in a community-dwelling older population. METHODS: An observational study was performed on all patients (N = 5570) admitted from 1997 to 2001 to home care programs in 19 home health agencies that participated in the National Silver Network project in Italy. Patient evaluation was performed through the Minimum Data Set-Home Care (MDS-HC) instrument. RESULTS: A 35.9% falls prevalence was found within 90 days of the patient assessment through the MDS-HC instrument. After adjusting for all potential confounding factors, the logistic regression showed a high increase in risk of falling for those patients who wandered (odds ratio [OR] 2.38; 95% confidence interval [CI] 1.81-3.12) or suffered with gait problems (OR 2.13; 95% CI 1.81-2.51). Patients affected by depression were more likely to fall (OR 1.53; 95% CI 1.36-1.73). Those who lived in an unsafe place with environmental hazards had an increase in the risk of falling (OR 1.51; 95% CI 1.34-1.69). The associations of main risk factors for falls were also evaluated. CONCLUSIONS: Rate of falls among frail elderly people living in the community is very high and frequently correlates with potentially reversible factors. To identify those with higher falling risk, home care staff and general practitioners could use the MDS-HC assessment tool.