Risk factors for falling in community-dwelling older adults: Which of them are associated with the recurrence of falls?

BackgroundThe aim of the study was to determine which risk factors were associated with the recurrence of falls among community-dwelling older adults.MethodsBased on a cross-sectional design, 1066 community-dwelling volunteers aged 65 and older were recruited. The use of psychoactive drugs, the number of drugs taken per day, the basic mobility assessed with the Timed Up & Go test (TUG), the maximal isometric voluntary contraction strength of hand, the lower limb proprioception, the distance binocular vision, the fear of falling and the history of falls during the past year were recorded. Subjects were separated into 4 groups based on the number of falls: 0, 1, 2 and > 2 falls.ResultsAmong the 395 (37.1%) fallers, 291 (27.3%) were single fallers and 104 (9.8%) were recurrent fallers (i.e., > 2 falls). The numbers of falls increased significantly with age (Incident Rate Ratio (IRR)=1.03, p<0.001), female gender (IRR=1.95, p<0.001), institutionalization (IRR=1.66, p=0.002), number of drugs taken per day (IRR=1.05, p<0.001), use of psychoactive drugs (IRR=1.29, p=0.009), increased time of TUG Test (IRR=1.02, p<0.001), use of a walking aid (IRR=1.59, p=0.002), and fear of falling (IRR=3.08, p<0.001). In addition, a high score at the handgrip test (IRR=0.97, p<0.001) and distance binocular vision (IRR=0.92, p<0.001) were associated with a decreased number of falls. After adjustment for potential confounders, only female gender (IRR=1.44, p<0.001), vision (IRR=0.95, p=0.006) and lower limb proprioception (IRR=0.95, p=0.046), and fear of falling (IRR=2.68, p<0.001) were still significantly associated with the number of falls.ConclusionThe current study shows that female gender, poor vision and lower limb proprioception, and fear of falling were associated with the recurrence of falls.

[1]  S. Cummings,et al.  Forgetting Falls , 1988, Journal of the American Geriatrics Society.

[2]  M. Tinetti Clinical practice. Preventing falls in elderly persons. , 2003, The New England journal of medicine.

[3]  S. Cummings,et al.  Risk factors for injurious falls: a prospective study. , 1991, Journal of gerontology.

[4]  E. T. Hsiao,et al.  Common protective movements govern unexpected falls from standing height. , 1997, Journal of biomechanics.

[5]  Y-C Pai,et al.  Role of feedforward control of movement stability in reducing slip-related balance loss and falls among older adults. , 2003, Journal of neurophysiology.

[6]  L. Rubenstein Falls in older people: epidemiology, risk factors and strategies for prevention. , 2006, Age and ageing.

[7]  S. D. de Rooij,et al.  Fear of falling: measurement strategy, prevalence, risk factors and consequences among older persons. , 2008, Age and ageing.

[8]  Orthopaedic Surgeons Panel On Falls Prevention Guideline for the Prevention of Falls in Older Persons , 2001 .

[9]  Lex M Bouter,et al.  A Classification Tree for Predicting Recurrent Falling in Community‐Dwelling Older Persons , 2003, Journal of the American Geriatrics Society.

[10]  K. Covinsky,et al.  History and mobility exam index to identify community-dwelling elderly persons at risk of falling. , 2001, The journals of gerontology. Series A, Biological sciences and medical sciences.

[11]  R. Baumgartner,et al.  Fear of falling and restriction of mobility in elderly fallers. , 1997, Age and ageing.

[12]  H. Brodaty,et al.  The GPCOG: A New Screening Test for Dementia Designed for General Practice , 2002, Journal of the American Geriatrics Society.

[13]  C. Becker,et al.  Systematic review of definitions and methods of measuring falls in randomised controlled fall prevention trials. , 2006, Age and ageing.

[14]  S. Lord,et al.  Physiological Factors Associated with Falls in Older Community‐Dwelling Women , 1994, Journal of the American Geriatrics Society.

[15]  K Bandeen-Roche,et al.  Association of comorbidity with disability in older women: the Women's Health and Aging Study. , 1999, Journal of clinical epidemiology.

[16]  D. Oliver,et al.  Development and evaluation of evidence based risk assessment tool (STRATIFY) to predict which elderly inpatients will fall: case-control and cohort studies , 1997, BMJ.

[17]  L. Gillespie,et al.  Preventing falls in elderly people , 2004, BMJ : British Medical Journal.

[18]  M. Tinetti,et al.  Falls and Injuries in Frail and Vigorous Community Elderly Persons , 1991, Journal of the American Geriatrics Society.

[19]  Diane Podsiadlo,et al.  The Timed “Up & Go”: A Test of Basic Functional Mobility for Frail Elderly Persons , 1991, Journal of the American Geriatrics Society.

[20]  L. Lipsitz,et al.  Causes and correlates of recurrent falls in ambulatory frail elderly. , 1991, Journal of gerontology.

[21]  Bastiaan R. Bloem,et al.  An update on falls , 2003, Current opinion in neurology.

[22]  C. Goldsmith,et al.  Muscle Weakness and Falls in Older Adults: A Systematic Review and Meta‐Analysis , 2004, Journal of the American Geriatrics Society.