Incidence and predictors of falls in the chinese elderly.

INTRODUCTION This is the first prospective longitudinal study carried out in a Chinese elderly population with the objective of identifying the incidence and predictors of falls. MATERIALS AND METHODS This is a population-based cohort study in Hong Kong with 1517 ambulatory elderly Chinese recruited using a multi-stage sampling method. Baseline data on demographic, comorbid diseases, drugs, Activities of Daily Living (ADL) [Barthel Index and Lawton's Instrumental Activities of Daily Living (IADL)], Geriatric Depression Scale (GDS-15), cognitive assessment by the Abbreviated Mental Test (AMT), fear of falling, self-perceived mobility problem, hand grip strength, lower limb power, balance and gait tests were performed. Every subject was followed up for 1 year. RESULTS Four hundred and one falls occurred in 294 fallers (19.3%) over 1 year of follow-up. The prevalence of falls and recurrent falls were 19.3% and 4.75%, respectively. The incidences of falls (i.e., the fall events) were 220, 324 and 270 per 1000 person-years for men, women and both gender, respectively. The independent predictors of falls were previous history of falls, advancing age, Parkinson's disease, knee extension power and gait speed. The independent predictors of recurrent falls were previous history of falls, self-perceived mobility problem, the knee extension strength and the Total Mobility Score of the Tinetti Balance and Gait Evaluation. CONCLUSIONS The incidence of falls in the Chinese elderly was 270 per 1000 person-years. History of falls, old age, Parkinson's disease, decreased lower limb power and impairment in balance and gait function were important independent predictors of falls or recurrent falls in the Chinese elderly. Effective fall prevention programmes targeted at improving these risk factors for falls should be developed for the Chinese elderly in Hong Kong and Asia.

[1]  Steven L Wolf,et al.  Selected As the Best Paper in the 1990s: Reducing Frailty and Falls in Older Persons: An Investigation of Tai Chi and Computerized Balance Training , 2003, Journal of the American Geriatrics Society.

[2]  S. Lo,et al.  A comparison of four functional tests in discriminating fallers from non-fallers in older people , 2003, Disability and rehabilitation.

[3]  B. Bégaud,et al.  Benzodiazepines and hip fractures in elderly people: case-control study , 2001, BMJ : British Medical Journal.

[4]  R M Pickering,et al.  A community-dwelling sample of people with Parkinson's disease: characteristics of fallers and non-fallers. , 2001, Age and ageing.

[5]  M. Tinetti,et al.  Drugs and Falls in Older People: A Systematic Review and Meta‐analysis: I. Psychotropic Drugs , 1999, Journal of the American Geriatrics Society.

[6]  L. Chu,et al.  Risk factors for falls in hospitalized older medical patients. , 1999, The journals of gerontology. Series A, Biological sciences and medical sciences.

[7]  Teresa To,et al.  Use of selective serotonin-reuptake inhibitors or tricyclic antidepressants and risk of hip fractures in elderly people , 1998, The Lancet.

[8]  A. Campbell,et al.  Randomised controlled trial of a general practice programme of home based exercise to prevent falls in elderly women , 1997, BMJ.

[9]  E H Wagner,et al.  The effect of strength and endurance training on gait, balance, fall risk, and health services use in community-living older adults. , 1997, The journals of gerontology. Series A, Biological sciences and medical sciences.

[10]  S. Ho,et al.  Risk factors for falls in the Chinese elderly population. , 1996, The journals of gerontology. Series A, Biological sciences and medical sciences.

[11]  Lester M. Wolfson,et al.  Balance and Strength Training in Older Adults: Intervention Gains and Tai Chi Maintenance , 1996, Journal of the American Geriatrics Society.

[12]  C. Pei,et al.  Validation of the Abbreviated Mental Test (Hong Kong version) in the elderly medical patient , 1995 .

[13]  D. Kiel,et al.  Falls , 1994, Neurology.

[14]  M. Tinetti,et al.  A multifactorial intervention to reduce the risk of falling among elderly people living in the community. , 1994, The New England journal of medicine.

[15]  S. Kivelä,et al.  Incidence rate of falls in an aged population in northern Finland. , 1994, Journal of clinical epidemiology.

[16]  D. C. Kennie Preventive Care for Elderly People , 1993 .

[17]  M. Tinetti,et al.  Development of the Common Data Base for the FICSIT Trials , 1993, Journal of the American Geriatrics Society.

[18]  H. Graham,et al.  Home accidents in older people: role of primary health care team. , 1992, BMJ.

[19]  N. Vetter,et al.  Can health visitors prevent fractures in elderly people? , 1992, BMJ.

[20]  J. Downton,et al.  Prevalence, characteristics and factors associated with falls among the elderly living at home , 1991, Aging.

[21]  J P Miller,et al.  Falls in the Elderly: Reliability of a Classification System , 1991, Journal of the American Geriatrics Society.

[22]  Vincent Mor,et al.  Multiple Stumbles: A Risk Factor for Falls in Community‐Dwelling Elderly; A Prospective Study , 1990, Journal of the American Geriatrics Society.

[23]  L. Lipsitz,et al.  High-intensity strength training in nonagenarians. Effects on skeletal muscle. , 1990, JAMA.

[24]  A. Campbell,et al.  Risk factors for falls in a community-based prospective study of people 70 years and older. , 1989, Journal of gerontology.

[25]  L. Rubenstein,et al.  Predictors of falls among elderly people. Results of two population-based studies. , 1989, Archives of internal medicine.

[26]  S. Cummings,et al.  Risk factors for recurrent nonsyncopal falls. A prospective study. , 1989, JAMA.

[27]  M. Tinetti,et al.  Risk factors for falls among elderly persons living in the community. , 1988, The New England journal of medicine.

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

[29]  M. Tinetti,et al.  Identifying mobility dysfunctions in elderly patients. Standard neuromuscular examination or direct assessment? , 1988, JAMA.

[30]  S. Ebrahim,et al.  Falls by elderly people at home: prevalence and associated factors. , 1988, Age and ageing.

[31]  Jennifer L. Kelsey,et al.  Methods in Observational Epidemiology , 1986 .

[32]  M. Tinetti,et al.  Fall risk index for elderly patients based on number of chronic disabilities. , 1986, The American journal of medicine.

[33]  M. Tinetti Performance‐Oriented Assessment of Mobility Problems in Elderly Patients , 1986, Journal of the American Geriatrics Society.

[34]  U. Nayak,et al.  Falls in the healthy elderly: predisposing causes. , 1985, Ergonomics.

[35]  Perry Bc Falls among the elderly living in high-rise apartments. , 1982 .

[36]  B. C. Perry Falls among the elderly living in high-rise apartments. , 1982, The Journal of family practice.

[37]  C. Gryfe,et al.  A longitudinal study of falls in an elderly population: I. Incidence and morbidity. , 1977, Age and ageing.