Falls in elderly people: a multifactorial analysis of risk markers using data from the Swedish general population study ‘Good Ageing in Skåne’

Background and aimsThe aim of this study was to describe the prevalence of falls in a general older population, especially among the most elderly, and the risk markers associated with falls.MethodsThis is a cross-sectional study in which 38 fall risk markers were analysed in non-, occasional- and frequent-fallers. The population was 2,865 individuals (aged 60–93), randomly selected from the general population register. The risk of falling was calculated as age-adjusted odds ratios. The relation between the number of risk markers for an individual and falls was also analysed.ResultsAbout one in ten reported falling during the past 6 months, 35 % of which were over 90 years old. Twenty-one risk markers were significantly related to falls confirming falling as a multifactorial problem. These included a variety of diseases, symptoms, medical and physical functions, life-style factors and the taking of certain drugs. The five risk markers with the highest odds ratio in frequent fallers were ‘tendency to fall’ (37.9), ‘low walking speed’ (12.8), consumption of ‘neuroleptics’ (10.9), ‘impaired mobility’ (10.0) and ‘dementia’ (5.4). Subjects with more than four and seven risk markers showed a 9- respectively 28-fold increase in the risk of falling, especially among frequent fallers and those aged over 90 years.ConclusionFalls are common in the elderly population and the risk is multifactorial. The results imply that there is an overrepresentation of fallers in a distinct subgroup of the very elderly and those with multiple risk markers. The self-perceived clinical sign ‘tendency to fall’ seems highly sensitive as indicator of individuals at risk. Several risk markers may be treatable. Fall risk seems to increase in a non-linear, almost exponential way with increasing number of risk markers.

[1]  Epidemiology, clinical significance, costs and fall prevention in elderly people. , 2008, Ortopedia, traumatologia, rehabilitacja.

[2]  L. Bouter,et al.  Falls in the elderly: a prospective study of risk factors and risk profiles. , 1996, American journal of epidemiology.

[3]  B. Bloem,et al.  Why old people fall (and how to stop them) , 2007, Practical Neurology.

[4]  Henry Brodaty,et al.  A Multifactorial Approach to Understanding Fall Risk in Older People , 2010, Journal of the American Geriatrics Society.

[5]  Karim M Khan,et al.  Meta-analysis of the impact of 9 medication classes on falls in elderly persons. , 2009, Archives of internal medicine.

[6]  K. Thorngren,et al.  Decrease in Physical Function after Fall-related Distal Forearm Fracture in Elderly Women , 2003 .

[7]  Sarah E Lamb,et al.  Systematic review of accuracy of screening instruments for predicting fall risk among independently living older adults. , 2008, Journal of rehabilitation research and development.

[8]  J. Eng,et al.  Falls in people with chronic obstructive pulmonary disease: an observational cohort study. , 2011, Respiratory medicine.

[9]  G. Fuller,et al.  Falls in the elderly. , 2000, American family physician.

[10]  Johan Berglund,et al.  A longitudinal study integrating population, care and social services data. The Swedish National study on Aging and Care (SNAC) , 2004, Aging clinical and experimental research.

[11]  S. Ivanoff,et al.  Restriction in social participation and lower life satisfaction among fractured in pain: results from the population study "Good Aging in Skåne". , 2008, Archives of gerontology and geriatrics.

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

[13]  Risk assessment for falls in the elderly population , 2007 .

[14]  E Glucksman,et al.  Falls in the elderly: what can be done? , 2000, The Medical journal of Australia.

[15]  M. Knight,et al.  Fall Risk in Patients with Acute Psychosis , 2010, Journal of nursing care quality.

[16]  Patrick Guinan,et al.  Who is My Patient? , 2006, The Linacre quarterly.

[17]  S. Folstein,et al.  "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. , 1975, Journal of psychiatric research.

[18]  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.

[19]  R. McClure,et al.  Healthy Aging as an Intervention to Minimize Injury from Falls among Older People , 2007, Annals of the New York Academy of Sciences.

[20]  Anne-Sophie Rigaud,et al.  Psychotropic Drugs and Falls in the Elderly People: Updated Literature Review and Meta-Analysis , 2011, Journal of aging and health.

[21]  P. Shekelle,et al.  Will my patient fall? , 2007, JAMA.

[22]  Nigel H. Lovell,et al.  Evaluation of functional deficits and falls risk in the elderly – methods for preventing falls , 2009, 2009 Annual International Conference of the IEEE Engineering in Medicine and Biology Society.

[23]  M. Tinetti,et al.  The patient who falls: "It's always a trade-off". , 2010, JAMA.

[24]  L. Nyberg,et al.  Why the elderly fall in residential care facilities, and suggested remedies. , 2004, The Journal of family practice.

[25]  Shobha S Rao Prevention of falls in older patients. , 2005, American family physician.

[26]  U. Sonn,et al.  Domestic activities and walking in the elderly: Evaluation from a 30- hour heart rate recording , 1990, Aging.