A risk profile for identifying community-dwelling elderly with a high risk of recurrent falling: results of a 3-year prospective study

Abstract

Introduction: The aim of the prospective study reported here was to develop a risk profile that can be used to identify community-dwelling elderly at a high risk of recurrent falling. Materials and methods: The study was designed as a 3-year prospective cohort study. A total of 1365 community-dwelling persons, aged 65 years and older, of the population-based Longitudinal Aging Study Amsterdam participated in the study. During an interview in 1995/1996, physical, cognitive, emotional and social aspects of functioning were assessed. A follow-up on the number of falls and fractures was conducted during a 3-year period using fall calendars that participants filled out weekly. Recurrent fallers were identified as those who fell at least twice within a 6-month period during the 3-year follow-up. Results: The incidence of recurrent falls at the 3-year follow-up point was 24.9% in women and 24.4% in men. Of the respondents, 5.5% reported a total of 87 fractures that resulted from a fall, including 20 hip fractures, 21 wrist fractures and seven humerus fractures. Recurrent fallers were more prone to have a fall-related fracture than those who were not defined as recurrent fallers (11.9% vs. 3.4%; OR: 3.8; 95% CI: 2.3-6.1). Backward logistic regression analysis identified the following predictors in the risk profile for recurrent falling: two or more previous falls, dizziness, functional limitations, weak grip strength, low body weight, fear of falling, the presence of dogs/cats in the household, a high educational level, drinking 18 or more alcoholic consumptions per week and two interaction terms (high education×18 or more alcohol consumptions per week and two or more previous falls × fear of falling) (AUC=0.71). Discussion: At a cut-off point of 5 on the total risk score (range 0-30), the model predicted recurrent falling with a sensitivity of 59% and a specificity of 71%. At a cut-off point of 10, the sensitivity and specificity were 31% and 92%, respectively. A risk profile including nine predictors that can easily be assessed seems to be a useful tool for the identification of community-dwelling elderly with a high risk of recurrent falling.

Risk factors for recurrent falls among Brazilian women and men: the Brazilian Osteoporosis Study (BRAZOS)

“…A number of studies have also found a higher prevalence of falls among women 1,2,8,9,13 . However, the Longitudinal Ageing Study Amsterdam (LASA) found a similar frequency between men and women (24.4% and 24.9%, respectively) 12 .…”

“…In general, the main risk factors associated with recurrent falls are female gender, advanced age, low weight, previous falls and fractures, current use of psychotropic medication, muscle weakness, reduced gait speed, functional disability, sedentary lifestyle, fear of falling, cognitive deterioration, presence of hazards in the home, alcoholic beverage intake and diverse illnesses, such as diabetes mellitus, arthritis, depression, urinary incontinence, Parkinson's disease, dizziness and stroke 12 . Table 2 Clinical risk factors for recurrent falls in the Brazilian population according to recurrent falls in the previous year.…”

“…Traditionally, depression, osteoarthritis, postural hypotension, dizziness, urinary incontinence and dementia are associated with a greater risk of falls 1,3,6,12 . In the BRAZOS study, the only illness related to a greater risk of falls and fractures in men and women was diabetes mellitus, which has also been demonstrated in other studies 3,21,22 .…”

“…Moreover, the history and circumstances of falls in the previous year, as well as aspects related directly to falls, such as household hazards (carpets, handrails, type of floor, furniture, pets, lighting), the use of gait assistance devices, type of shoes and functional tests (ability to stand up from a chair without using the arms; vision and hearing acuteness) were also investigated. Fear of falling was assessed using a visual analogue scale (0-100mm), with 0 representing no fear and 100 representing extreme fear; values over 40 were considered significant and as having an impact on the activities of daily living 12 .…”

“…Having had more than two falls in the previous year was defined as recurrent falling and considered the dependent variable for the logistic regression analysis 3,6,12 . Low-impact fracture was defined as that stemming from a fall from an individual's own height or less after 50 years of age.…”