Development of a fall-risk assessment profile for community-dwelling older adults by using the National Health Interview Survey in Taiwan

Abstract

Background: Falls represent a global health issue among older adults and cause a considerable burden on medical systems. In this study, a fall-risk assessment profile was developed for community-dwelling older adults. Method: The data of survey participants aged > 65 years were obtained from three rounds (2005, 2009, and 2013) of the National Health Interview Survey in Taiwan. In total, 8356 older participants were included in this study. Logistic regression analyses were used to determine potential predictors associated with falls. The regression coefficients of the predictors in the final model were translated into scores (by multiplying by 5) and then summed to obtain a total risk-score for falls. A receiver operating characteristic (ROC) curve was used to evaluate the discriminative performance of the risk assessment profile. Result: Self-reported falls within 1 year accounted for 19.1% of the total falls. The predictors that were included in the risk profile according to the logistic regression analysis results were as follows: female sex (adjusted odds ratio = 1.57; risk-score = 2), living alone (adjusted odds ratio = 1.56; risk-score = 2), urinary incontinence (adjusted odds ratio = 1.36; risk-score = 2), perceived unhealthiness (adjusted odds ratio = 1.32; risk-score = 1), perceived pain (adjusted odds ratio = 1.51; risk-score = 2), hospital admission in the past year (adjusted odds ratio = 2.42; riskscore = 4), low activity of daily living (ADL) scores (adjusted odds ratio = 1.29; risk-score = 1), and low mobility function scores (adjusted odds ratio = 1.68; risk-score = 3). At a total risk-score cutoff point of 6 (range 0-17), the model predicted falls with a sensitivity and specificity of 75.16 and 52.75%, respectively (area under the ROC curve = 0.70). Conclusion: The fall-risk assessment profile comprising eight predictors-female sex, living alone, incontinence, perceived unhealthiness, perceived pain, hospital admission in the past year, low ADL scores, and low mobility function scores-may serve as an assessment tool for identification of older adults with a high risk of falling, and assessment results can be used to facilitate community-based intervention.

Prevalence and factors associated with falls among older persons in Malaysia

“…28 In addition, previous studies suggest that those with impaired ADLs may lack confidence and have paradoxical experience of falls due to increased fear of falling. 8 The ADLs implied in this study were basic activities, which included mobility and selfcare difficulties. Our study found no association between IADL and falls as IADLs imply more complex activities related to independent living in the community such as managing finances and abilities to take medications.…”

“…International studies have suggested a prevalence of falls of nearly 30% among older populations 10–12 . As for Asian countries, previous reports from Japan, 13 Taiwan 8 and Thailand 7 suggested a prevalence of falls 15.8%, 17.0% and 26.1% among their older populations respectively. Previous studies conducted in Malaysia have reported prevalence of 4.07%–32.8%.…”

“…1 Risk factors of falls that have been identified include gender, age, education, living situation, history of falling, fear of falling, various health conditions including muscle weakness, joint paints, vertigo, diabetes mellitus, hypertension, cancer, arthritis, osteoporosis, psychiatric disorders, urinary incontinence, poor self-rated health, higher body mass index, lower handgrip strength, visual disorders, gait and balance impairments. [4][5][6][7][8] Difficulties in performing activities of daily living (ADL) and instrumental ADL (IADL) were also identified as possible risk factors for falling accidents among older persons. [6][7][8][9] Medication use is also associated with an increased risk of falls among older persons.…”

“…[4][5][6][7][8] Difficulties in performing activities of daily living (ADL) and instrumental ADL (IADL) were also identified as possible risk factors for falling accidents among older persons. [6][7][8][9] Medication use is also associated with an increased risk of falls among older persons. 7 International studies have suggested a prevalence of falls of nearly 30% among older populations.…”

“…As falls may be attributed to physical, sensory and cognitive changes associated with aging, in combination with environments that are not adapted for an aging population, the burden of falls is also expected to increase with population aging 1 . Risk factors of falls that have been identified include gender, age, education, living situation, history of falling, fear of falling, various health conditions including muscle weakness, joint paints, vertigo, diabetes mellitus, hypertension, cancer, arthritis, osteoporosis, psychiatric disorders, urinary incontinence, poor self‐rated health, higher body mass index, lower handgrip strength, visual disorders, gait and balance impairments 4–8 . Difficulties in performing activities of daily living (ADL) and instrumental ADL (IADL) were also identified as possible risk factors for falling accidents among older persons 6–9 .…”