Living alone as a red flag sign of falls among older people in rural Taiwan

Abstract

a b s t r a c tBackground/Purpose: Fall is a common geriatric syndrome and is associated with physical injuries, fear of falling, limitation of activities of daily living, and increased medical expenditure. Although risk factors of falls have been explored extensively, little is known about the impact of solitary living on falls in the elderly. The main purpose of this study was to evaluate the impact of solitary living on risk of fall among older people who visited the outpatient geriatric services in rural Taiwan. Methods: From September 2009 to August 2010, all patients who visited the primary careebased outpatient geriatric services were invited for study. For all participants, comprehensive geriatric assessment was performed by a well-trained research nurse. Common risk factors of falls were collected in addition to solitary living, such as polypharmacy (more than four drugs), visual impairment, hearing impairment, age, gender, and cognitive impairment. Results: Overall, 173 (mean age ¼ 78.8 AE 6.8 years, men ¼ 73.4%) patients were enrolled, and 42 (24.2%) of them reported falls in the past year. Two-thirds of fall events occurred outdoors and mainly (66.7%) during walking. Two-thirds of falls were associated with injuries, and half of the patients reported reduced activities of daily living because of fear of falling. Compared with nonfallers, fallers were significantly more likely to live alone (28.6% vs. 14%, p ¼ 0.031), but age (79.0 AE 7.2 years vs. 78.8 AE 6.8 years, p ¼ 0.89); gender (66.7% vs. 76.7%, p ¼ 0.197); polypharmacy (47.6% vs. 39.8%, p ¼ 0.378); use of psycotropic agents (4.8% vs. 0.8%, p ¼ 0.096); visual impairment (35.7% vs. 35.7%, p ¼ 0.995); hearing impairment (21.4% vs. 23.4%, p ¼ 0.79); and cognitive impairment (21.4% vs. 12.5%, p ¼ 0.158) were not statistically significant. Conclusions: In rural Taiwan, solitary living is an important risk factor of falls among patients who visited primary careebased outpatient geriatric services. Further prospective study is needed to evaluate the impact of solitary living on risk of falls, and improvement of outdoor environment is also of great importance to reduce fall-related injuries.

Self‐Reported Hearing Loss and Nonfatal Fall‐Related Injury in a Nationally Representative Sample

“…Compared to pure‐tone audiometry, the gold standard for hearing loss assessment, self‐reported hearing loss has a sensitivity of 65%, a specificity of 85%, and a positive predictive value of 28% for bilateral hearing loss in a US‐representative sample . Neither audiometry nor self‐report has been more consistently associated with falls or fall‐related injury in the past . However, the self‐reported hearing‐loss measure we used herein has been associated with injuries in previous studies, and more strongly associated with self‐reported injury than pure‐tone audiometry in at least one study .…”

“…The NHIS sample is large, and because our analyses were weighted to reflect the age, sex, and race/ethnicity distribution of the 2010 Census, the association we observed between self‐reported hearing status and fall should be generalizable to the noninstitutionalized adult population of the United States. The 2016 NHIS included a supplemental section on dizziness and balance problems, permitting us to adjust for vestibular function, a major confounder that has not been consistently addressed in prior studies . While the subjectivity and nonspecificity of dizziness symptoms (eg, “a floating, spacey, or disconnected sensation”) can result in unreliable measurement of vestibular function in studies relying on self‐report, our definition of vestibular vertigo has a specificity of 94% and a sensitivity of 84% for clinically diagnosed vestibular vertigo and has been previously applied in several population‐based studies …”

“…Previous investigations were done in relatively homogeneous study populations, including female twins, retired industrial workers with occupational hearing loss, and rural outpatients, which limits their generalizability . This limitation was addressed in several large studies in the United States, Poland, and Australia, by using population‐based sampling methods, but their results are still not widely generalizable since their samples remained largely white .…”

“…Many, but not all, previous studies reported age‐adjusted estimates of the association between hearing loss and falls . Where both crude and adjusted estimates were also reported, age and sex adjustment significantly impacted the estimate .…”

“…Prior work suggests that hearing loss may be a risk factor for fall‐related injuries among older adults . But this observed association is controversial due to concern about uncontrolled confounding by concomitant vestibular dysfunction .…”