Abstract
Our purpose was to identify risk factors for falls among older adults who had recently undergone hip fracture surgery. The subjects in this study were 69 older adults (aged 65 years or more) who had sustained a hip fracture and were admitted to an orthopedic rehabilitation ward after surgery. Potential fall risk factors were assessed using the physiological profile assessment, timed-up-and-go test, berg balance test, and activities-specific balance confidence scale at discharge from the hospital. Each individual was followed for a period of 6 months to obtain information on the incidence of falls. Receiver operating characteristic curves were constructed to determine the optimal cutoff score for each potential risk factor identified. Multivariate logistic regression was then used to identify the significant predictors of falls and their odds ratios (ORs). During the 6-month follow-up period, 10 of the 69 patients experienced one or more falls. The results showed that fallers were older than nonfallers (p = 0.009). Fallers also had poorer performance in the high-contrast visual acuity test (p = 0.015) and lower knee flexor (p = 0.021) and knee extensor (p = 0.005) muscle strength values. Multivariate logistic regression analysis showed that high-contrast visual acuity (cutoff score Z = −2.280, OR = 6.14, 95 % CI 1.13–33.29, p = 0.035) and knee extensor muscle strength (cutoff score Z = −1.835, OR = 4.81, 95 % CI 1.04−22.33, p = 0.045) were predictors of falls. Poor visual acuity and knee muscle weakness are modifiable predictors of falls and should be the key target areas in fall-prevention programs for older adults with hip fractures.
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References
Kanis JA, Johnell O (2005) Requirements for DXA for the management of osteoporosis in Europe. Osteoporos Int 16:229–238
Kanis JA, Johnell O, Oden A, Sembo I, Redlund-Johnell I, Dawson A, De Laet C, Jonsson B (2000) Long-term risk of osteoporotic fracture in Malmo. Osteoporos Int 11:669–674
Kanis JA, Oden A, Johnell O, De Laet C, Jonsson B, Oglesby AK (2003) The components of excess mortality after hip fracture. Bone 32:468–473
Johnell O, Kanis JA (2006) An estimate of the world-wide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 17:1726–1733
Cummings SR, Melton LJ (2002) Epidemiology and outcomes of osteoporotic fractures. Lancet 359:1677–1761
Weatherall M (1994) One year follow-up of patients with fracture of proximal femur. N Z Med J 107:308–309
Jette A, Harris B, Clearly P (1987) Functional recovery after hip fracture. Arch Phys Med Rehabil 68:735–740
Norton R, Campbell AJ, Lee-Joe T, Robinson E, Butler M (1997) Circumstances of falls resulting in hip fractures among older people. J Am Geriatr Soc 45:1108–1112
Pearse EO, Redfern DJ, Sinha M, Edge AJ (2003) Outcome following a second hip fracture. Injury 34:518–521
Colon-Emeric C, Kuchibhatla M, Pieper C (2003) The contribution of hip fracture to risk of subsequent fractures: data from two longitudinal studies. Osteoporos Int 14:879–882
Stenvall M, Elinge E, von Heideken Wågert P, Lundström M, Gustafson Y, Nyberg L (2005) Having had a hip fracture-association with dependency among the oldest old. Age Ageing 34:294–297
Van Helden S, Cals J, Kessels F, Brink P, Dinant GJ, Geusens O (2006) Risk of new clinical fractures within 2 years following a fracture. Osteoporos Int 17:348–354
Ip D, Ip FK (2006) Elderly patients with two episodes of fragility hip fractures form a special subgroup. J Orthop Surg 14:245–248
Van Helden S, Wyers CE, Dagnelie PC, Van Dongen MC, Willems G, Brink PRG, Geusens PP (2007) Risk of falling in patients with a recent fracture. BMC Musculoskelet Disord 8:55
Kristensen MT, Foss NB, Kehlet H (2007) Timed up and go test as a predictor of falls within 6 months after hip fracture surgery. Phys Ther 87:24–30
Stewart A, Walker LG, Porter RW, Reid DM, Primrose WR (1999) Predicting a second hip fracture. J Clin Desitom 2:363–370
Lord SR, Menz HB, Tiedemann A (2003) A physiological profile approach to falls risk assessment and prevention. Phys Ther 83:237–251
Podsiadlo D, Richardson S (1991) The Timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 39:142–148
Nordin E, Rosendahl E, Lundin-Olsson L (2006) Timed “Up & Go” test: reliability in older people dependent in activities of daily living: focus on cognitive state. Phys Ther 86:646–655
Berg KO, Maki BE, Williams JI, Holliday PJ, Wood-Dauphinee SL (1992) Clinical and laboratory measures of postural balance in an elderly population. Arch Phys Med Rehabil 73:1073–1080
Berg K, Wood-Dauphinee S, Williams JI (1995) The balance scale: reliability assessment with elderly residents and patients with an acute stroke. Scand J Rehabil Med 27:27–36
Mak MK, Lau AL, Law FS, Cheung CC, Wong IS (2007) Validation of the Chinese translated activities-specific balance confidence scale. Arch Phys Med Rehabil 88:496–503
Van Marwijk HW, Wallace P, De Bock GH, Hermans J, Kaptein AA, Mulder JD (1995) Evaluation of the feasibility, reliability and diagnostic value of shortened version of the geriatric depression scale. Br J Gen Pract 45:195–199
Jitapunkul S, Pillay I, Ebrahim S (1991) The abbreviated mental test: its use and validity. Age Ageing 20:332–336
Tinetti ME, Speechley M, Ginter SF (1988) Risk factors for falls among elderly persons living in the community. N Engl J Med 319:1701–1707
Nevitt MC, Cummings SR, Kidd S, Black D (1989) Risk factors for recurrent nonsyncopal falls. JAMA 261:2663–2668
Delbaere K, Noortgate NVD, Bourgois J, Vanderstaeten G, Tine W, Cambier D (2006) The physical performance test as a predictor of frequent fallers: a prospective community-based cohort study. Clin Rehabil 20:83–90
Ko SU, Stenholm S, Metter EJ, Ferrucci L (2012) Age-associated gait patterns and the role of lower extremity strength—results from the Baltimore Longitudinal Study of Aging. Arch Gerontol Geriatr 55:474–479
Manty M, de Leon CF, Rantanen T, Era P, Pedersen AN, Ekmann A, Schroll M, Avlund K (2012) Mobility-related fatigue, walking speed and muscle strength in older people. J Gerontol A Biol Sci Med Sci 67:523–529
Suzuki M, Kirimoto H, Inamura A, Yagi M, Omori Y, Yamada S (2012) The relationship between knee extension strength and lower extremity functions in nursing home residents with dementia. Disabil Rehabil 34:202–209
Liu-Ambrose T, Khan K, Eng JJ, Janssen PA, Lord SR, McKay HA (2004) Both resistance and agility training reduce fall risk in 75- to 85-year old women with low bone mass: a six-month randomized controlled trial. J Am Geriatr Soc 52:657–665
Province MA, Hadley EC, Hornbrook MC, Lipsitz LA, Miller JP, Mulrow CD, Ory MG, Sattin RW, Tinetti ME, Wolf SL (1995) The effects of exercise on falls in elderly patients. A preplanned meta-analysis of the FICSIT trials. Frailty and injuries: cooperative studies of intervention techniques. JAMA 273:1341–1347
Sylliaas H, Brovold T, Wyller TB, Bergland A (2012) Prolonged strength training in older patients after hip fracture: a randomized controlled trial. Age Ageing 41:206–212
Lord SR, Ward JA (1994) Age-associated differences in sensorimotor function and balance in community dwelling women. Age Ageing 23:452–460
Lord SR, Rogers MW, Howland A, Fitzpatrick R (1999) Lateral stability, sensorimotor function and falls I older people. J Am Geriatr Soc 47:1077–1081
Maki BE, Holliday PJ, Topper AK (1994) A prospective study of postural control and risk of falling in an ambulatory and independent elderly population. J Gerontol Med Sci 49:M72–M84
Ivers RQ, Cumming RG, Mitchell P, Attebo K (1998) Visual impairment and falls in older adults: the Blue Mountains eye study. J Am Geriatr Soc 46:58–64
Klein BEK, Moss SE, Klein R, Lee KE, Cruikshanks KJ (2003) Associations of visual function with physical with physical outcomes and limitations 5 years later in an older population. The Beaver Dame eye study. Ophthalmology 110:644–650
Tinetti ME, Williams TF, Mayewski R (1986) Fall risk index for elderly patients based on number of chronic disabilities. Am J Med 80:429–434
Cummings SR, Nevitt MC, Browner W, Stone K, Fox KM, Ensrud KE, Cauley J, Black D, Vogt TM (1995) Risk factors for hip fracture in white women: study of Osteoporosis Fractures Research Group. N Engl J Med 332:767–773
Cumming RG, Ivers R, Clemson L, Cullen J, Hayes MF, Tanzer M, Mitchell P (2007) Improving vision to prevent falls in frail older people: a randomized trial. J Am Geriatr Soc 55:175–181
Lord SR, Dayhew J, Howland A (2002) Multifocal glasses impair edge-contrast sensitivity and depth perception and increase the risk of falls in older people. J Am Geriatr Soc 50:1760–1766
Lord SR, Smith ST, Menant JC (2012) Vision and falls in older people: risk factors and intervention strategies. Clin Geriatr Med 26:569–581
Desapriya E, Subzwari S, Scime-Beltrano G, Samayawardhena LA, Pike I (2010) Vision improvement and reduction in falls after expedited cataract surgery: systematic review and meta-analysis. J Cataract Refract Surg 36:13–19
Ringe JD (2012) The effects of vitamin D on falls and fractures. Scand J Clin Lab Invest Suppl 243:73–78
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Yau, D.T.Y., Chung, R.C.K. & Pang, M.Y.C. Knee Muscle Strength and Visual Acuity are the Most Important Modifiable Predictors of Falls in Patients after Hip Fracture Surgery: A Prospective Study. Calcif Tissue Int 92, 287–295 (2013). https://doi.org/10.1007/s00223-012-9681-7
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DOI: https://doi.org/10.1007/s00223-012-9681-7