A risk profile for identifying community-dwelling elderly with a high risk of recurrent falling: results of a 3-year prospective study
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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.
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).
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.
KeywordsAccidental falls Aged Cohort study Community-dwelling Fractures Risk assessment
We thank Jan Poppelaars for his help in data management and processing the data, Els Lommerse, Sylvia Witteveen and Mohammad Asad Abdullah for collecting the data. With respect to funding: this study is based on data collected in the context of the Longitudinal Aging Study Amsterdam (LASA), which is largely funded by the Ministry of Health, Welfare, and Sports of the Netherlands. This study was also partly funded by the Praeventiefonds, The Hague, the Netherlands (grant no. 28-25510). P. Lips received a research grant from Eli Lilly and Co. and from Merck and Co. and has been a consultant for Merck and Co and Organon. There is no conflict of interest in connection with this paper.
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