A risk profile for identifying community-dwelling elderly with a high risk of recurrent falling: results of a 3-year prospective study
- 1.5k Downloads
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.
- 4.Murray CJL, Lopez AD (1996) Global and regional descriptive epidemiology of disability: incidence, prevalence, health expectancies and years lived with disability. In: Murray CJL, Lopez AD (eds) The global burden of disease. Harvard University Press, Boston, pp 201–246Google Scholar
- 9.Allfram PA (1964) An epidemiologic study of cervical and trochanteric fractures of the femur in an urban population. Acta Orthop Scand 65(Suppl):1–109Google Scholar
- 13.Gillespie LD, Gillespie WJ, Robertson MC, Lamb SE, Cumming RG, Rowe BH (2003) Interventions for preventing falls in elderly people (Cochrane Review) 4:CD000340Google Scholar
- 20.Deeg DJH, Knipscheer CPM, van Tilburg W (eds) (1993) Autonomy and well-being in the aging population: concepts and design of the Longitudinal Aging Study Amsterdam. Netherlands Institute of Gerontology, Bunnik, The NetherlandsGoogle Scholar
- 21.Smit JH, de Vries MZ Procedures and results of the field work. In: Deeg DJH, Westendorp-de Serriere M (eds) Autonomy and well-being in the aging population, I: report from the Longitudinal Aging Study Amsterdam 1992–1993. VU University Press, Amsterdam, pp 7–13Google Scholar
- 22.Smit JH, de Vries MZ, Poppelaars JL (1998) Data-collection and fieldwork procedures. In: Deeg DJH, Beekman ATF, Kriegsman DMW, Westendorp-de Seriere M (eds) Autonomy and well-being in the aging population, II: report from the Longitudinal Aging Study Amsterdam 1992–1996. VU University Press, Amsterdam, pp 9–20Google Scholar
- 23.Kellogg International Work Group on the prevention of falls by the elderly (1987) The prevention of falls in later life. Dan Med Bull 34:1–24Google Scholar
- 27.Van Sonsbeek JLA (1988) Methodological and substantial aspects of the OECD indicator of chronic functional limitations. Maandbericht Gezondheid (CBS) 88:4–17Google Scholar
- 29.Tinetti ME, Richman D, Powell L (1990) Falls efficacy as a measure of fear of falling. J Gerontol 45:239–243Google Scholar
- 30.Central Bureau of Statistics (1989) Health Interview Questionnaire. CBS, The HagueGoogle Scholar
- 31.Hosmer DW, Lemeshow S (1989) Applied Logistic Regression. John Wiley & Sons, New YorkGoogle Scholar
- 32.Parker MJ, Gillespie LD, GillespieWJ (2004) Hip protectors for preventing hip fractures in the elderly (Cochrane Review). Cochrane Database Syst Rev 3:CD001255Google Scholar
- 34.Altman DG (1991) Practical statistics for medical research. Chapman & Hall, LondonGoogle Scholar