Abstract
To investigate the role of malnutrition, impaired mobility and care dependency in predicting fallers in older Dutch home care clients.
Design
This study is a secondary analysis of data of the annual independent National Prevalence Measurement of Care Problems of Maastricht University. The design involves a cross-sectional, multicentre point prevalence measurement (malnutrition, mobility), and a 30 days incidence measurement (falls).
Setting
Dutch home care organisations.
Participants
2971 clients (older than 65 years) from 22 home care organizations participated.
Measurements
A standardized questionnaire was used to register amongst others data of weight, height, number and type of diseases (like for example neurologic diseases, dementia, CVA, COPD, eye/ear disorders, musculoskeletal disorders), nutritional intake, use of psychopharmaca, undesired weight loss, fall history, mobility, and care dependency.
Results
The study was able to show that fallers are more often malnourished than non-fallers in the univariate analysis. Most importantly the study indicated by multivariate analysis that fallers could be predicted by the risk factors immobility ((OR 2.516 95% CI 1.144–5.532), high care dependency (OR 1.684 95% CI 1.121–2.532) and malnutrition (OR 1.978 95% CI 1.340–2.920).
Conclusion
The findings of this study stress that malnutrition, impaired mobility and care dependency are potential reversible factors related to falls. Therefore early identification and management of nutritional status, impaired mobility and care dependency are important aspects for a possible fall prevention strategy.
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References
European Commission (2009) Communication from the Commission to the European Parliament, the Council, the European Economic and Social Committee and the Committee of the Regions — Dealing with the impact of an ageing population in the EU (Ageing Report)
Fried LP, Guralnik JM (1997) Disability in older adults: evidence regarding significance, etiology, and risk. J Am Geriatr Soc 45:92–100
Gillispie 2003 Gillespie LD, Gillespie WJ, Robertson MC, Lamb SE, Cumming RG, Rowe BH (2003) Interventions for preventing falls in elderly people. Cochrane Database Syst Rev:CD000340
Tinetti ME (2003) Clinical practice. Preventing falls in elderly persons. N Engl J Med 348:42–49
Neyens JCL. Fall prevention in psychogeriatric nursing home residents. PhD dissertation. Maastricht, Maastricht University, 2007
Dijcks BP, Neyens JC, Schols JM, van Haastregt JC, de Witte LP (2005) [Falls in nursing homes: on average almost two per bed per year, resulting in a fracture in 1.3%]. Ned Tijdschr Geneeskd 149:1043–1047
Rubenstein LZ, Josephson KR, Robbins AS (1994) Falls in the nursing home. Ann Intern Med 121:442–451
Zijlstra R. Managing concerns about falls. Fear of falling and avoidance of activity in older people. PhD dissertation. Maastricht, Maastricht University, 2008
Bezon J, Echevarria KH, Smith GB (1999) Nursing outcome indicator: preventing falls for elderly people. Outcomes Manag Nurs Pract 3:112–116
Schwartz AV, Villa ML, Prill M, Kelsey JA, Galinus JA, Delay RR, Nevitt MC, Bloch DA, Marcus R, Kelsey JL (1999) Falls in older Mexican-American women. J Am Geriatr Soc 47:1371–1378
O’Loughlin JL, Robitaille Y, Boivin JF, Suissa S (1993) Incidence of and risk factors for falls and injurious falls among the community-dwelling elderly. Am J Epidemiol 137:342–354
Campbell AJ, Borrie MJ, Spears GF (1989) Risk factors for falls in a community-based prospective study of people 70 years and older. J Gerontol 44:M112–117
Davis JW, Ross PD, Nevitt MC, Wasnich RD (1999) Risk factors for falls and for serious injuries on falling among older Japanese women in Hawaii. J Am Geriatr Soc 47:792–798
Hausdorff JM, Rios DA, Edelberg HK (2001) Gait variability and fall risk in community-living older adults: a 1-year prospective study. Arch Phys Med Rehabil 82:1050–1056
Luukinen H, Koski K, Laippala P, Kivela SL (1995) Predictors for recurrent falls among the home-dwelling elderly. Scand J Prim Health Care 13:294–299
Luukinen H, Koski K, Kivela SL, Laippala P (1996) Social status, life changes, housing conditions, health, functional abilities and life-style as risk factors for recurrent falls among the home-dwelling elderly. Public Health 110:115–118
Nevitt 1989, Nevitt MC, Cummings SR, Kidd S, Black D (1989) Risk factors for recurrent nonsyncopal falls. A prospective study. JAMA 261:2663–2668
Weiner DK, Hanlon JT, Studenski SA (1998) Effects of central nervous system polypharmacy on falls liability in community-dwelling elderly. Gerontol 44:217–221
Tinetti ME, Doucette J, Claus E, Marottoli R (1995) Risk factors for serious injury during falls by older persons in the community. J Am Geriatr Soc 43:1214–1221
Tromp AM, Pluijm SM, Smit JH, Deeg DJ, Bouter LM, Lips P (2001) Fall-risk screening test: a prospective study on predictors for falls in community-dwelling elderly. J Clin Epidemiol 54:837–844
CBO (2004) Richtlijn ‘Preventie van valincidenten bij ouderen’. Van Zuiden Communications B.V., Alphen aan den Rijn
Guideline for the prevention of falls in older persons (2001). American Geriatrics Society, British Geriatrics Society, and American Academy of Orthopaedic Surgeons Panel on Falls Prevention. J Am Geriatr Soc 49:664–672
Morley JE, Baumgartner RN, Roubenoff R, Mayer J, Nair KS (2001) Sarcopenia. J Lab Clin Med 137:231–243
Cruz-Jentoft AJ, Landi F, Topinkova E, Michel JP (2010) Understanding sarcopenia as a geriatric syndrome. Curr Opin Clin Nutr Metab Care 13:1–7
Janssen I, Heymsfield SB, Ross R (2002) Low relative skeletal muscle mass (sarcopenia) in older persons is associated with functional impairment and physical disability. J Am Geriatr Soc 50:889–896
Baumgartner RN, Koehler KM, Gallagher D, Romero L, Heymsfield SB, Ross RR, Garry PJ, Lindeman RD (1998) Epidemiology of sarcopenia among the elderly in New Mexico. Am J Epidemiol 147:755–763
Morley JE (1987) Nutritional problems in the elderly. Bol Asoc Med P R 79:505–507
Commodore DI (1995) Falls in the elderly population: a look at incidence, risks, healthcare costs, and preventive strategies. Rehabil Nurs 20:84–89
Coleman Y, Welch S, McMahon J (2000) Nutrition and falls. Geriaction 18:12–13
Daniels L, Lynne (2002) Nutrition screening and assesment of patients attending a multidisciplinary falls clinic. Nutrition & Dietetics: The Journal of the Dietitians Association of Australia. ISSN: 1446-6368
Johnson CS (2003) The association between nutritional risk and falls among frail elderly. J Nutr Health Aging 7:247–250
Gray-Donald K, Payette H, Boutier V (1995) Randomized clinical trial of nutritional supplementation shows little effect on functional status among free-living frail elderly. J Nutr 125:2965–2971
Vellas B, Conceicao J, Lafont C, Fontan B, Garry PJ, Adoue D, Albarede JL (1990) Malnutrition and falls. Lancet 336:1447
Vellas B, Baumgartner RN, Wayne SJ et al. Relationship between malnutrition and falls in the elderly. Nutrition 8:105–108
Bergstrom N, Braden BJ, Laguzza A, Holman V (1987) The Braden Scale for Predicting Pressure Sore Risk. Nurs Res 36:205–210
Dijkstra A, Tiesinga LJ, Plantinga L, Veltman G, Dassen TW (2005) Diagnostic accuracy of the care dependency scale. J Adv Nurs 50:410–416
Meijers JMM, Halfens RJG, Van Bokhorst-de van der Schueren MAE, Dassen T, Schols JMGA. Malnutrition in Dutch healthcare: Prevalence, prevention, treatment and quality indicators. Nutrition 25:512–519
Dijkstra A, Buist G, Dassen T (1998) Operationalization of the concept of ‘nursing care dependency’ for use in long-term care facilities. Aust N Z J Ment Health Nurs 7:142–151
Henderson V (1966) The nature of Nursing: a Definition and its implications for Practice, Research and Education. Macmillan Press, New York
Kinney JM (2004) Nutritional frailty, sarcopenia and falls in the elderly. Curr Opin Clin Nutr Metab Care 7:15–20
Mertens EI, Halfens RJ, Dassen T (2007) Using the Care Dependency Scale for fall risk screening. J Adv Nurs 58:594–601
Studenski S, Duncan PW, Chandler J, Samsa G, Prescott B, Hogue C, Bearon LB Predicting falls: the role of mobility and nonphysical factorsJ Am Geriatr Soc. 1994 Mar;42(3):297–302
Graafmans WC, Ooms ME, Hofstee HM, Bezemer PD, Bouter LM, Lips P (1996) Falls in the elderly: a prospective study of risk factors and risk profiles. Am J Epidemiol 143:1129–1136
Tromp AM, Smit JH, Deeg DJ, Bouter LM, Lips P (1998) Predictors for falls and fractures in the Longitudinal Aging Study Amsterdam. J Bone Miner Res 13:1932–1939
Mathias S, Nayak US, Isaacs B (1986) Balance in elderly patients: the “get-up and go” test. Arch Phys Med Rehabil 67:387–389
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
Fiatarone MA, O’Neill EF, Ryan ND, Clements KM, Solares GR, Nelson ME, Roberts SB, Kehayias JJ, Lipsitz LA, Evans WJ (1994) Exercise training and nutritional supplementation for physical frailty in very elderly people. N Engl J Med 330:1769–1775
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Meijers, J.M.M., Halfens, R.J.G., Neyens, J.C.L. et al. Predicting falls in elderly receiving home care: The role of malnutrition and impaired mobility. J Nutr Health Aging 16, 654–658 (2012). https://doi.org/10.1007/s12603-012-0010-7
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DOI: https://doi.org/10.1007/s12603-012-0010-7