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Use of a clustering method to describe the clinical profiles of older fallers: the value of a multidisciplinary consultation

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Key summary points

AbstractSection Aim

To use a clustering method with no preconceived ideas to identify older fallers living in the community and thus to suggest appropriate treatment plans.

AbstractSection Findings

we found three different functional clusters: (i) a low-mobility cluster of individuals who had difficulty getting up from the floor unaided and needed a mobility aid for walking, (ii) an intermediate group of rather sedentary individuals with a high body mass index and a gait speed of ~ 0.6 m s-1, and (iii) active participants who performed well in physical tests.

AbstractSection Message

The population of older fallers referred for a multidisciplinary geriatric consultation is heterogeneous; when combined with simple tests, the presence of certain clinical characteristics can contribute to determine the most appropriate pathways.

Abstract

Objectives

The population of older adults is particularly heterogeneous with regard to frailty and the risk of falling, the two of which are linked. We conducted an exploratory, analysis (with no preconceived ideas) of data collected during multidisciplinary falls consultations (MFCs), to identify people with similar profiles.

Materials and methods

We performed an observational, multicentre study of older patients (aged 75 and over) having been evaluated in an MFC. We excluded adults with a Mini Mental State Examination score < 14/30, an activities of daily living score < 4/6, or an unstable medical condition. Each participant underwent a clinical interview, impedancemetry, and a physical activity assessment (a questionnaire, and use of an activity tracker on 5 consecutive days). The K-means method and ascending hierarchical clustering were used to identify clusters of people with common characteristics.

Results

Of the 106 participants, the median [IQR] mean number of falls in the previous 6 months was 1 [2]. Three functional clusters were identified: (i) fallers with poor mobility, difficulty getting up off the ground after a fall, and using a mobility aid for walking; (ii) an intermediate sedentary group with a gait speed of ~ 0.6 m s−1, and (iii) active people with a timed “up and go” test time below 15 s and a gait speed above 0.8 m s−1.

Conclusions

The population of older fallers referred for an MFC is heterogeneous. The presence of certain clinical characteristics enabled the definition of three patient clusters, which might help physicians to determine the most appropriate care objectives and pathways.

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Data availability

The data are available by contacting the principal author as the data are at the Orléans hospital centre.

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Author information

Authors and Affiliations

  1. Court Séjour Gériatrique, Department of Medicine, CHR d’Orléans, 14 Av. de l’Hôpital, 45067, Orleans, France

    M. Pambet, J. B. Gauvain & A. Valery

  2. Department of Geriatric Medicine, Centre de Recherche sur l’Autonomie et la Longévité (CeRAL), UPRES EA 4638, UNAM, Université d’Angers, 4 rue Larrey, 49933, Angers, France

    C. Annweiler

  3. HAVAE, UR20217, University of Limoges, F-87000, Limoges, France

    S. Mandigout

  4. Department of Geriatric Medicine and Pôle Vieillissement, Université de Tours, 2 boulevard tonnellé, 37044, Tours, France

    B. Fougere

  5. Clinique de gérontologie et service de médecine interne et gériatrie, Hôpital gériatrique les Bateliers, Université de Lille, 23 Rue des Bateliers, 59037, Lille, France

    F. Puisieux

Authors
  1. M. Pambet
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  2. J. B. Gauvain
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  3. A. Valery
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  4. C. Annweiler
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  5. S. Mandigout
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  6. B. Fougere
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  7. F. Puisieux
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Contributions

All authors conceived and designed the study. Dr MP, Dr JBG and Dr AV prepared material and collected and analyzed data. The first draft of the manuscript was written by Dr MP, and all authors commented on and revised subsequent versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to S. Mandigout.

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Conflicts of interest

The authors declare that they have no conflicts of interest with regard to the present study.

Ethical approval

The protocol was approved by the independent ethics committee at Orleans University Hospital (Orléans, France; reference: 2016-02, dated April 26, 2001) and the French National Consultative Committee on Information Processing in Medical Research at the French Ministry of Research (Paris, France; reference: 16.522, dated July 12, 2016).

Informed consent

All participants were given comprehensive written and verbal information on the study’s objectives and procedures, the right to refuse to participate, and the ability to withdraw from the study at any time.

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Pambet, M., Gauvain, J.B., Valery, A. et al. Use of a clustering method to describe the clinical profiles of older fallers: the value of a multidisciplinary consultation. Eur Geriatr Med 14, 1097–1104 (2023). https://doi.org/10.1007/s41999-023-00829-3

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  • DOI: https://doi.org/10.1007/s41999-023-00829-3

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