Skip to main content
Book cover

Medication-Related Falls in Older People pp 13–38Cite as

Falls Count and Counting Falls: Making Sense of Data About Falls

Abstract

It is often challenging to make sense of research reports on falls. The choice of statistical method depends on whether the outcome is binary (faller: yes/no), a rate (falls per person-time in view), ordinal (number of falls per person) or time to fall (first). The most useful methods for analysing falls are those that estimate parameters as they provide an estimated value for risk associated with different levels of a factor or intervention. Less useful are statistics that simply provide a yes/no answer as to whether the factor or intervention affects risk (hypothesis testing). As falls are negative events, when parameters such as odds ratios (OR), incidence rate ratios (IRR), hazard ratios (HR), proportional odds ratios (POR) or cumulative odds ratios (COR) are greater than 1.0, they indicate that the factor is associated with a higher risk of falls; when <1.0, the factor or the intervention is associated with a lower risk of falls. All of these statistical parameters can be used to identify risk factors for falls or to evaluate effective interventions.

Keywords

  • Incidence Rate Ratio
  • Population Attributable Risk
  • Proportional Odds Model
  • Fall Prevention Programme
  • Gait Problem

These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

This is a preview of subscription content, access via your institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • DOI: 10.1007/978-3-319-32304-6_3
  • Chapter length: 26 pages
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
eBook
USD   84.99
Price excludes VAT (USA)
  • ISBN: 978-3-319-32304-6
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
Softcover Book
USD   109.99
Price excludes VAT (USA)
Hardcover Book
USD   149.99
Price excludes VAT (USA)
Learn about institutional subscriptions
Fig. 3.1
Fig. 3.2
Fig. 3.3

Abbreviations

AR:

Attributable risk

CI:

Confidence interval

COR:

Cumulative odds ratios

df:

Degree of freedom

FRIDs:

Fall risk-increasing drugs

GEE:

Generalised estimating equations

HR:

Hazard ratio

IRR:

Incidence rate ratio

IR:

Incidence rate

NNH:

Number needed to harm

NNT:

Number needed to treat

OBD:

Occupied bed days

OR:

Odds ratio

PAR:

Population attributable risk

POR:

Proportional odds ratios

RCT:

Randomised controlled trial

RR:

Rate ratio

SD:

Standard deviation

VIP:

Very important point

References

  1. Public Health Agency of Canada (PHAC) (2014) Falls in Canada: second report [Online]. Available: http://www.phac-aspc.gc.ca/seniors-aines/publications/public/injury-blessure/seniors_falls-chutes_aines/assets/pdf/seniors_falls-chutes_aines-eng.pdf. Accessed July 2015

  2. Blake AJ, Morgan K, Bendall MJ, Dallosso H, Ebrahim SB, Arie TH et al (1988) Falls by elderly people at home: prevalence and associated factors. Age Ageing 17:365–372

    CAS  CrossRef  PubMed  Google Scholar 

  3. Anonymous (1987) The prevention of falls in later life. A report of the Kellogg International Work Group on the Prevention of Falls by the Elderly. Dan Med Bull 34(Suppl 4):1–24

    Google Scholar 

  4. Ungar A, Rafanelli M, Iacomelli I, Brunetti MA, Ceccofiglio A, Tesi F et al (2013) Fall prevention in the elderly. Clin Cases Miner Bone Metab 10(2):91–95

    PubMed  PubMed Central  Google Scholar 

  5. Goodwin VA, Abbott RA, Whear R, Bethel A, Ukoumunne OC, Thompson-Coon J et al (2014) Multiple component interventions for preventing falls and fall-related injuries among older people: systematic review and meta-analysis. BMC Geriatr 14:15

    CrossRef  PubMed  PubMed Central  Google Scholar 

  6. Scott V, Wagar L, Elliott S (2010) Falls & related injuries among older Canadians: fall-related hospitalizations & intervention initiatives [Online]. Available: http://www.hiphealth.ca. Accessed July 2015

  7. Svantesson U, Babagbemi B, Foster L, Alricsson M (2014) Influences on modern multifactorial falls prevention interventions and fear of falling in non-frail older adults: a literature review. J Clin Med Res 6(5):314–320

    PubMed  PubMed Central  Google Scholar 

  8. Martin JT, Wolf A, Moore JL, Rolenz E, DiNinno A, Reneker JC (2013) The effectiveness of physical therapist-administered group-based exercise on fall prevention: a systematic review of randomized controlled trials. J Geriatr Phys Ther 36(4):182–193

    CrossRef  PubMed  Google Scholar 

  9. Canadian Institute for Health Information (CIHI) (2014) Preventing falls: from evidence to improvement in Canadian Health Care [Online]. Available: https://www.accreditation.ca/sites/default/files/falls-joint-report-2014-en.pdf. Accessed July 2015

  10. Statistics Canada (2006) Portrait of seniors in Canada [Online]. Available: http://www.statcan.gc.ca/pub/89-519-x/89-519-x2006001-eng.pdf. Accessed July 2015

  11. Merom D, Stanaway FF, Handelsman DJ, Waite LM, Seibel MJ, Blyth FM et al (2014) Swimming and other sporting activities and the rate of falls in older men: longitudinal findings from the Concord Health and Ageing in Men Project. Am J Epidemiol 180(8):830–837

    CrossRef  PubMed  Google Scholar 

  12. Peeters GM, Verweij LM, van Schoor NM, Pijnappels M, Pluijm SM, Visser M et al (2010) Which types of activities are associated with risk of recurrent falling in older persons? J Gerontol Ser A Biol Sci Med Sci 65(7):743–750

    CrossRef  Google Scholar 

  13. Tuli T, Haechl O, Berger N, Laimer K, Jank S, Kloss F et al (2010) Facial trauma: how dangerous are skiing and snowboarding? J Oral Maxillofacial Surg 68(2):293–299

    CrossRef  Google Scholar 

  14. Barnett L, Green S, van Buerden E, Campbell E, Radvan D (2009) Older people playing ball: what is the risk of falling and injury? J Sci Med Sport 12(1):177–183

    CrossRef  PubMed  Google Scholar 

  15. Bennett A, Gnjidic D, Gillett M, Carroll P, Matthews S, Johnell K et al (2014) Prevalence and impact of fall-risk-increasing drugs, polypharmacy, and drug-drug interactions in robust versus frail hospitalised falls patients: a prospective cohort study. Drugs Aging 31(3):225–232

    CrossRef  PubMed  Google Scholar 

  16. World Health Organization (2008) WHO global report on falls prevention in older age [Online]. Available: http://www.who.int/ageing/publications/Falls_prevention7March.pdf. Accessed July 2015

  17. Currie L (2008) In: Hughes RG (ed) Fall and injury prevention. Agency for Healthcare Research and Quality, Rockville

    Google Scholar 

  18. Hauer K, Lamb SE, Jorstad EC, Todd C, Becker C (2006) Systematic review of definitions and methods of measuring falls in randomised controlled fall prevention trials. Age Ageing 35(1):5–10

    CrossRef  PubMed  Google Scholar 

  19. Lord SR, Ward JA, Williams P, Anstey KJ (1993) An epidemiological study of falls in older community-dwelling women: the Randwick falls and fractures study. Aust J Public Health 17(3):240–245

    CAS  CrossRef  PubMed  Google Scholar 

  20. Mayo NE, Asano M, Barbic SP (2013) When is a research question not a research question? J Rehabil Med 45(6):513–518

    CrossRef  PubMed  Google Scholar 

  21. Mayo NE, Korner-Bitensky N, Georges P, Becker R (1989) Preventing falls among patients in a rehabilitation hospital. Can J Rehabil 2:235–240

    Google Scholar 

  22. Vandenbroucke JP, von Elm E, Altman DG, Gotzsche PC, Mulrow CD, Pocock SJ et al (2007) Strengthening the reporting of observational studies in epidemiology (STROBE): explanation and elaboration. Ann Intern Med 147(8):W163–W194

    CrossRef  PubMed  Google Scholar 

  23. Hill AB (1961) Principles of medical statistics. The Lancet, London

    Google Scholar 

  24. Mayo NE, Korner-Bitensky N, Kaizer F (1990) Relationship between response time and falls among stroke patients undergoing physical rehabilitation. Int J Rehabil Res 13(1):47–55

    CAS  CrossRef  PubMed  Google Scholar 

  25. Mayo NE, Bronstein D, Scott SC, Finch LE, Miller S (2014) Necessary and sufficient causes of participation post-stroke: practical and philosophical perspectives. Qual Life Res 23(1):39–47

    CrossRef  PubMed  Google Scholar 

  26. Porta M (2008) A dictionary of epidemiology. Oxford University Press, Oxford. New York, NY

    Google Scholar 

  27. Rothman KJ, Greenland S (1998) Modern epidemiology. Lippincott-Raven, Philadelphia

    Google Scholar 

  28. Cesari M, Landi F, Torre S, Onder G, Lattanzio F, Bernabei R (2002) Prevalence and risk factors for falls in an older community-dwelling population. J Gerontol A Biol Sci Med Sci 57(11):M722–M726

    CrossRef  PubMed  Google Scholar 

  29. Matsuda PN, Shumway-Cook A, Bamer AM, Johnson SL, Amtmann D, Kraft GH (2011) Falls in multiple sclerosis. PM R 3(7):624–632

    CrossRef  PubMed  Google Scholar 

  30. Cox DR, Oakes D (1984) Analysis of survival data. Chapman & Hall, New York

    Google Scholar 

  31. George B, Seals S, Aban I (2014) Survival analysis and regression models. J Nucl Cardiol 21(4):686–694

    CrossRef  PubMed  PubMed Central  Google Scholar 

  32. Buckeridge D, Huang A, Hanley J, Kelome A, Reidel K, Verma A et al (2010) Risk of injury associated with opioid use in older adults. J Am Geriatr Soc 58(9):1664–1670

    CrossRef  PubMed  Google Scholar 

  33. Mayo NE, Goldberg MS (2009) When is a case-control study not a case-control study? J Rehabil Med 41(4):209–216

    CrossRef  PubMed  Google Scholar 

  34. Mayo NE, Goldberg MS (2009) When is a case-control study a case-control study? J Rehabil Med 41(4):217–222

    CrossRef  PubMed  Google Scholar 

  35. Mayo NE, Korner-Bitensky N, Becker R, Georges P (1989) Predicting falls among patients in a rehabilitation hospital. Am J Phys Med Rehabil 68(3):139–146

    CAS  CrossRef  PubMed  Google Scholar 

  36. Laupacis A, Sackett DL, Roberts RS (1988) An assessment of clinically useful measures of the consequences of treatment. N Engl J Med 318(26):1728–1733

    CAS  CrossRef  PubMed  Google Scholar 

  37. Healey F, Lowe D, Darowski A, Windsor J, Treml J, Byrne L et al (2014) Falls prevention in hospitals and mental health units: an extended evaluation of the FallSafe quality improvement project. Age Ageing 43(4):484–491

    CrossRef  PubMed  Google Scholar 

  38. Mayo NE (2009) Randomized trials and other parallel comparisons of treatment. In: Bailar JC, Hoaglin DC (eds) Medical uses of statistics. Wiley & The New England Journal of Medicine, Hoboken, pp 51–89

    Google Scholar 

  39. Sherrington C, Lord SR, Vogler CM, Close JC, Howard K, Dean CM et al (2014) A post-hospital home exercise program improved mobility but increased falls in older people: a randomised controlled trial. PLoS One 9(9), e104412

    CrossRef  PubMed  PubMed Central  Google Scholar 

  40. Tinetti ME, Baker DI, McAvay G, Claus EB, Garrett P, Gottschalk M et al (1994) A multifactorial intervention to reduce the risk of falling among elderly people living in the community. N Engl J Med 331(13):821–827

    CAS  CrossRef  PubMed  Google Scholar 

  41. Donner A, Brown KS, Brasher P (1990) A methodological review of non-therapeutic intervention trials employing cluster randomization, 1979–1989. Int J Epidemiol 19(4):795–800

    CAS  CrossRef  PubMed  Google Scholar 

  42. Donner A, Klar N (2000) Design and analysis of cluster randomization trials in health research. Arnold Publishing Company, London

    Google Scholar 

  43. Donner A, Klar N (2004) Pitfalls of and controversies in cluster randomization trials. Am J Public Health 94(3):416–422

    CrossRef  PubMed  PubMed Central  Google Scholar 

  44. Donner A, Klar N (1996) Statistical considerations in the design and analysis of community intervention trials. J Clin Epidemiol 49(4):435–439

    CAS  CrossRef  PubMed  Google Scholar 

  45. Cumming RG, Sherrington C, Lord SR, Simpson JM, Vogler C, Cameron ID et al (2008) Cluster randomised trial of a targeted multifactorial intervention to prevent falls among older people in hospital. BMJ 336(7647):758–760

    CrossRef  PubMed  PubMed Central  Google Scholar 

  46. van der Velde N, Stricker BH, Pols HA, van der Cammen TJ (2007) Risk of falls after withdrawal of fall-risk-increasing drugs: a prospective cohort study. Br J Clin Pharmacol 63(2):232–237

    CrossRef  PubMed  Google Scholar 

  47. Rubin DB (1997) Estimating causal effects from large data sets using propensity scores. Ann Intern Med 127(8 Pt 2):757–763

    CAS  CrossRef  PubMed  Google Scholar 

  48. Hemming K, Lilford R, Girling AJ (2015) Stepped-wedge cluster randomised controlled trials: a generic framework including parallel and multiple-level designs. Stat Med 34(2):181–196

    CrossRef  PubMed  Google Scholar 

  49. Mdege ND, Man MS, Taylor nee Brown CA, Torgerson DJ (2011) Systematic review of stepped wedge cluster randomized trials shows that design is particularly used to evaluate interventions during routine implementation. J Clin Epidemiol 64(9):936–948

    CrossRef  PubMed  Google Scholar 

  50. Brown CA, Lilford RJ (2006) The stepped wedge trial design: a systematic review. BMC Med Res Methodol 6:54

    CrossRef  PubMed  PubMed Central  Google Scholar 

  51. Mayo NE (2015) Dictionary of quality of life and health outcomes measurement: International Society for Quality of Life, Milwaukee, WI USA

    Google Scholar 

  52. Hill AM, McPhail SM, Waldron N, Etherton-Beer C, Ingram K, Flicker L et al (2015) Fall rates in hospital rehabilitation units after individualised patient and staff education programmes: a pragmatic, stepped-wedge, cluster-randomised controlled trial. Lancet 385(9987):2592–2599

    CrossRef  PubMed  Google Scholar 

  53. Lamb SE (2015) The case for stepped-wedge studies: a trial of falls prevention. Lancet 385:2556–2557

    CrossRef  PubMed  Google Scholar 

  54. Scott SC, Goldberg MS, Mayo NE (1997) Statistical assessment of ordinal outcomes in comparative studies. J Clin Epidemiol 50(1):45–55

    CAS  CrossRef  PubMed  Google Scholar 

  55. Robertson MC, Campbell AJ, Herbison P (2005) Statistical analysis of efficacy in falls prevention trials. J Gerontol A Biol Sci Med Sci 60(4):530–534

    CrossRef  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Center for Outcomes Research and Evaluation, McGill University Health Centre - Research Institute, Montreal, QC, Canada

    Nancy E. Mayo BSc(PT), MSc, PhD

  2. Faculty of Medicine, Division of Clinical Epidemiology, McGill University, Montreal, QC, Canada

    Nancy E. Mayo BSc(PT), MSc, PhD

  3. Faculty of Medicine, School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada

    Nancy E. Mayo BSc(PT), MSc, PhD & Sabrina M. Figueiredo BSc(PT), MSc

  4. Division of Clinical Epidemiology, McGill University, Montreal, QC, Canada

    Sabrina M. Figueiredo BSc(PT), MSc

Authors
  1. Nancy E. Mayo BSc(PT), MSc, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sabrina M. Figueiredo BSc(PT), MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nancy E. Mayo BSc(PT), MSc, PhD .

Editor information

Editors and Affiliations

  1. University of Ottawa and The Ottawa Hospital, Head, Division of Geriatric Medicine University of Ottawa and The Ottawa Hosp, Montréal, Québec, Canada

    Allen R. Huang

  2. Head, Faculty of Pharmacy Université de Montréal, Université de Montréal, Montréal, Québec, Canada

    Louise Mallet

Rights and permissions

Reprints and Permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Mayo, N.E., Figueiredo, S.M. (2016). Falls Count and Counting Falls: Making Sense of Data About Falls. In: Huang, A., Mallet, L. (eds) Medication-Related Falls in Older People. Adis, Cham. https://doi.org/10.1007/978-3-319-32304-6_3

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-32304-6_3

  • Published:

  • Publisher Name: Adis, Cham

  • Print ISBN: 978-3-319-32302-2

  • Online ISBN: 978-3-319-32304-6

  • eBook Packages: MedicineMedicine (R0)