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Predictors of falls in the elderly by location

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Abstract

Background and aims: In the elderly, balance and walking impairments are assumed to play an important role in causing falls. We have assessed prospectively the predictive ability of health, function and balance variables regarding falls and their location. Methods: Falls which occurred during one year in a random sample of 307 women aged 75 years and over (mean 80.8 years, response rate 74.5%) living in the community were recorded and related to baseline registrations of health, medication and tests of walking and balance. Results: In all, 155 women (50.5%) reported 308 falls. Outdoor falls were significantly more frequent than indoor falls (57.5 vs 42.5%). The variables having had a fall before the start of the study, osteoporosis, hypertension, feeling depressed, unable to climb 40 cm high steps and walking slowly, all independently predicted a higher number of falls overall. Regarding fall location, having experienced a fall before study start was associated with more falls indoors as well as outdoors. Vision impairment, symptoms of depression, a faster comfortable walking speed, and being able to cope with higher steps were all independent predictors of more outdoor falls also after adjustment for outdoor exposure. A slower comfortable walking speed, a higher amplitude of the center of pressure movements in the frontal plane, a poorer score on the Timed Up & Go test, multi-morbidity, poor cognition and hypertension were independent risk factors for indoor falls. Neither number of drugs used nor any specific medication appeared as independent risk factors for falls in this study. Conclusions: The findings of this study suggest that risk factors for indoor and outdoor falls are different. Location of fall may be an important confounder in studies of predictors of falls in the elderly which should encompass this type of information.

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References

  1. Hill K, Schwarz J, Ricker L, Carroll S. Falls among healthy, community-dwelling, older women: a prospective study of frequency, circumstances, consequences and prediction accuracy. Aust NZ J Public Health 1999; 23: 41–8.

    Article  CAS  Google Scholar 

  2. Bergland A, Pettersen AM, Laake K. Functional status among elderly Norwegian fallers living at home. Physiother Res Int 2000; 5: 33–45.

    Article  PubMed  CAS  Google Scholar 

  3. Tromp AM, Smit JH, Deeg DJ, Bouter LM, Lips P. Predictors for falls and fractures in the Longitudinal Aging Study Amsterdam. J Bone Miner Res 1998; 13: 1932–9.

    Article  PubMed  CAS  Google Scholar 

  4. Shumway-Cook A, Brauer S, Woollacott M. Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go Test. Phys Ther 2000; 80: 896–903.

    PubMed  CAS  Google Scholar 

  5. Hausdorff JM, Rios DA, Edelberg HK. Gait variability and fall risk in community-living older adults: a 1-year prospective study. Arch Phys Med Rehabil 2001; 82: 1050–6.

    Article  PubMed  CAS  Google Scholar 

  6. van Weel C, Vermeulen H, van den Bosch W. Falls, a community care perspective. Lancet 1995; 345: 1549–51.

    Article  PubMed  Google Scholar 

  7. Jorm AF, Grayson D, Creasey H, Waite L, Broe GA. Long-term benzodiazepine use by elderly people living in the community. Aust NZ J Public Health 2000; 24: 7–10.

    Article  CAS  Google Scholar 

  8. Leipzig RM, Cumming RG, Tinetti ME. Drugs and falls in older people: a systematic review and meta-analysis: I. Psychotropic drugs. J Am Geriatr Soc 1999; 47: 30–9.

    CAS  Google Scholar 

  9. Leipzig RM, Cumming RG, Tinetti ME. Drugs and falls in older people: a systematic review and meta-analysis: II. Cardiac and analgesic drugs. J Am Geriatr Soc 1999; 47: 40–50.

    CAS  Google Scholar 

  10. Weinberg LE, Strain LA. Community-dwelling older adults’ attributions about falls. Arch Phys Med Rehabil 1995; 76: 955–60.

    Article  PubMed  CAS  Google Scholar 

  11. Jitapunkul S, Songkhla MN, Chayovan N, et al. Falls and their associated factors: a national survey of the Thai elderly. J Med Assoc Thai 1998; 81: 233–42.

    PubMed  CAS  Google Scholar 

  12. Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med 1988; 319: 1701–7.

    Article  PubMed  CAS  Google Scholar 

  13. Arfken CL, Lach HW, Birge SJ, Miller JP. The prevalence and correlates of fear of falling in elderly persons living in the community. Am J Public Health 1994; 84: 565–70.

    Article  PubMed  CAS  Google Scholar 

  14. Speechley M, Tinetti M. Falls and injuries in frail and vigorous community elderly persons. J Am Geriatr Soc 1991; 39: 46–52.

    PubMed  CAS  Google Scholar 

  15. Reinsch S, MacRae P, Lachenbruch PA, Tobis JS. Attempts to prevent falls and injury: a prospective community study. Gerontologist 1992; 32: 450–6.

    Article  PubMed  CAS  Google Scholar 

  16. Gillespie LD, Gillespie WJ, Robertson M, Lamb SE, Cumming R, Rowe BH. Interventions for preventing falls in elderly people. Cochrane Database Syst Rev 2001; 3: (CD000340).

  17. Braekhus A, Laake K, Engedal K. The Mini-Mental State Examination: identifying the most efficient variables for detecting cognitive impairment in the elderly. J Am Geriatr Soc 1992; 40: 1139–45.

    PubMed  CAS  Google Scholar 

  18. Tinetti ME, Doucette JT, Claus EB. The contribution of predisposing and situational risk factors to serious fall injuries. J Am Geriatr Soc 1995; 43: 1207–13.

    PubMed  CAS  Google Scholar 

  19. Bergland A, Jarnlo GB, Laake K. Validity of an index of self-reported walking for balance and falls in elderly women. Adv Physiother 2002; 4: 65–73.

    Article  Google Scholar 

  20. Linn BS, Linn MW. Objective and self-assessed health in the old and very old. Soc Sci Med 1980; 14A: 311–5.

    CAS  Google Scholar 

  21. Thorslund M, Norström T. The relationship between different measures of health in an elderly population. J Appl Gerontol 1993; 12: 61–70.

    Article  Google Scholar 

  22. Goldberg D. Identifying psychiatric illness among general medical patients. BMJ 1985; 291: 161–2.

    Article  PubMed  CAS  Google Scholar 

  23. Malt UF. The validity of the general health questionnaire in a sample of accidentally injured adults. Ada Psychiatr Scand 1989; 355 (Suppl): 103–12.

    Article  CAS  Google Scholar 

  24. Muthén BO. Analyses of linear structural equations using a comprehensive measurement mode. User’s Guide. Mooresville: Scientific Software, 1988.

    Google Scholar 

  25. Galanos AN, Pieper CF, Cornoni-Huntley JC, Bales CW, Fillenbaum GG. Nutrition and function: is there a relationship between body mass and the functional capabilities of community-dwelling elderly? J Am Geriatr Soc 1994; 42: 368–73.

    PubMed  CAS  Google Scholar 

  26. The WHO Collaborating Center for Drug Statistics Methodology 2000. WHO Collaborating Center for Drug Statistic Methodology, Norway 2000: ATC-index with DDDs, Oslo, Norway.

  27. Dixon WJ. BMDP Statistical Software. Berkeley: University of California Press, 1992.

    Google Scholar 

  28. Muthén L, Muthén B. Mplus. The comprehensive modeling program for applied research. User’s Guide. Los Angeles: Muthén and Muthén CA, 1998.

    Google Scholar 

  29. Luukinen H, Koski K, Hiltunen L, Kivela SL. Incidence rate of falls in an aged population in northern Finland. J Clin Epidemiol 1994; 47: 843–50.

    Article  PubMed  CAS  Google Scholar 

  30. Cummings SR, Nevitt MC, Kidd S. Forgetting falls. The limited accuracy of recall of falls in the elderly. J Am Geriatr Soc 1988; 36: 613–6.

    CAS  Google Scholar 

  31. Luukinen H, Herala M, Koski K, Honkanen R, Laippala P, Kivela SL. Fracture risk associated with a fall according to type of fall among the elderly. Osteoporos Int 2000; 11: 631–4.

    Article  PubMed  CAS  Google Scholar 

  32. Bergland A, Pettersen AM, Laake K. Falls reported among elderly Norwegians living at home. Physiother Res Int 1998; 3: 164–74.

    Article  PubMed  CAS  Google Scholar 

  33. Schwartz AV. Villa ML. Prill M. et al. Falls in older Mexican-American women. J Am Geriatr Soc 1999; 47: 1371–8.

    CAS  Google Scholar 

  34. Means KM, Rodell DE, O’Sullivan PS. Obstacle course performance and risk of falling in community-dwelling elderly persons. Arch Phys Med Rehabil 1998; 79: 1570–6.

    Article  PubMed  CAS  Google Scholar 

  35. Tromp AM, Pluijm SM, Smit JH, Deeg DJ, Bouter LM, Lips P. Fall-risk screening test: a prospective study on predictors for falls in community-dwelling elderly. J Clin Epidemiol 2001; 54: 837–44.

    Article  PubMed  CAS  Google Scholar 

  36. Huxham FE. Goldie PA. Patla AE. Theoretical consideration in balance assessment. Aust J Physiother 2001; 47: 89–100.

    CAS  Google Scholar 

  37. Luukinen H, Koski K, Laippala P, Kivela SL. Predictors for recurrent falls among the home-dwelling elderly. Scand J Prim Health Care 1995; 13: 294–9.

    Article  PubMed  CAS  Google Scholar 

  38. Brauer SG, Burns YR, Galley P.A prospective study of laboratory and clinical measures of postural stability to predict community-dwelling fallers. J Gerontol 2000; 55: M469–76.

    Article  CAS  Google Scholar 

  39. Topper AK, Maki BE, Holliday PJ. Are activity-based assessments of balance and gait in the elderly predictive of risk of falling and/or type of fall? J Am Geriatr Soc 1993; 41: 479–87.

    PubMed  CAS  Google Scholar 

  40. Lord SR, Ward JA, Williams P, Anstey KJ. An epidemiological study of falls in older community-dwelling women: the Randwick falls and fractures study. Aust J Public Health 1993; 17: 240–5.

    Article  PubMed  CAS  Google Scholar 

  41. Maki BE, Holliday PJ, Topper AK. A prospective study of postural balance and risk of falling in an ambulatory and independent elderly population. J Gerontol 1994; 49: M72–84.

    Article  PubMed  CAS  Google Scholar 

  42. O’Loughlin JL, Boivin JF, Robitaille Y, Suissa S. Falls among the elderly: distinguishing indoor and outdoor risk factors in Canada. J Epidemiol Community Health 1994; 48: 488–91.

    Article  PubMed  Google Scholar 

  43. Bath PA, Morgan K. Differential risk factor profiles for indoor and outdoor falls in older people living at home in Nottingham. UK. Eur J Epidemiol 1999; 15: 65–73.

    Article  CAS  Google Scholar 

  44. Yasumura S, Haga H, Nagai H, Suzuki T, Amano H, Shibata H. Rate of falls and the correlates among elderly people living in an urban community in Japan. Age Ageing 1994; 23: 323–7.

    Article  PubMed  CAS  Google Scholar 

  45. Mulrow C, Lau J, Cornell J, Brand M. Pharmacotherapy for hypertension in the elderly. Cochrane Database Syst Rev 2000; 2: (CD000028).

    Google Scholar 

  46. Cumming RG. Epidemiology of medication-related falls and fractures in the elderly. Drugs Aging 1998; 12: 43–53.

    Article  PubMed  CAS  Google Scholar 

  47. Rankin JK, Woollacott MH, Shumway-Cook A, Brown LA. Cognitive influence on postural stability: a neuromuscular analysis in young and older adults. J Gerontol 2000; 55: M112–9.

    Article  CAS  Google Scholar 

  48. Blanchard M. Depressive illness. In Ebrahim S. Kalache A. Eds. Epidemiology in old age. BMJ Publishing Group. 1996: 279–89.

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Correspondence to Astrid Bergland.

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Bergland, A., Jarnlo, GB. & Laake, K. Predictors of falls in the elderly by location. Aging Clin Exp Res 15, 43–50 (2003). https://doi.org/10.1007/BF03324479

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