Original articleA risk model for the prediction of recurrent falls in community-dwelling elderly: A prospective cohort study
Introduction
Falls in the elderly represent a major problem in general practice, because of their high incidence, the involvement of many risk factors, and the considerable postfall morbidity and mortality 1, 2, 3, 4 . In community-dwelling elderly of 65 years or over lifetime cumulative incidence of falls ranges between 25 and 40% [5]. Major injury caused by falls accounts for about 10% of all falls, of which 1% concern hip fractures and 5% other fractures 1, 6. By far, most hip fractures are caused by falls 1, 4. Hip fractures have important consequences such as a high mortality in the first 3 months, a decline in the level of functioning, a threat to independence and the need for cost-consuming clinical care and rehabilitation facilities [6]. Psychosocial consequences of falls are fear of falling and social isolation, both also caused by mobility impairment [7]. Falls in the elderly are multifactorial events: intrinsic (patient-related), extrinsic (environment-related) and behavioral (activity-related) risk factors contribute to risk 1, 4. Particularly in recurrent falls, intrinsic risk factors have been reported to play a dominant role and extrinsic risk factors mainly an additional role 1, 2, 3, 4, 5. The main intrinsic risk factors for recurrent falling appear to be mobility problems 1, 2, 3, 4, 5.
Because of the high incidence and important consequences of falls, and the evidence that many recurrent falls are preventable, efforts to develop a strategy to prevent recurrent falls in primary care settings should be made [8]. In the past decade several randomized controlled studies have shown that multidimensional assessments and interventions in reducing falls and fall-related injury are effective 9, 10, 11, 12, 13, 14. From community surveys there is a consistent pattern showing that mobility risk factors have a great influence on falls, of which many are preventable 1, 2, 3, 4. Therefore, the focus on preventive efforts in primary care has to be directed on the improvement of mobilty. For the identification of elderly at risk for recurrent falls, a valid and feasible fall and mobility assessment protocol in primary health care is needed [15]. Several tests for the assessment of mobility problems have been recommended by many authors, but generally lack an evidence base and/or a sufficient feasibility in general practice 16, 17. Other authors have made efforts to construct a fall risk model to facilitate the risk assessment of falls in community-dwelling elderly, but these risk models are not easy to apply in clinical practice 18, 19.
Therefore, we set up a prospective study to answer the following questions:
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- What is the predictive value of risk factors for recurrent falls in a community-based population?
Section snippets
Study population
Participants were randomly recruited from the respondents of a mail questionnaire in a prior retrospective study on the incidence of, risk factors for and consequences of falls sent to 2,744 of the 2,946 elderly persons aged 70 years or over, registered in four primary health care practices [20]. Subjects with wheelchair dependency (n = 18), serious cognitive impairment (n = 72), illiteracy (n = 3), severe somatic or psychiatric disease (n = 52), who were admitted into a nursing clinic or
Subjects
The baseline procedure was completed by 302 and the follow-up by 287 participants: 115 men (40%) and 172 women (60%) with a mean age of 77.2 (SD 4.9) and 78.5 (SD 5.2) years, respectively. About 37% were 80 years or over and 50% widowed or single.
Registered reasons for loss during baseline period and follow-up were: died (10), refused further participation for personal reasons (3), physically unable (3), cognitively unable (1), admitted into a hospital or nursing clinic (2), moved to another
Main results
This prospective study yielded a survey of risk factors for recurrent falls and a risk model for the prediction of recurrent falls, consisting of variables easy to assess in general practice. According to the converted scores in the the risk model, based on the regression coefficients, it appears that an abnormal postural sway, a history of two or more falls in the previous year, poor scores for handgrip dynamometry, and depression are the best predictors. The range of the scores of the model
Acknowledgements
This study was funded by a grant from Zorg Onderzoek Nederland (ZON) (Care Research in the Netherlands). Grant number: 28-2365.
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