Abstract
Falls determine huge epidemiological, clinical, and economic burden in the older population worldwide, presenting high odds of severe disability. The present study aimed to estimate the prevalence of falls and associated factors in older Brazilians using a systematic review with meta-analysis. Searches were performed in SciELO, PubMed, LILACS, Web of Science, Scopus and PsycINFO databases with no date or language restrictions. Studies on community-dwelling older persons aged ≥ 60 years from both sexes and with a sample size of ≥ 300 participants included. Exclusion criteria were studies conducted specifically for older adults diagnosed with chronic disabling diseases that predispose them to falls. Risk of bias of included studies was assessed using a critical appraisal tool focusing on prevalence designs. A random-effects meta-analysis was used to pool the prevalence of falls across studies. Exploratory analysis was conducted examining subgroup estimates, prevalence ratios and meta-regression. Thirty-seven studies involving 58,597 participants were included. Twelve-month prevalence of falls was 27% (95%CI: 24.3-30.0), with significantly higher estimates in female than male (PR = 1.57; 95%CI: 1.32-1.86), in age group ≥ 80 years than age group 60-69 years (PR = 1.46; 95%CI: 1.15-1.84), and in participants from the Central region than participants from the South region (PR = 1.36; 95%CI: 1.10-1.69) of Brazil. Risk of bias scores did not impact heterogeneity in the 12-month meta-analysis. These estimates strongly support evidence-based public interventions to prevent falls in older Brazilians, especially in women and the oldest-old population.
Highlights
Falls have multifactor causes in old age and may occur due to decreased muscle mass and strength, reduced mobility, flexibility, visual acuity, psychological aspects such as depression and fear of falling, cognitive decline, gait changes, postural disorders and body imbalance [1,2]
The review protocol was registered at the International Prospective Register of Systematic Reviews (PROSPERO) under number CRD42018092326
The 37 included studies represented 25 States and the five geographic regions of Brazil, including a total of 58,597 participants (58.7% were women), with mean age ranging from 68.0 ± 8.4 to 87.3 ± 3.7
Summary
Falls have multifactor causes in old age and may occur due to decreased muscle mass and strength, reduced mobility, flexibility, visual acuity, psychological aspects such as depression and fear of falling, cognitive decline, gait changes, postural disorders and body imbalance [1,2]. According to the most recent public data collected over a five-year period, the number of falls in older Brazilians treated at the Brazilian Unified National Health System (SUS) facilities and subsequently hospitalized was 399,681, costing the Ministry of Health a total of BRL 464,874,275.91 (≈ USD 138,002,773.85) 5. A study conducted in Bahia State in 2014, characterized hospitalizations and the cost of falls in older persons and reported a total of 4,851 hospitalizations, an average stay of seven days, and total costs of BRL 5,842,576.52 (≈ USD 1,734,498.68) 6. Multi-sector public policies geared to the care of the older population have been recommended for several decades [7,8,9,10]. Studies on fall prevalence in older Brazilians have shown inconsistent results perhaps because it is an extensive country or due to socioeconomic differences between regions. The prevalence was 53.6% in the city of Natal (Rio Grande do Norte State) 11, 32.1% in the city of Juiz de Fora (Minas Gerais State) 12, 16.1% in the city of São Paulo 13, and 34.8% in South and Northeast regions 14
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