Established Risk Factor For Falls Research Articles

Predicting First-Time Injurious Falls in Older Men and Women Living in the Community: Development of the First Injurious Fall Screening Tool

ObjectivesThe aim of this study was to create a screening tool to predict first-time injurious falls in community-living older men and women. DesignLongitudinal cohort study between 2001 and 2009. SettingThe Swedish National Study on Aging and Care in Kungsholmen (SNAC-K), Sweden. ParticipantsCommunity-living older adults (n = 2808; 1750 women and 1058 men) aged ≥60 years (mean age 73, standard deviation 10.3). MeasurementsThe outcome was injurious falls within 5 years from baseline survey. Data on the risk factors for falls were collected through interviews, clinical examinations, and tests at baseline. Several previously established fall risk factors were identified for the development of the screening tool. The tool was formulated based on the β coefficients from sex-specific multivariate Cox proportional hazards models. The discriminative power was assessed using Harrell C statistic. ResultsOld age, living alone, being dependent in instrumental activities of daily living, and impaired balance were the factors included in the final score of the First Injurious Fall (FIF) screening tool. The predictive values (Harrell C statistic) for the scores were 0.75 for women and 0.77 for men. The sensitivity and specificity at the Youden cut-off points were 0.69 and 0.70 for women, and 0.72 and 0.71 for men. Conclusions and ImplicationsThe FIF screening tool for first injurious fall in older persons consists of 3 questions and a physical test (5-second 1-leg standing balance with eyes open). Quick and easy to administer, it could be ideal for use in primary care or public health to identify older men and women at high fall risk, who may benefit from primary preventive interventions.

Person-Centered Fall Risk Awareness Perspectives: Clinical Correlates and Fall Risk.

To identify clinical correlates of person-centered fall risk awareness and their validity for predicting falls. Prospective cohort study. Community. Ambulatory community-dwelling older adults without dementia (N = 316; mean age 78, 55% female). Fall risk awareness was assessed using a two-item questionnaire that asked participants about overall likelihood of someone in their age group having a fall and their own personal risk of falling over the next 12 months. Incident falls were recorded over study follow-up. Fifty-three participants (16.8%) responded positively to the first fall risk awareness question about being likely to have a fall in the next 12 months, and 100 (31.6%) reported being at personal risk of falling over the next 12 months. There was only fair correlation (κ = 0.370) between responses on the two questions. Prior falls and depressive symptoms were associated with positive responses on both fall risk awareness questions. Age and other established fall risk factors were not associated with responses on either fall risk awareness question. The fall risk awareness questionnaire did not predict incident falls or injurious falls. Fall risk awareness is low in older adults. Although person-centered fall risk awareness is not predictive of falls, subjective risk perceptions should be considered when designing fall preventive strategies because they may influence participation and behaviors.

A simple test of choice stepping reaction time for assessing fall risk in people with multiple sclerosis

Purpose To determine (a) the discriminant validity for established fall risk factors and (b) the predictive validity for falls of a simple test of choice stepping reaction time (CSRT) in people with multiple sclerosis (MS). Method People with MS (n = 210, 21–74y) performed the CSRT, sensorimotor, balance and neuropsychological tests in a single session. They were then followed up for falls using monthly fall diaries for 6 months. Results The CSRT test had excellent discriminant validity with respect to established fall risk factors. Frequent fallers (≥3 falls) performed significantly worse in the CSRT test than non-frequent fallers (0–2 falls). With the odds of suffering frequent falls increasing 69% with each SD increase in CSRT (OR = 1.69, 95% CI: 1.27–2.26, p = <0.001). In regression analysis, CSRT was best explained by sway, time to complete the 9-Hole Peg test, knee extension strength of the weaker leg, proprioception and the time to complete the Trails B test (multiple R2 = 0.449, p < 0.001). Conclusions A simple low tech CSRT test has excellent discriminative and predictive validity in relation to falls in people with MS. This test may prove useful in documenting longitudinal changes in fall risk in relation to MS disease progression and effects of interventions.Implications for rehabilitationGood choice stepping reaction time (CSRT) is required for maintaining balance.A simple low-tech CSRT test has excellent discriminative and predictive validity in relation to falls in people with MS.This test may prove useful documenting longitudinal changes in fall risk in relation to MS disease progression and effects of interventions

The MOBILIZE Boston Study: design and methods of a prospective cohort study of novel risk factors for falls in an older population.

BackgroundFalls are the sixth leading cause of death in elderly people in the U.S. Despite progress in understanding risk factors for falls, many suspected risk factors have not been adequately studied. Putative risk factors for falls such as pain, reductions in cerebral blood flow, somatosensory deficits, and foot disorders are poorly understood, in part because they pose measurement challenges, particularly for large observational studies.MethodsThe MOBILIZE Boston Study (MBS), an NIA-funded Program Project, is a prospective cohort study of a unique set of risk factors for falls in seniors in the Boston area. Using a door-to-door population-based recruitment, we have enrolled 765 persons aged 70 and older. The baseline assessment was conducted in 2 segments: a 3-hour home interview followed within 4 weeks by a 3-hour clinic examination. Measures included pain, cerebral hemodynamics, and foot disorders as well as established fall risk factors. For the falls follow-up, participants return fall calendar postcards to the research center at the end of each month. Reports of falls are followed-up with a telephone interview to assess circumstances and consequences of each fall. A second assessment is performed 18 months following baseline.ResultsOf the 2382 who met all eligibility criteria at the door, 1616 (67.8%) agreed to participate and were referred to the research center for further screening. The primary reason for ineligibility was inability to communicate in English. Results from the first 600 participants showed that participants are largely representative of seniors in the Boston area in terms of age, sex, race and Hispanic ethnicity. The average age of study participants was 77.9 years (s.d. 5.5) and nearly two-thirds were women. The study cohort was 78% white and 17% black. Many participants (39%) reported having fallen at least once in the year before baseline.ConclusionOur results demonstrate the feasibility of conducting comprehensive assessments, including rigorous physiologic measurements, in a diverse population of older adults to study non-traditional risk factors for falls and disability. The MBS will provide an important new data resource for examining novel risk factors for falls and mobility problems in the older population.

Risk factors for falls in older disabled women with diabetes: the women's health and aging study.

The aim of this study was to determine whether older disabled women with diabetes have an increased risk of falls compared to women without diabetes and to identify fall risk factors among this high-risk subgroup of patients. Data are from the Women's Health and Aging Study I (n = 1002, age > or = 65 years), a prospective, population-based cohort study of the one third most disabled women in the Baltimore (MD) urban community-dwelling population. Participants were followed semiannually for 3 years. Falls were ascertained at each interview. Diabetes was ascertained by means of a standardized algorithm using multiple sources of information. Baseline prevalence of diabetes was 15.5%. Of the 878 women who participated in at least one follow-up visit and were able to walk at baseline, 64.9% fell at least once during the study and 29.6% experienced two or more falls during a follow-up interval. After adjustment for traditional risk factors, women with diabetes had a higher probability of any fall (odds ratio [OR] 1.38; 95% confidence interval [CI], 1.04-1.81) and of falling two or more times during a follow-up interval (OR 1.69; CI, 1.18-2.43), compared with women without diabetes. Among diabetic women, presence of widespread musculoskeletal pain (OR 5.58; CI, 1.89-16.5), insulin therapy (OR 2.02; CI, 1.10-3.71), overweight (OR 3.50; CI, 1.21-10.1), and poor lower-extremity performance (OR 7.76; CI, 1.03-58.8) were independently associated with increased likelihood of recurrent falls, after adjusting for major risk factors. There were synergistic effects of diabetes and lower-extremity pain and also diabetes and body mass index levels on the risk of falling (p for interactions <.05). Even among disabled older women diabetes is associated with an increased risk of falling, independent of established fall risk factors. In this specific group of older women, pain, high body mass index, and poor lower-extremity performance are powerful predictors of falling.

Older women with osteoporosis have increased postural sway and weaker quadriceps strength than counterparts with normal bone mass: overlooked determinants of fracture risk?

Fracture risk is determined by both bone health and fall risk. Evidence suggests that older women with osteoporosis may have a greater risk of falling compared with their age-matched counterparts without osteoporosis ( 1). To determine whether fall risk screening should be a routine part of medical assessment in older women with osteoporosis, a comparison of fall risk between those with osteoporosis and healthy age-matched counterparts is needed. The purpose of this study was to compare 3 established fall risk factors between these 2 groups of women. 42 women between the ages of 64 and 75 years old participated in this study. 21 women with osteoporosis were matched by age and current physical activity level to 21 women without osteoporosis. The performance on 3 fall risk factors (quadriceps strength, balance, and functional mobility) was compared between the 2 groups using multivariate analysis of variance. The level of significance was set at p <or=.05. There was an overall difference between the 2 groups on the fall risk factors (Wilk's lambda = 0.769, p =.018). Dominant quadriceps strength and composite balance score were, respectively, 18% significantly less and 11% worse in women with osteoporosis than those without. Functional mobility was not significantly different between the 2 groups. This study highlights older women with osteoporosis as a high fracture risk group due to having both lower bone density, and possibly, higher fall risk compared with their age-matched counterparts without osteoporosis. Both fall risk screening and fall risk reduction may be prudent to prevent fractures in women with osteoporosis.