Original article
Fall-risk screening test: A prospective study on predictors for falls in community-dwelling elderly

https://doi.org/10.1016/S0895-4356(01)00349-3Get rights and content

Abstract

This large prospective cohort study was undertaken to construct a fall-risk model for elderly. The emphasis of the study rests on easily measurable predictors for any falls and recurrent falls. The occurrence of falls among 1285 community-dwelling elderly aged 65 years and over was followed during 1 year by means of a “fall calendar.” Physical, cognitive, emotional and social functioning preceding the registration of falls were studied as potential predictors of fall-risk. Previous falls, visual impairment, urinary incontinence and use of benzodiazepines were the strongest predictors identified in the risk profile model for any falls (area under the curve [AUC] = 0.65), whereas previous falls, visual impairment, urinary incontinence and functional limitations proved to be the strongest predictors in the model for recurrent falls (AUC = 0.71). The probability of recurrent falls for subsequent scores of the screening test ranged from 4.7% (95% Confidence Interval [CI]: 4.0–5.4%) to 46.8% (95% CI: 43.0–50.6%). Our study provides a fall-risk screening test based on four easily measurable predictors that can be used for fall-risk stratification in community-dwelling elderly.

Introduction

Falls leading to physical trauma and restriction of activity are among the principal causes of morbidity in the elderly [1]. Thirty percent of people over the age of 65 years who live in the community fall at least once per year and this proportion increases strongly with age 2, 3, 4. About 40% of all serious fall injuries among elderly resulted in hospital admission and after hospitalization, 30–40% of these patients are transferred to a nursing home [5]. As a consequence, the health care costs associated with falls and fall-related injuries are high [6]. Serious injuries caused by a fall include fractures, joint dislocations, and head trauma. Psychological trauma such as fear of falling is another consequence of falls which may lead to self-imposed restrictions in activity and, consequently, loss of independence 3, 7.

Falls are a multicausal phenomenon with a complex interaction between intrinsic (within-subject) factors and extrinsic or environmental factors 8, 9. About 50% of fallers in the community experience two or more falls per year [4]. Elderly with multiple falls need extra attention of health professionals because multiple fallers in general have a worse health status and significantly more intrinsic predictors than single fallers 4, 10, 11. The most important intrinsic predictors for falls have been shown to be decreased mobility, cognitive impairment, use of medication, depression, urinary incontinence, stroke, postural hypotension, dizziness, fear of falling, impaired vision, and a history of previous falls 2, 10, 12, 13. Many, but not all, of these predictors are clues for prevention. A multiple predictor intervention strategy appears to be effective in reducing the risk of further falls and limiting functional impairment. Several studies among elderly living in the community have shown that the rate of falling in the group assigned to such an intervention was 9–20% lower than that in the control group 14, 15, 16, 17, 18.

However, because of feasibility, efficiency, and cost-effectiveness, intervention should preferably be focussed on people at high risk for falls. Selection of community-dwelling elderly with a high risk of falling is difficult. Several studies on the prediction of falls and recurrent falls in elderly people have been published 13, 19, although mostly without evidence of feasibility. The aim of the present study, using data from a large prospective cohort of elderly, including similar numbers of men and women, is to develop a fall-risk screening test for community-dwelling older adults. The screening procedure in this study is based on simple predictors, which can be measured without much effort. The emphasis of this study, embedded in the multidisciplinary Longitudinal Aging Study Amsterdam (LASA), rests on identifying subgroups with highest risk and not on the identification of causal risk factors.

Section snippets

Subjects

The study was conducted within the framework of the Longitudinal Aging Study Amsterdam (LASA), a 10-year multidisciplinary cohort study on predictors and consequences of changes in autonomy and well-being in the aging population in the Netherlands [20]. A random sample of older men and women (aged 55–85 years) stratified by age, sex, and expected mortality, was drawn from the population registers of 11 municipalities, in three regions of the Netherlands. The sample represents the older Dutch

Results

The mean age was 75.2 (6.5 years, range 64.8–88.6 years). The cumulative incidences of any falls and recurrent falls in 1-year of follow-up for women and men are shown in Table 1. At least one fall occurred in 33.3% (95% CI: 30.7–35.9%) of the participants. Single falls were reported by 21.9% (95% CI: 19.6–24.2%) and recurrent falls by 11.4% (95% CI: 9.7–13.1%) of the participants. The difference of the cumulative incidence of recurrent falls between women and men was not significant, whereas

Discussion

In this large prospective cohort study of 1285 participants, subgroups with the highest risk for falls were identified. In contrast to most other studies, the population sample in this study includes similar numbers of women and men and, moreover, this study considers a multidisciplinary set of easily measurable study variables as possible predictors of falls. Multiple regression analyses identified four predictors that were significantly associated with recurrent falls: previous falls, urinary

Acknowledgements

The authors thank Nel van de Kreeke, Els Lommerse, Jan Poppelaars, Maarten de Vries and Mariëtte Westendorp for their help in collecting and processing the data. The study is based on data collected in the context of the Longitudinal Aging Study Amsterdam (LASA), which is funded by the Ministry of Health, Welfare, and Sports of the Netherlands. The study on falls was supported by the Praeventiefonds, The Hague. Informed consent was obtained from all participants and the study was approved by

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