Morbilidad, factores de riesgo y consecuencias de las caídas en ancianos

Risk Factors and Number of Falls as Determinants of Quality of Life of Community-Dwelling Older Adults

BACKGROUND AND PURPOSE

In older adults, the psychological impact and effects related to the loss of functional capacity are directly related to perceived quality of life (QOL). The predictors of better QOL are increased physical activity, lower prevalence of overweight, lower cases of depression, and lower rate of reported alcohol abuse. On the contrary, the predictors of decreased QOL are female gender, comorbidity, deficient nutritional condition, polypharmacy, loss of mobility, depression and dependency, poor economic conditions, and social isolation and loneliness. Furthermore, QOL in older adults is more dependent on the number of falls than comorbidity. The objective was to investigate the determinants of perceived QOL among independent community-dwelling older adults and to quantify the influence of number of falls and number of risk factors on QOL.

METHODS

This is a cross-sectional study of 572 older adults (>70 years of age) seen in 10 primary care centers in La Ribera, Valencia, Spain. Comprehensive geriatric assessment was done by 4 nurses in primary care centers. Functional status and sociodemographic and clinical variables were collected. Quality of life was assessed with the EQ-5D scale.

RESULTS

Females predominated (63.3%). Mean age (standard deviation) was 76.1 (3.9) years. The male gender (β = .09; 95% confidence interval [CI]: 0.05-0.13) was found to be predictive of better QOL, together with physical activity (β = .04; 95% CI: 0.02-0.06), while the use of drugs affecting the central nervous system (β = -.08; 95% CI: -0.12 to -0.03), overweight (β = -.06; 95% CI: 0.1 to - 0.02), comorbidity (β = -.09; 95% CI: -0.13 to -0.05), the presence of fall risk factors (β = -.02; 95% CI: -0.03 to 0.01), and the number of previous falls (β = -.03; 95% CI: -0.06 to 0.01) had a negative impact upon the EQ-5D Index score.

CONCLUSIONS

If perceived QOL is used as an indicator of the success of intervention programs, certain factors accompanying the adoption of measures for the prevention of falls may mask the results (failure or success) of the intervention. Because most determinants of QOL are modifiable and physical activity has the potential to improve QOL, this research suggests that physical activity programs should be a component of health care for older adults.

Characteristics, consequences and prevention of falls in institutionalised older adults in the province of Malaga (Spain): a prospective, cohort, multicentre study

OBJECTIVES

Falls are an important adverse event among institutionalised persons. It is in this clinical setting where falls occur more frequently than in any other, despite the measures commonly taken to prevent them. This study aimed to determine the characteristics of a typical institutionalised elderly patient who suffers a fall and to describe the physical harms resulting from this event. We then examined the association between falls and the preventive measures used.

METHODS

This was a prospective cohort study in 37 nursing homes in Spain. The participants were all the nursing home residents institutionalised in these centres from May 2014 to July 2016. Participants were followed up for 9 months. During this period, two observations were made to evaluate the preventive measures taken and to record the occurrence of falls.

RESULTS

896 residents were recruited, of whom 647 completed the study. During this period, 411 falls took place, affecting 213 residents. The injuries caused by the falls were mostly minor or moderate. They took place more frequently among women and provoked 22 fractures (5.35%). The most commonly used fall prevention measure was bed rails (53.53% of cases), followed by physical restraint (16.79%). The latter measure was associated with a higher incidence of injuries not requiring stitches (OR=2.06, 95% CI 1.01 to 4.22, P=0.054) and of injuries that did require stitches (OR=3.51, 95% CI 1.36 to 9.01, P=0.014) as a consequence of falls. Bed rails protected against night-time falls.

CONCLUSIONS

Falls are a very common adverse event in nursing homes. The prevention of falls is most commonly addressed by methods to restrain movement. The use of physical restraints is associated with a greater occurrence of injuries caused by a fall.

Changes in health-related quality of life and activities of daily living after hip fracture because of a fall in elderly patients: a prospective cohort study

BACKGROUND

The impact of hip fracture because of a fall on health-related quality of life (HRQoL) and activities of daily living (ADL) have not been well established.

AIM

To evaluate changes in HRQoL and the ability to conduct ADL among patients with hip fracture because of a fall and to compare these changes with patients who did not fall and break a hip, adjusting by gender and age.

METHODS

Adults aged 65 or more who attended the emergency departments of seven public hospitals were recruited in a prospective double-cohort study (fracture cohort, n = 776; non-fracture cohort, n = 115). ADL and HRQoL were assessed at baseline (during the postfall hospitalisation or by telephone afterwards) and 6 months later using the Barthel Index and the Lawton Brody Index for ADL, and the Short Form Health Survey (SF-12) and Western Ontario and McMaster Universities Osteoarthritis Index short form (WOMAC-SF) for HRQoL.

RESULTS

Adjusting by gender, age and baseline status, a hip fracture was a strong predictor of decline in all outcomes measured except for mental quality of life among men (measured by SF-12). Hip fracture patients younger than 74 years reported significantly more pain (measured by WOMAC-SF) than the comparison group (p = 0.02), but this difference was not observed among older patients (p = 0.19 for 75-84 years; p = 0.39 for ≥ 85 years).

DISCUSSION

Hip fractures have profound effects on HRQoL and ADL in both men and women, regardless of age. This indicates the need for special follow-up care of elderly hip fracture patients in the immediate and late postfracture periods.

[Fear of falling]

Fear of falling (FF) can be considered as a protective response to a real threat, preventing the elderly from performing activities with high risk of falling, but can also lead to a restriction of the activities that will result in a long-term adverse effect on social, physical or cognitive functions. There is a prevalence of FF in 30% in the elderly who have no history of falls, and double that in those with a history of falling. Its prevalence is increased in women and with advanced age. Several scales have been developed to measure the psychological effects of FF, among which are noted are, the Fall Efficacy Scale (FES), the Activities-specific Balance and Confidence Scale (ABC), and the survey of activities and fear of falling in the elderly (SAFE). It has negative consequences in the functionality, the subjective feeling of well-being, and in the consequent loss of independence. The functional and physical deterioration, or the quality of life is clearly related to the FF, although it has not been established if these factors are cause or effect. Multiple interventions have been recommended, bringing about changes that reinforce their confidence to carry out activities. Interventions and research should promote a realistic and appropriate approach to the risk of falls and teach the elderly to perform activities safely. The reduction in FF is an important goal in itself to improve the subjective feeling of well-being, and the benefits could be increased if this reduction was also accompanied by an increase in safe behaviour, social participation, and activities of the daily life.