The prevalence, characteristics and correlates of falls in Korean community-dwelling older adults

Prevalence of falls, injury from falls and associations with chronic diseases among community-dwelling older adults in Guangzhou, China: a cross-sectional study

Introduction

As a developing country with the largest older adult population in the world, strengthening the research on falls among the older adults is undoubtedly an urgent item in China. This study aimed to explore the prevalence and risk factors associated with falls and injury from falls among community-dwelling older adults in Guangzhou, China, particularly focusing on their associations with chronic diseases.

Methods

A total of 1,629 participants aged 65 years and above were selected from 11 counties in Guangzhou by the multi-stage stratified random sampling method in 2021. Socio-demographic characteristics, health and lifestyle factors, the status of falls, and injury from falls were measured by structured questionnaires through face-to-face interviews. Chi-square tests and logistic regression analysis were used to identify factors associated with falls and injury from falls. Chord diagrams were used to explore their associations with chronic diseases.

Results

A total of 251 participants (15.41%, 95% CI: 13.98%-17.25%) reported falls, and 162 participants (9.46%, 95% CI:7.72%-11.55%) indicated an injury from falls. Logistic regression analysis showed the results as follows: female patients (adjusted OR = 1.721, 95% CI: 1.681-1.761) aged ≥80 years (1.910, 1.847-1.975), unemployed (1.226, 1.171-1.284), uninsured (1.555, 1.448-1.671), average monthly household income of 2,001-4,000 CNY (1.878, 1.827-1.930), number of services provided by the community health center ≥13 times per year (1.428, 1.383-1.475), illness within 2 weeks (1.633, 1.595-1.672), high-intensity physical activity (2.254, 2.191-2.32), sedentary (1.094, 1.070-1.117), and number of chronic disease illnesses ≥3 (1.930, 1.870-1.993). Meanwhile, those risk factors were also associated with injury from falls. The older adults with medium-intensity physical activity were at lower risk (0.721, 0.705-0.737) of falls and higher risk (1.086, 1.057-1.117) of being injured from falls. Chord diagrams showed the correlations between chronic diseases and falls and injury from falls among community-dwelling older adults in Guangzhou, China.

Conclusion

The high prevalence of falls is found among community-dwelling older adults in Guangzhou, China, which is related to multiple factors such as demographic variables, lifestyle, and health status, especially for chronic diseases. Therefore, targeted interventions should be developed and implemented urgently.

Global prevalence of falls in the older adults: a comprehensive systematic review and meta-analysis

BACKGROUND

With increasing life expectancy, declining mortality, and birth rates, the world's geriatric population is increasing. Falls in the older people are one of the most common and serious problems. Injuries from falls can be fatal or non-fatal and physical or psychological, leading to a reduction in the ability to perform activities of daily living. The aim of this study was to determine the prevalence of falls in the older people through systematic review and meta-analysis.

METHODS

In this systematic review and meta-analysis, the data from studies on the prevalence of falls in the older people in the world were extracted in the databases of Scopus, Web of Science (WoS), PubMed and Science Direct, and Google Scholar, Magiran and Scientific Information Database (SID) without any time limit until August 2020. To analyze the eligible studies, the stochastic effects model was used, and the heterogeneity of the studies with the I² index was investigated. Data analysis was conducted with Comprehensive Meta-Analysis software (Version 2).

RESULTS

In the review of 104 studies with a total sample size of 36,740,590, the prevalence of falls in the older people of the world was 26.5% (95% CI 23.4-29.8%). The highest rate of prevalence of falls in the older people was related to Oceania with 34.4% (95% CI 29.2-40%) and America with 27.9% (95% CI 22.4-34.2%). The results of meta-regression indicated a decreasing trend in the prevalence of falls in the older people of the world by increasing the sample size and increasing the research year (P < 0.05).

CONCLUSION

The problem of falls, as a common problem with harmful consequences, needs to be seriously considered by policymakers and health care providers to make appropriate plans for preventive interventions to reduce the rate of falls in the older people.

Prevalence, Circumstances, and Risk Factors of Falls Among Community Dwelling Members of University of the Third Age

Objective: Study aimed to identify the prevalence of falls and associated contributory factors among older Malaysians.

Methods: A cross sectional study among community dwelling older adults aged 50 years and above. Self-administered questionnaires on history of falls in the previous 12 months, physical assessment and computerized and clinical measures of balance were assessed on a single occasion.

Results: Forty nine (31.0%) participants fell, with 4.4% reported having multiple falls within the previous 12 months. Slips were the most prevalent cause of falls, accounting for 49% of falls. More than half (54.5%) of falls occurred in the afternoon while participants walked inside the home (32.7%), outside home (30.6%), and 36.7% were in community areas. More than half of respondents were identified as having turning instability. Step Test, turn sway, depression, physical activity level and edge contrast sensitivity were significantly worse for fallers (p < 0.05). Multiple logistic regression analysis showed that turning performance, visual acuity and back pain were significantly associated with falls risk, accounting for 72% of the variance of risk factors for falls among studied population.

Conclusion: Falls are common among community dwelling older Malaysians. The findings provide information of falls and falls risk factors among community dwelling older adults in Malaysia. Future intervention studies should target locally identified falls risk factors. This study has highlighted the importance of instability during turning as an important fall risk factor.

Relationships Between Neighborhood Social Capital and The Occurrence of Outdoor Falls in Canadian Older Adults: A Multilevel Analysis

OBJECTIVE

The aim of this study was to examine whether neighborhood-level social capital is a risk factor for falls outside of the home in older adults.

METHODS

Health questionnaires were completed by community-dwelling Canadians aged +65 years living in Kingston (Ontario) and St-Hyacinthe (Quebec), supplemented by neighborhood-level census data. Multilevel logistic regression models with random intercepts were fit. Variations in the occurrence of falls across neighborhoods were quantified by median odds ratio and 80% interval odds ratio.

RESULTS

Between-neighborhood differences explained 7% of the variance in the occurrence of falls; this variance decreased to 2% after adjustment for neighborhood-level variables. In the fully adjusted models, higher levels of social capital increased the odds of falls by almost 2 times: (odds ratio [OR] = 2.10, 95% confidence interval [CI] = [1.19, 3.71]).

DISCUSSION

Living in neighborhoods with higher levels of social capital was associated with higher risk of falling in older adults, possibly through more involvement in social activities.

Longitudinal Trends in Fall Accidents in Community Dwelling Korean Adults: The 2008-2013 Korean Community Health Survey

Objective

To describe the longitudinal characteristics of unintentional fall accidents using a representative population-based sample of Korean adults.

Methods

We examined data from the Korean Community Health Survey from 2008 to 2013. Univariate analysis and multivariable logistic regression were used to identify the characteristics of fall accidents in adults.

Results

Between 2008 and 2013, the incidence rate of fall accidents requiring medical treatment increased from 1,248 to 3,423 per 100,000 people (p<0.001), while the proportion of indoor fall accidents decreased from 38.12% to 23.16% (p<0.001). Females had more annual fall accidents than males (p<0.001). The major reason for fall accidents was slippery floors (33.7% in 2011 and 36.3% in 2013). Between 2008 and 2010, variables associated with higher fall accident risk included specific months (August and September), old age, female gender, current drinker, current smoker, diabetes, osteoarthritis, osteoporosis, and depression. A high level of education and living with a partner were negatively associated with fall accident risk. In 2013, people experiencing more than 1 fall accident felt more fear of falling than those having no fall accidents (odds ratio [OR] for 1 fall, 2.12; 95% confidence interval [CI], 2.04–2.12; OR for more than 2 falls, 2.97; 95% CI, 2.83–3.10).

Conclusion

The occurrence of fall accidents has consistently increased in Korea from 2008 to 2013. Future intervention studies are needed to reduce the increasing incidence rates of fall accidents in community dwelling adults.

Medications associated with falls in older people: systematic review of publications from a recent 5-year period

PURPOSE

Falls are an important public health problem in older people. Medication use is considered a risk factor for falls. This study systematically reviewed recent studies to determine the medications that might be associated with the risk of falling in older people.

METHODS

We conducted a systematic review of prospective and retrospective studies identified through the MEDLINE and CINAHL databases that quantitatively assessed the contribution of medications to falls risk in participants ≥60 years old published in English between May 2008 and April 2013.

RESULTS

The search identified 1,895 articles; 36 articles met the inclusion criteria. Of the 19 studies that investigated the effect of polypharmacy on the risk of falling, six studies reported that the risk of falling increased with polypharmacy. Data on the use of antihypertensive medications including calcium channel blockers, beta-blockers, and angiotensin system blocking medications were collected in 14 studies, with mixed results. Twenty-nine studies reported an association between the risk of falls and psychotropic medications including sedatives and hypnotics, antidepressants, and benzodiazepines.

CONCLUSIONS

The use of sedatives and hypnotics and antidepressants including tricyclic antidepressants, selective serotonin reuptake inhibitors, and serotonin norepinephrine reuptake inhibitors appears to be related with an increased risk of falls. It is not clear if the use of antihypertensive medications is associated with the risk of falls in older people.

Fall risk factors in community-dwelling elderly depending on their physical function, cognitive status and symptoms of depression

Falls are the leading cause of unintentional injuries and injury-related disability, morbidity and mortality in the geriatric population. Therefore, they may also lower quality of life. The aim of this study was to analyze the fall risk factors in the community-dwelling elderly depending on their physical function, cognitive status and symptoms of depression. The study involved 304 individuals aged 65–100 years with a mean age of 78.6 ± 7.4. This survey-based study was conducted using the Geriatric Environmental Inquiry, the Barthel Scale (BS), the Abbreviated Mental Test Score (AMTS), the Geriatric Depression Scale (GDS) and the Tinetti Test (TT). There was a statistically significant correlation between the BS, the TT and the incidence of falls (p < 0.05). The number of falls correlated significantly with the results of the BS (R = −0.39), the GDS (R = 0.18), and the TT (R = −0.40). A statistically significant correlation was also noted between the TT results and the results of the BS (R = 0.77), the AMTS (R = 0.40) and the GDS (R = −0.37). The incidence of falls may significantly increase in people with a lower functional status, which may be related to cognitive process disturbances and lower affective functioning. A comprehensive geriatric assessment, related to all aspects of advanced-age patients’ efficiency, is recommended. Fall prevention strategies should include actions undertaken to evaluate and treat depression and cognitive disturbances.

Zero-Inflated Poisson Modeling of Fall Risk Factors in Community-Dwelling Older Adults

The aim of this study was to identify risk factors for falls among community-dwelling older adults. The study used a cross-sectional descriptive design. Self-report questionnaires were used to collect data from 658 community-dwelling older adults and were analyzed using logistic and zero-inflated Poisson (ZIP) regression. Perceived health status was a significant factor in the count model, and fall efficacy emerged as a significant predictor in the logistic models. The findings suggest that fall efficacy is important for predicting not only faller and nonfaller status but also fall counts in older adults who may or may not have experienced a previous fall. The fall predictors identified in this study--perceived health status and fall efficacy--indicate the need for fall-prevention programs tailored to address both the physical and psychological issues unique to older adults.

Functional status and prevalence of falls and fractures in population-based sample of postmenopausal women from the RAC-OST-POL Study

BACKGROUND

Prevalence of osteoporotic fractures and falls, and functional status may be related with each other.

OBJECTIVE

The aim of the study was to assess functional status and prevalence of falls and fractures in Polish postmenopausal women in a representative, randomly selected population sample from RAC-OST-POL Study.

DESIGN

Population-based epidemiological study.

SETTING

Raciborz city and district, Poland.

PARTICIPANTS

The study included 618 postmenopausal women aged ≥ 55 years (mean age 66.3 ± 7.8 years).

MEASUREMENTS

Data concerning falls, fractures etc. were collected using on a questionnaire. Functional assessment was carried out using Instrumental Activity of Daily Living (IADL) Lawton's test and 'Stand up & go' (SUG) test. Skeletal status was assessed using DXA at the hip and with phalangeal quantitative ultrasound (QUS).

RESULTS

Fifty-six per cent of studied women have got a reduced mobility estimated using SUG test (time > 10 s). Functional independence level estimated using IADL test is reduced among 14% of women (≤ 23 points). Twenty-eight per cent of women sustained osteoporotic fracture and 34% of women have got a positive fall history in the last year. The number of falls or fractures correlates significantly with results of IADL and SUG tests. Functional status of women who fell or sustained fracture was significantly decreased in comparison with women without falls or fractures. The significant factors increasing the risk of fall are: presence of depression, presence of chronic disease and a reduced functional independence. The significant factors increasing the risk of fractures are: history of fall, age, T-score value for trochanter bone mineral density.

CONCLUSION

Results of the study indicate that functional status plays an important role as a factor increasing the risk of falls and fractures in postmenopausal women.

Prevalencia de quedas de idosos em situacao de fragilidade

OBJETIVO: Analisar a prevalência de quedas em idosos frágeis, suas consequências e fatores demográficos associados. MÉTODOS: Estudo epidemiológico e transversal com amostra probabilística de 240 idosos em Ribeirão Preto, SP. A coleta de dados foi realizada no período de novembro de 2010 a fevereiro de 2011. Foi aplicado questionário que incluiu dados sociodemográficos, avaliação de quedas e a Escala de Fragilidade de Edmonton. Foram realizadas análises uni e bivariada. RESULTADOS: A média de idade foi de 73,5 (dp=:8,4) anos, maior no sexo feminino; 25% dos entrevistados tinham idade ≥ 80 anos; 11,3% apresentaram fragilidade moderada e 9,6% fragilidade severa. A prevalência de quedas no idoso frágil foi de 38,6%, maior no sexo feminino e nos idosos mais jovens (60 a 79 anos); 26,8% sofreram de uma a duas quedas, 27,1% ocorreram no dormitório, 84,7% caíram da própria altura, 55,9% apresentaram alteração do equilíbrio, 54,2% sofreram escoriações e 78% apresentaram medo de sofrer nova queda; houve maior chance de queda no idoso frágil 1,973 (1,094;3,556) quando comparado ao não frágil. CONCLUSÕES: É necessária a abordagem da saúde do idoso frágil, principalmente quanto ao risco de quedas, maior investimento nas estratégias de prevenção dessas síndromes e na formação de recursos humanos preparados para melhor atender essa população.

Accidental falls in the elderly and their relation with functional capacity

AIM: This study aimed to determinate the prevalence of falls in the elderly and its relationship with the functional capacity. METHOD: This is an epidemiological and cross-sectional study; a two-stage cluster sample of 240 male and female subjects aged over 60 years was used. Data were collected from November 2010 to February 2011. The following questionnaires were used: socio-demographic profile, assessment of falls, Functional Independence Measure, Lawton and Brody Scale. Significance was set at 0.05. To identify the occurrence of falls and their relation with functional capacity, the prevalence ratio and prevalence odds ratios were used, as well as multiple logistic regression. RESULTS: Average age was 73.5 years (±8.4); 25% 80 years or more, with preponderance of female gender; 48.8% attended school between 1-4 years. The average was 1.33 falls (±0.472), with prevalence in women and elderly between 60 and 79 years old; the most frequently sites were the backyard and bathroom. Strong correlation between the level of functional independence and instrumental activities and age was found, but no relation between elderly victims of falls and the gender and age variables. CONCLUSION: Women who suffered falls related to functional independence were predominant, which can be prevented through elderly health promotion strategies, a policy that serves to offer living conditions to people in the aging process.

Alternative view of health behavior: the experience of older Korean women

In this study we explored the perspectives of older Korean women on the principles and meanings of health behavior. Participants were 12 women age 65 and older, with no serious illnesses requiring hospitalization, who were living independently. We used an interpretative phenomenological approach for data collection and analysis. Seven themes emerged: (a) eating well in accordance with one's physical requirements; (b) maintaining one's inherited health; (c) controlling one's illness properly; (d) maintaining good relationships with close relatives and friends; (e) being modest and free from greed; (f) staying in harmony with nature; and (g) regaining energy and vitality. These experiences were mainly based on the traditional Korean concept of health promotion, "food is medicine," rather than on Western concepts of health promotion. In providing optimal geriatric nursing care for Korean older women, the results will be significant because they are based on older women's traditional Korean perspectives of health promotion rather than existing perspectives of Western medicine.