Risk factors for falls in the Thai elderly in an urban community.

BACKGROUND: Instability or falls in the elderly are a health condition meeting all criteria for prevention i.e. high frequency, evidence of preventability and a high burden of morbidity. The consequences of a fall affect not only the elderly per se such as fractures and various kinds of physical and mental impairment, but also the family and the society as a whole in terms of the financial expenditure involved. The need for a comprehensive study to identify the risk factors for falls among the Thai elderly is, therefore, crucial for further management. OBJECTIVE: To identify the significant risk factors for falls among the Thai elderly for further prevention and management. METHOD: A cross-sectional study in the urban community around Siriraj Hospital, Bangkok. 1,043 community-dwelling people aged > or = 60 years were recruited. A structured questionnaire, including mental test and physical examinations as well as various laboratory tests, were used to identify the risk factors for falls between faller and control groups. RESULTS: The overall prevalence of falls among elderly Thais in an urban area was 19.8 per cent during a period of 6 months. However, the prevalence was 24.1 per cent in women but only 12.1 per cent in men. Older people who were likely to fall also had a lower bone mass which predisposed them to future fractures. The independent risk factors for falls after multiple logistic regression analysis were: female gender, hypertension, deafness, poor memory, poor self-perceived health status, poor performance in the instrumental activities of daily living, kyphoscoliosis, use of spectacles, rapid pulse rate after a 5 minute rest, higher serum transferrin and poor nutrition in terms of low lean body mass and reduced serum albumin level. CONCLUSIONS: Special sense, activity of daily living, nutritional status, kyphoscoliosis, hypertension and cognitive ability were six important factors determining the likelihood of fall among the elderly in an urban area.

Strategy to prevent falls in the Thai elderly: a controlled study integrated health research program for the Thai elderly.

Instability or falls are one of the important warning symptoms of underlying serious illness among the elderly, so many studies have concentrated on the risk factors for falls. However, a study involving a strategic method to reduce the incidence of falls is the next step and is the main objective of this study. 1,043 elderly subjects living in the urban area around Siriraj Hospital Medical School, Bangkok, were recruited, 585 of them were allocated to the study group and 458 subjects to the control group. A leaflet containing information on important risk factors of falls within their community was enclosed with a follow-up postcard in the study group only. In addition, this particular group was allowed free access to the geriatric clinic at Siriraj Hospital if there was any health problem. All of them received a postcard asking about any falls which had occurred over the previous 2 months on 6 occasions and a telephone call if the postcards were not returned to the team. The percentage of elderly who kept in contact was 92.5 per cent, 90.6 per cent, 89.3 per cent, 89.2 per cent, 86.2 per cent and 85.45 per cent for the first to final follow-up respectively. After one year of longitudinal study, the overall incidence of falls was 6.6 per cent in the study group and 10.1 per cent in the control group. The incidence of falls began to show a statistically significant difference between the two groups at the fourth and sixth episodes of follow-up (P = 0.002 and 0.004). The Kaplan-Meier survival analysis also revealed a statistically significant difference in the incidence of falls between the two groups (P =0.01). In conclusion, the incidence of falls was significantly reduced in the study group and a repeated campaign to alert the elderly to the risk of falling is a cost-effective way of fall prevention among the healthy elderly in the community.

Health status of Siriraj Hospital's nurses: Uncover the underlying health problems.

Health care providers' exposure to the hospital environment including infectious diseases and lack of self-awareness of illnesses may lead to critical health problems. The present cross sectional study was conducted to survey the magnitude of health problems in nurses at Siriraj Hospital. The study population included 1,435 nurses, 1,366 female and 69 male, with an average age of 44 ฑ 6 (range 30-60) years. Results of the study showed that 5.7 % of subjects had high fasting plasma glucose (FPG), 59.4 % had hypercholesterolemia (cholesterol > 200 mg/dl) and 6.0 % had hypertriglyceridemia (triglyceride > 200 mg/dl). Isolated hypercholesterolemia and isolated hypertriglyceridemia were found in 54.4 % and 1.0 % respectively. Combined hypercholesterolemia with hypertriglyceridemia was found in 5.0 %. Hyperuricemia was found in 8.2 % of subjects. Serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels of more than 2 times the upper normal limit were found in 0.4 % and 1.5 % respectively. Serum alkaline phosphatase of more than the upper normal limit was found in 4.2 %. Anemia was found in 24.9% of cases. Abnormal chest x-ray findings including nodules, calcification, infiltration, fibrosis and effusion were found in 4.5 %. This study uncovered underlying health problems in the majority of the population of health care providers at Siriraj Hospital, who were presumed to be healthy. The most frequent finding was dyslipidemia, which was found in more than half of the study population. This abnormality may lead to more serious illnesses especially cardiovascular diseases. More intensive study is required to determine the associated factors and to find the appropriate strategy in managing this problem on the basis.