Risk factors in falls among the elderly according to extrinsic and intrinsic precipitating causes.

The aim of this prospective cohort study was to identify the risk factors involved in falls in 190 elderly residents of two geriatric centres in Granada (Andalusia, Spain). Because different types of falls may be associated with different factors, falls were classified according to the precipitating cause, either extrinsic or intrinsic. The incidence density and the ratios for crude and adjusted density were calculated. Cox proportional risk analysis was used to calculate adjusted incidence density ratios. Of the 121 falls identified, 63 (52.1%) had a extrinsic precipitating cause, 43 (35.5%) had an intrinsic precipitating cause, and no precipitating cause was determined in 15 falls. The rate of falls with an extrinsic precipitating cause was 0.39 per person per year, while falls with an intrinsic precipitating cause showed a frequency of 0.27 per person per year. For falls with an extrinsic precipitating cause, the most significant risk factors were: age, diabetes mellitus, a history of falling, and treatment with neuroleptics or oral bronchodilators. The number of illnesses acted as a protective factor. For falls with an intrinsic precipitating cause, the independent risk factors were: age, diabetes, dementia, alterations of gait and balance, previous falls, and treatment with digitalins, neuroleptics or antidepressants. These results suggest that the susceptibility to a fall with an intrinsic precipitating cause is easier to identify and has a greater potential for being controlled.

[Risk factors associated with falls in institutionalized elderly population. A prospective cohort study]. / Factores de riesgo de caídas en una población anciana institucionalizada. Estudio de cohortes prospectivo.

BACKGROUND: Falls in elderly subjects are a frequent cause of morbidity and mortality. The present study investigated risk factors associated with falls in institutionalized elderly subjects. PATIENTS AND METHODS: The subjects of this prospective cohort study were 190 persons aged 65 years or older, who were able to walk unassisted. We recorded sociodemographic variables, morbidity, drugs, functional capacity, cognitive status, gait and balance. Crude and adjusted density ratios (DR) were calculated and Cox proportional risk analysis was performed. RESULTS: A total of 121 falls occurred in 7 persons, for a fall rate of 0.75 per person per year. Independent risk factors identified with multivariate analysis were diabetes mellitus (DR = 3.6), slow gait (DR = 1.7), failed Romberg test (DR = 3.2) and fall(s) during the previous 12 months (DR = 1.9). Drugs that were associated with significant risk were digitalis, antiarrhythmics, neuroleptics, antidepressants and oral bronchodilators. A higher number of chronic diseases acted as a protective factor. CONCLUSIONS: The main risk factors associated with falls in elderly were easy to identify. Analysis of these factors can help to identify elderly persons with a high risk of falls, and thus focus appropriate preventive measures on these subjects.

[Frequency, characteristics and consequences of falls in a cohort of institutionalized elderly patients]. / Frecuencia, características y consecuencias de las caídas en una cohorte de ancianos institucionalizados.

OBJECTIVE: Falls in the elderly are a major problem because of their high morbility and mortality rates and health expenditures. However, there are few studies about this problem in our country. The purpose of the present study was to know the frequency, features and consequences of falling among institutionalized elders. METHODS: We carried out a prospective cohort study using a sample of 190 persons aged 65 years and older living in two nursing homes. All subjects underwent a comprehensive evaluation at the onset of the study. During a mean follow-up period of 310 days, all falls were recorded. RESULTS: There were a total of 121 falls in 72 (37.9%) subjects, twenty five of whom (34.7%) experienced two or more falls. The fall incidence per person-year was 0.75. As compared with males, females had a density ratio (DR) of 2 (1.2-3.2; 95% confidence interval-CI). Falling was more frequent in the bedrooms and living rooms (43.8%). DISCUSSION: This results agree with others studies about the high fall incidence in the elderly and bring out new features about circumstances and consequences of falls.