Generic placeholder image

Current Aging Science

Editor-in-Chief

ISSN (Print): 1874-6098
ISSN (Online): 1874-6128

Research Article

Prevalence and Determinants of Falls in Community-dwelling Older Adults in Türkiye: A Population-based Cross-sectional Study Conducted between 2014-2015

Author(s): Nezahat Muge Catikkas*, Tugba Obekli Erdogan, Jean Yves Reginster, Meryem Merve Oren, Caglar Ozer Aydin, Duygu Erbas Sacar, Serdar Ozkok, Cihan Kilic, Mehmet Akif Karan and Gulistan Bahat

Volume 16, Issue 2, 2023

Published on: 20 February, 2023

Page: [133 - 142] Pages: 10

DOI: 10.2174/1874609816666230109153424

Price: $65

Abstract

Purpose: Falls are a common public health problem in older adults regarding increased morbidity, mortality, and healthcare costs. Determining the factors associated with falls is of utmost importance for detecting at risk people. We present here a field study conducted to examine the prevalence of falls and the associated factors among community-dwelling older adults.

Methods: In this population-based cross-sectional study, we included adults aged > 60 years living in the Fatih District of the Istanbul Province between November 2014-May 2015, through a simple random sampling method. We noted age, sex, falls, fear of falling, number of diseases and medications, the presence of diabetes, hypertension, dyslipidemia, urinary and fecal incontinence, and chronic pain. Frailty was assessed with the FRAIL questionnaire. Functional capacity was evaluated by Katz’s 6-item ADL and Lawton Brody’s 8-item IADL scales. The European quality-5 dimension (EQ-5D) questionnaire was used for the quality of life assessment. The cognitive status screening was conducted with a Mini-cog test. Depressive mood was evaluated with the Geriatric Depression scale short form (GDS-SF). Malnutrition screening was conducted by the mini-nutritional assessment short form. Handgrip strength (HGS) was measured with a hand dynamometer. Body composition was assessed through a bioimpedance analysis. The 4-meter usual gait speed was recorded. The European Working Group on Sarcopenia in Older People2 (EWSGOP2) criteria was used for the sarcopenia definition. The Romberg and the postural instability tests were evaluated for balance and gait. Continuous variables were expressed as mean ± standard deviation or median and interquartile range for descriptive statistics, while categorical variables were expressed as the number and percentages. The differences between groups were determined through an independent sample t-test or Mann-Whitney U test when required, and Chi-square and Fisher’s exact tests were applied for categorical variables. A multivariate logistic regression analysis was used to determine the independent factors associated with falls among the factors identified as significant in univariate analyses.

Results: The prevalence of falls was 28.5% [mean age: 75.4 ± 7.3 (range: 61-101 years), 53.6% female], and a significant association was identified between falls and the number of diseases and medications, diabetes, chronic pain, frailty, ADL, IADL, and EQ-5D scores, dementia, GDS-SF score and level of ambulation in univariate analyses (p = 0.001, 0.030, 0.030, 0.010, 0.004, 0.040, 0.007, 0.003, 0.030 and 0.007, respectively). In the multivariate analysis, positive dementia (OR = 3.66, 95% CI = 1.40-9.53; p = 0.010) and frailty screenings (OR =1.47, 95% CI = 1.05-2.06; p = 0.020) were identified as associates of falls.

Conclusion: Falls were independently associated with positive dementia and frailty screening. These results will help develop specific and tailored precautions for at-risk groups to prevent the negative outcomes of falls.

Graphical Abstract

[1]
Ungar A, Rafanelli M, Iacomelli I, et al. Fall prevention in the elderly. Clin Cases Miner Bone Metab 2013; 10(2): 91-5.
[PMID: 24133524]
[2]
Al-Aama T. Falls in the elderly: Spectrum and prevention. Can Fam Physician 2011; 57(7): 771-6.
[PMID: 21753098]
[3]
Yeong UY, Tan SY, Yap JF, Choo WY. Prevalence of falls among community-dwelling elderly and its associated factors: A cross-sectional study in Perak, Malaysia. Malays Fam Physician 2016; 11(1): 7-14.
[PMID: 28461842]
[4]
Galizia G, Abete P, Morrione A. Unexplained falls are frequent in patients with fall-related injury admitted to orthopaedic wards: The UFO study (unexplained falls in older patients). Current Gerontology and Geriatrics Research 2013.
[5]
Jin J. US Preventive Services Task Force. Interventions to prevent falls in community dwelling older adults. JAMA 2018; 319(16): 1696-704.
[PMID: 29710167]
[6]
Karan MA. Falls in older people: Importance, and risk assessment. Aegean J Med Sci 2018; 4: 129-32.
[7]
Ferrari S, Reginster JY, Brandi ML, et al. Erratum to: Unmet needs and current and future approaches for osteoporotic patients at high risk of hip fracture. Arch Osteoporos 2017; 12(1): 25.
[http://dx.doi.org/10.1007/s11657-017-0319-2] [PMID: 28255680]
[8]
Ek S, Rizzuto D, Xu W, Calderón-Larrañaga A, Welmer AK. Predictors for functional decline after an injurious fall: A population-based cohort study. Aging Clin Exp Res 2021; 33(8): 2183-90.
[http://dx.doi.org/10.1007/s40520-020-01747-1] [PMID: 33161531]
[9]
Güner SG, Nural N. Prevalence of and risk factors for falls and disability among elderly individuals in a Turkish population (Trabzon Province). Int J Med Res Health Sci 2016; 5(8): 156-63.
[10]
Kamide N, Sato H, Sakamoto M, Shiba Y. The effect of the interaction between fall-related self-efficacy and gait function on the occurrence of falls in community-dwelling older people. Aging Clin Exp Res 2021; 33(10): 2715-22.
[http://dx.doi.org/10.1007/s40520-021-01807-0] [PMID: 33629277]
[11]
Ganz DA, Bao Y, Shekelle PG, Rubenstein LZ. Will my patient fall? JAMA 2007; 297(1): 77-86.
[http://dx.doi.org/10.1001/jama.297.1.77] [PMID: 17200478]
[12]
Simón M, Giraldo L, Sommer J, et al. Fall risk assessment through a self-service terminal in the outpatient setting. Stud Health Technol Inform 2019; 264(264): 1352-5.
[PMID: 31438146]
[13]
von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies. Ann Intern Med 2007; 147(8): 573-7.
[http://dx.doi.org/10.7326/0003-4819-147-8-200710160-00010] [PMID: 17938396]
[14]
Delgado DA, Lambert BS, Boutris N, et al. Validation of digital visual analog scale pain scoring with a traditional paper-based visual analog scale in adults. J Am Acad Orthop Surg Glob Res Rev 2018; 2(3): e088.
[http://dx.doi.org/10.5435/JAAOSGlobal-D-17-00088] [PMID: 30211382]
[15]
Yaray O, Akesen B. Ocaklioğlu G, Aydinli U. Validation of the Turkish version of the visual analog scale spine score in patients with spinal fractures. Acta Orthop Traumatol Turc 2011; 45(5): 353-8.
[PMID: 22033000]
[16]
Morley JE, Malmstrom TK, Miller DK. A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans. J Nutr Health Aging 2012; 16(7): 601-8.
[http://dx.doi.org/10.1007/s12603-012-0084-2] [PMID: 22836700]
[17]
Hymabaccus B, Yavuz BB, Tuna Dogrul R. Validation of frail scale in Turkish older adults. Eur Geriatr Med 2018; 9 (Suppl. 1): 115.
[18]
Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW. Studies of illness in the aged. JAMA 1963; 185(12): 914-9.
[http://dx.doi.org/10.1001/jama.1963.03060120024016] [PMID: 14044222]
[19]
Arik G, Varan HD, Yavuz BB, et al. Validation of Katz index of independence in activities of daily living in Turkish older adults. Arch Gerontol Geriatr 2015; 61(3): 344-50.
[http://dx.doi.org/10.1016/j.archger.2015.08.019] [PMID: 26328478]
[20]
Lawton MP, Brody EM. Assessment of older people: Self-maintaining and instrumental activities of daily living. Gerontologist 1969; 9(3 Part 1): 179-86.
[http://dx.doi.org/10.1093/geront/9.3_Part_1.179] [PMID: 5349366]
[21]
Isik EI, Yilmaz S, Uysal I, Basar S. Adaptation of the lawton instrumental activities of daily living scale to Turkish: Validity and reliability study. Ann Geriatr Med Res 2020; 24(1): 35-40.
[http://dx.doi.org/10.4235/agmr.19.0051] [PMID: 32743320]
[22]
Cho CY, Alessi CA, Cho M, et al. The association between chronic illness and functional change among participants in a comprehensive geriatric assessment program. J Am Geriatr Soc 1998; 46(6): 677-82.
[http://dx.doi.org/10.1111/j.1532-5415.1998.tb03800.x] [PMID: 9625181]
[23]
Rabin R, Charro FEQ-SD. A measure of health status from the EuroQol Group. Ann Med 2001; 33(5): 337-43.
[http://dx.doi.org/10.3109/07853890109002087] [PMID: 11491192]
[24]
Kahyaoğlu Süt H, Unsar S. Is EQ-5D a valid quality of life instrument in patients with acute coronary syndrome? Anadolu Kardiyol Derg 2011; 11(2): 156-62.
[http://dx.doi.org/10.5152/akd.2011.037] [PMID: 21342862]
[25]
Borson S, Scanlan J, Brush M, Vitaliano P, Dokmak A. The Mini-Cog: A cognitive? Vital signs? measure for dementia screening in multi-lingual elderly. Int J Geriatr Psychiatry 2000; 15(11): 1021-7.
[http://dx.doi.org/10.1002/1099-1166(200011)15:11<1021:AID-GPS234>3.0.CO;2-6] [PMID: 11113982]
[26]
Gedik G, Ülger Z. Arık G Validation of the mini-cog test for screening cognitive impairment in Turkish older adults. Uluslararası Akademik Geriatri Kongresi 2017; p. 38.
[27]
Aprahamian I, Martinelli JE, Neri AL, Yassuda MS. The clock drawing test A review of its accuracy in screening for dementia. Dement Neuropsychol 2009; 3(2): 74-80.
[http://dx.doi.org/10.1590/S1980-57642009DN30200002] [PMID: 29213615]
[28]
Savaş D, Yerlikaya D, Yener G. Turkish norms and validity-reliability study of two different scoring systems of clock drawing test. Turk J Neurol 2018; 24: 143.
[29]
Almeida OP, Almeida SA. Short versions of the geriatric depression scale: A study of their validity for the diagnosis of a major depressive episode according to ICD-10 and DSM-IV. Int J Geriatr Psychiatry 1999; 14(10): 858-65.
[http://dx.doi.org/10.1002/(SICI)1099-1166(199910)14:10<858:AID-GPS35>3.0.CO;2-8] [PMID: 10521885]
[30]
Durmaz B, Soysal P, Ellidokuz H, Isik AT. Validity and reliability of geriatric depression scale-15 (short form) in Turkish older adults. North Clin Istanb 2018; 5(3): 216-20.
[PMID: 30688929]
[31]
Kaiser MJ, Bauer JM, Ramsch C, et al. Validation of the mini nutritional assessment short-form (MNA®-SF): A practical tool for identification of nutritional status. J Nutr Health Aging 2009; 13(9): 782-8.
[http://dx.doi.org/10.1007/s12603-009-0214-7] [PMID: 19812868]
[32]
Sarikaya D, Halil M, Kuyumcu ME, et al. Mini nutritional assessment test long and short form are valid screening tools in Turkish older adults. Arch Gerontol Geriatr 2015; 61(1): 56-60.
[http://dx.doi.org/10.1016/j.archger.2015.04.006] [PMID: 25944059]
[33]
Roberts HC, Denison HJ, Martin HJ, et al. A review of the measurement of grip strength in clinical and epidemiological studies: Towards a standardised approach. Age Ageing 2011; 40(4): 423-9.
[http://dx.doi.org/10.1093/ageing/afr051] [PMID: 21624928]
[34]
Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: Revised European consensus on definition and diagnosis. Age Ageing 2019; 48(4): 601.
[http://dx.doi.org/10.1093/ageing/afz046] [PMID: 31081853]
[35]
Wang JG, Zhang Y, Chen HE, et al. Comparison of two bioelectrical impedance analysis devices with dual energy X-ray absorptiometry and magnetic resonance imaging in the estimation of body composition. J Strength Cond Res 2013; 27(1): 236-43.
[http://dx.doi.org/10.1519/JSC.0b013e31824f2040] [PMID: 22344056]
[36]
Bahat G, Cruz-Jentoft A. Putting sarcopenia at the forefront of clinical practice. Eur Geriatr Med 2019; 1(2): 43-5.
[http://dx.doi.org/10.4274/ejgg.galenos.2019.82]
[37]
Bahat G, Tufan A, Tufan F, et al. Cut-off points to identify sarcopenia according to European working group on sarcopenia in Older People (EWGSOP) definition. Clin Nutr 2016; 35(6): 1557-63.
[http://dx.doi.org/10.1016/j.clnu.2016.02.002] [PMID: 26922142]
[38]
Balaban Ö. Nacır B. Evaluation of equilibrium function. Am J Phys Med Rehabil 2009; 12: 133-9.
[39]
Visser M, Marinus J, Bloem BR, Kisjes H, van den Berg BM, van Hilten JJ. Clinical tests for the evaluation of postural instability in patients with parkinson’s disease. Arch Phys Med Rehabil 2003; 84(11): 1669-74.
[http://dx.doi.org/10.1053/S0003-9993(03)00348-4] [PMID: 14639568]
[40]
Cevizci S. Uluocak Ş, Aslan C, Gökulu G, Bilir O, Bakar C. Prevalence of falls and associated risk factors among aged population: Community based cross-sectional study from Turkey. Cent Eur J Public Health 2015; 23(3): 233-9.
[http://dx.doi.org/10.21101/cejph.a4053] [PMID: 26615656]
[41]
Janakiraman B, Temesgen MH, Jember G, et al. Falls among community-dwelling older adults in Ethiopia; A preliminary cross-sectional study. PLoS One 2019; 14(9): e0221875.
[http://dx.doi.org/10.1371/journal.pone.0221875] [PMID: 31504057]
[42]
Bekibele CO, Gureje O. Fall incidence in a population of elderly persons in Nigeria. Gerontology 2010; 56(3): 278-83.
[http://dx.doi.org/10.1159/000236327] [PMID: 19738364]
[43]
Almeida LMS, Meucci RD, Dumith SC. Prevalence of falls in elderly people: A population based study. Rev Assoc Med Bras 2019; 65(11): 1397-403.
[http://dx.doi.org/10.1590/1806-9282.65.11.1397] [PMID: 31800903]
[44]
Telatar TG, Üner S, Özcebe H, Biçer BK. Sarı ÖY. Defining falls and associated risk factors in elderly among age groups and sex. Selcuk Med J 2020; 36(2): 101-8.
[45]
Halil M, Ulger Z, Cankurtaran M, et al. Falls and the elderly: Is there any difference in the developing world? Arch Gerontol Geriatr 2006; 43(3): 351-9.
[http://dx.doi.org/10.1016/j.archger.2005.12.005] [PMID: 16522334]
[46]
Allan LM, Ballard CG, Rowan EN, Kenny RA. Incidence and prediction of falls in dementia: A prospective study in older people. PLoS One 2009; 4(5): e5521.
[http://dx.doi.org/10.1371/journal.pone.0005521] [PMID: 19436724]
[47]
Montero-Odasso M, Speechley M. Falls in cognitively impaired older adults: Implications for risk assessment and prevention. J Am Geriatr Soc 2018; 66(2): 367-75.
[http://dx.doi.org/10.1111/jgs.15219] [PMID: 29318592]
[48]
Cheng MH, Chang SF. Frailty as a risk factor for falls among community dwelling people: Evidence from a meta-analysis. J Nurs Scholarsh 2017; 49(5): 529-36.
[http://dx.doi.org/10.1111/jnu.12322] [PMID: 28755453]
[49]
Akın S, Mazıcıoglu MM, Mucuk S, et al. The prevalence of frailty and related factors in community-dwelling Turkish elderly according to modified Fried Frailty Index and FRAIL scales. Aging Clin Exp Res 2015; 27(5): 703-9.
[http://dx.doi.org/10.1007/s40520-015-0337-0] [PMID: 25762157]
[50]
Del Brutto OH, Mera RM, Peinado CD, Zambrano M, Sedler MJ. Frailty and risk of falls in community-dwelling older adults living in a rural setting. The Atahualpa Project. J Frailty Aging 2020; 9(3): 150-4.
[PMID: 32588029]
[51]
Bahat G, Ozkok S, Kilic C, Karan MA. SARC-F questionnaire detects frailty in older adults. J Nutr Health Aging 2021; 25(4): 448-53.
[http://dx.doi.org/10.1007/s12603-020-1543-9] [PMID: 33786561]
[52]
Araújo Neto AH, Patrício ACFA, Ferreira MAM, et al. Falls in institutionalized older adults: Risks, consequences and antecedents. Rev Bras Enferm 2017; 70(4): 719-25.
[http://dx.doi.org/10.1590/0034-7167-2017-0107] [PMID: 28793100]
[53]
Hacıdursunoğlu Erbaş D, Çınar F, Eti Aslan F. Elderly patients and falls: A systematic review and meta-analysis. Aging Clin Exp Res 2021; 33(11): 2953-66.
[http://dx.doi.org/10.1007/s40520-021-01843-w] [PMID: 33864235]
[54]
Vinik AI, Camacho P, Reddy S, et al. Aging, diabetes, and falls. Endocr Pract 2017; 23(9): 1120-42.
[http://dx.doi.org/10.4158/EP171794.RA] [PMID: 28704101]
[55]
Fried TR, O’Leary J, Towle V, Goldstein MK, Trentalange M, Martin DK. Health outcomes associated with polypharmacy in community-dwelling older adults: A systematic review. J Am Geriatr Soc 2014; 62(12): 2261-72.
[http://dx.doi.org/10.1111/jgs.13153] [PMID: 25516023]
[56]
Boyle N, Naganathan V, Cumming RG. Medication and falls: Risk and optimization. Clin Geriatr Med 2010; 26(4): 583-605.
[http://dx.doi.org/10.1016/j.cger.2010.06.007] [PMID: 20934612]
[57]
Seppala LJ, Petrovic M, Ryg J, et al. STOPPFall (Screening tool of older persons prescriptions in older adults with high fall risk): A Delphi study by the EuGMS task and finish group on fall-risk-increasing drugs. Age Ageing 2021; 50(4): 1189-99.
[http://dx.doi.org/10.1093/ageing/afaa249] [PMID: 33349863]
[58]
Britton GB, O’Bryant SE, Johnson LA, et al. Inflammatory biomarkers, depressive symptoms and falls among the elderly in Panama. Curr Aging Sci 2019; 11(4): 236-41.
[http://dx.doi.org/10.2174/1874609812666190215125104] [PMID: 30767759]
[59]
Blain H, Dabas F, Mekhinini S, et al. Effectiveness of a programme delivered in a falls clinic in preventing serious injuries in high-risk older adults: A pre and post-intervention study. Maturitas 2019; 122: 80-6.
[http://dx.doi.org/10.1016/j.maturitas.2019.01.012] [PMID: 30797536]
[60]
Pérez-Ros P, Martínez-Arnau FM, Tarazona-Santabalbina FJ. Risk factors and number of falls as determinants of quality of life of community-dwelling older adults. J Geriatr Phys Ther 2019; 42(2): 63-72.
[http://dx.doi.org/10.1519/JPT.0000000000000150] [PMID: 29939905]
[61]
Blyth FM, Noguchi N. Chronic musculoskeletal pain and its impact on older people. Best Pract Res Clin Rheumatol 2017; 31(2): 160-8.
[http://dx.doi.org/10.1016/j.berh.2017.10.004] [PMID: 29224694]
[62]
Pirrie M, Saini G, Angeles R, Marzanek F, Parascandalo J, Agarwal G. Risk of falls and fear of falling in older adults residing in public housing in Ontario, Canada: Findings from a multisite observational study. BMC Geriatr 2020; 20(1): 11.
[http://dx.doi.org/10.1186/s12877-019-1399-1] [PMID: 31918674]
[63]
WHO global report on falls prevention in older age. Geneva: World Health Organization. 2008. Available from: WHo-Global-reporton-falls-prevention-in-older-age.pdf
[64]
Yang M, Liu Y, Zuo Y, Tang H. Sarcopenia for predicting falls and hospitalization in community-dwelling older adults: EWGSOP versus EWGSOP2. Sci Rep 2019; 9(1): 17636.
[http://dx.doi.org/10.1038/s41598-019-53522-6] [PMID: 31776354]
[65]
Adly NN, Abd-El-Gawad WM, Abou-Hashem RM. Relationship between malnutrition and different fall risk assessment tools in a geriatric in-patient unit. Aging Clin Exp Res 2020; 32(7): 1279-87.
[http://dx.doi.org/10.1007/s40520-019-01309-0] [PMID: 31482296]
[66]
Lackoff AS, Hickling D, Collins PF, Stevenson KJ, Nowicki TA, Bell JJ. The association of malnutrition with falls and harm from falls in hospital inpatients: Findings from a 5-year observational study. J Clin Nurs 2020; 29(3-4): 429-36.
[http://dx.doi.org/10.1111/jocn.15098] [PMID: 31715045]
[67]
Javaid MK. Efficacy and efficiency of fracture liaison services to reduce the risk of recurrent osteoporotic fractures. Aging Clin Exp Res 2021; 33(8): 2061-7.
[http://dx.doi.org/10.1007/s40520-021-01844-9] [PMID: 34047929]
[68]
Blain H, Masud T, Dargent-Molina P, et al. A comprehensive fracture prevention strategy in older adults: The European Union Geriatric Medicine Society (EUGMS) statement. J Nutr Health Aging 2016; 20(6): 647-52.
[http://dx.doi.org/10.1007/s12603-016-0741-y] [PMID: 27273355]
[69]
Body JJ, Bergmann P, Boonen S, et al. Non-pharmacological management of osteoporosis: A consensus of the Belgian Bone Club. Osteoporos Int 2011; 22(11): 2769-88.
[http://dx.doi.org/10.1007/s00198-011-1545-x] [PMID: 21360219]

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy