A risk profile for identifying community-dwelling elderly with a high risk of recurrent falling: results of a 3-year prospective study.
BACKGROUND
The aim of the prospective study reported here was to develop a risk profile that can be used to identify community-dwelling elderly at a high risk of recurrent falling.


METHODS
The study was designed as a 3-year prospective cohort study. A total of 1365 community-dwelling persons, aged 65 years and older, of the population-based Longitudinal Aging Study Amsterdam participated in the study. During an interview in 1995/1996, physical, cognitive, emotional and social aspects of functioning were assessed. A follow-up on the number of falls and fractures was conducted during a 3-year period using fall calendars that participants filled out weekly. Recurrent fallers were identified as those who fell at least twice within a 6-month period during the 3-year follow-up.


RESULTS
The incidence of recurrent falls at the 3-year follow-up point was 24.9% in women and 24.4% in men. Of the respondents, 5.5% reported a total of 87 fractures that resulted from a fall, including 20 hip fractures, 21 wrist fractures and seven humerus fractures. Recurrent fallers were more prone to have a fall-related fracture than those who were not defined as recurrent fallers (11.9% vs. 3.4%; OR: 3.8; 95% CI: 2.3-6.1). Backward logistic regression analysis identified the following predictors in the risk profile for recurrent falling: two or more previous falls, dizziness, functional limitations, weak grip strength, low body weight, fear of falling, the presence of dogs/cats in the household, a high educational level, drinking 18 or more alcoholic consumptions per week and two interaction terms (high education x 18 or more alcohol consumptions per week and two or more previous falls x fear of falling) (AUC=0.71).


CONCLUSIONS
At a cut-off point of 5 on the total risk score (range 0-30), the model predicted recurrent falling with a sensitivity of 59% and a specificity of 71%. At a cut-off point of 10, the sensitivity and specificity were 31% and 92%, respectively. A risk profile including nine predictors that can easily be assessed seems to be a useful tool for the identification of community-dwelling elderly with a high risk of recurrent falling.
Pluijm
S M F
SM
Institute for Research in Extramural Medicine (EMGO-Institute), VU University Medical Center (Vumc), Amsterdam, The Netherlands.
Smit
J H
JH
Tromp
E A M
EA
Stel
V S
VS
Deeg
D J H
DJ
Bouter
L M
LM
Lips
P
P
D000058:Accidental Falls / Q000517:prevention & control*; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D000428:Alcohol Drinking; D000818:Animals; D000829:Animals, Domestic; D004244:Dizziness / Q000150:complications; D004812:Epidemiologic Methods; D005239:Fear; D005260:Female; D050723:Fractures, Bone / Q000209:etiology*; D006306:Health Surveys; D006801:Humans; D008297:Male; D009426:Netherlands; D012008:Recurrence; D013851:Thinness