Preclinical disability as a risk factor for falls in community-dwelling older adults.
BACKGROUND
Falls are common and serious problems in older adults. The goal of this study was to examine whether preclinical disability predicts incident falls in a European population of community-dwelling older adults.


METHODS
Secondary data analysis was performed on a population-based longitudinal study of 1644 community-dwelling older adults living in London, U.K.; Hamburg, Germany; Solothurn, Switzerland. Data were collected at baseline and 1-year follow-up using a self-administered multidimensional health risk appraisal questionnaire, including validated questions on falls, mobility disability status (high function, preclinical disability, task difficulty), and demographic and health-related characteristics. Associations were evaluated using bivariate and multivariate logistic regression analyses.


RESULTS
Overall incidence of falls was 24%, and increased by worsening mobility disability status: high function (17%), preclinical disability (32%), task difficulty (40%), test-of-trend p <.003. In multivariate analysis adjusting for other fall risk factors, preclinical disability (odds ratio [OR] = 1.7, 95% confidence interval [CI], 1.1-2.5), task difficulty (OR = 1.7, 95% CI, 1.1-2.6) and history of falls (OR = 4.7, 95% CI, 3.5-6.3) were the strongest significant predictors of falls. In stratified multivariate analyses, preclinical disability equally predicted falls in participants with (OR = 1.7, 95% CI, 1.0-3.0) and without history of falls (OR = 1.8, 95% CI, 1.1-3.0).


CONCLUSIONS
This study provides longitudinal evidence that self-reported preclinical disability predicts incident falls at 1-year follow-up independent of other self-reported fall risk factors. Multidimensional geriatric assessment that includes preclinical disability may provide a unique early warning system as well as potential targets for intervention.
Clough-Gorr
Kerri M
KM
Department of Geriatrics, Inselspital University of Bern Hospital, Bern, Switzerland.
Erpen
Thomas
T
Gillmann
Gerhard
G
von Renteln-Kruse
Wolfgang
W
Iliffe
Steve
S
Beck
John C
JC
Stuck
Andreas E
AE
D000058:Accidental Falls / Q000517:prevention & control / Q000706:statistics & numerical data*; D000061:Accidents, Home / Q000517:prevention & control / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D004185:Disability Evaluation; D006233:Persons with Disabilities; D015577:Geriatric Assessment / Q000379:methods; D005858:Germany; D006699:Home Care Services / Q000706:statistics & numerical data*; D006801:Humans; D008131:London; D008137:Longitudinal Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013557:Switzerland