A classification and regression tree for predicting recurrent falling among community-dwelling seniors using home-care services.
OBJECTIVE
A prospective, observational study was undertaken to identify risk profiles of subjects regarding the recurrence of falling among community-dwelling seniors using home-care services.


METHODS
A convenience sample of 868 community-dwelling older persons, aged 65 years or older, who use home-care services offered by public community-based centres in the province of Québec. Subjects were recruited between 2002 and 2005, assessed for fall-related risk factors, and monitored for prospective falls. Data were examined by a classification and regression tree (CART) and survival analyses.


RESULTS
Ninety-nine participants reported two falls within six months of entry to the study. Thus, the incidence of recurrent fallers was 11.4%. The tree analysis classified the population into five groups differing in risk of recurrent falling, based on history of falls in the three months prior to the initial interview, Berg balance score, type of housing, and usual alcohol consumption in the six months preceding study entry. The relative risks varied from 0.7 to 5.1. The survival analysis showed that the length of time before becoming a recurrent faller varies among risk profiles.


CONCLUSIONS
The study permitted the construction of easily interpretable risk profiles of recurrent falling. These can guide clinicians and public health practitioners to identify high-risk individuals and to decide on the appropriate intervention and follow-up.
Leclerc
Bernard S
BS
Service de surveillance, recherche et evaluation, Direction de santé publique et d'evaluation, Agence de la santé et des services sociaux de Lanaudière, Joliette, QC. bernard-simon.leclerc@inspq.qc.ca
Bégin
Claude
C
Cadieux
Elizabeth
E
Goulet
Lise
L
Allaire
Jean-François
JF
Meloche
Julie
J
Leduc
Nicole
N
Kergoat
Marie-Jeanne
MJ
D000058:Accidental Falls / Q000401:mortality / Q000706:statistics & numerical data*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000009:adverse effects / Q000503:physiopathology; D005260:Female; D015577:Geriatric Assessment / Q000706:statistics & numerical data*; D006699:Home Care Services / Q000706:statistics & numerical data*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D009864:Ontario; D004856:Postural Balance / Q000502:physiology; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D011634:Public Health / Q000706:statistics & numerical data; D012008:Recurrence; D012044:Regression Analysis; D012111:Residence Characteristics; D018570:Risk Assessment; D012307:Risk Factors