title: Older individuals with diabetes have an increased risk of recurrent falls: analysis of potential mediating factors: the Longitudinal Ageing Study Amsterdam.
abstract: OBJECTIVE
  to compare the incidence of recurrent falls in older people with and without diabetes, and to examine diabetes- and fall-related risk factors explaining the increased risk of recurrent falls associated with diabetes.
  
  
  METHODS
  population-based cohort study of 1,145 (85 with diabetes) community-dwelling participants, aged ≥65 years, from The Longitudinal Aging Study Amsterdam (LASA). Falls were assessed prospectively (every 3 months) during a 3-year follow-up period. Incidence of recurrent falls was estimated with Poisson regression analyses. The associations between diabetes and time to recurrent falls, defined as at least two falls occurring within a 6-month period, and the potential explanatory role of several risk factors herein, were analysed with the use of Cox-regression models.
  
  
  RESULTS
  during a mean follow-up of 139 weeks, 30.6% of the individuals with and 19.4% of the individuals without diabetes fell recurrently [incidence rate of 129.7 versus 77.4 per 1,000 persons-years, respectively, HR = 1.67 (95% CI: 1.11-2.51)]. Adjustments for potential confounders did not change the increased risk associated with diabetes [HR = 1.63 (1.06-2.52)]. Factors that partly explained this increased risk were: greater number of medication, higher levels of pain, poorer self-perceived health, lower physical activity and grip strength, more limitations in ADLs, lower-extremity physical performance and cognitive impairment. Altogether, these variables accounted for 47% of the increased risk of recurrent falls associated with diabetes [adjusted HR = 1.30 (0.79-2.11)].
  
  
  CONCLUSIONS
  fall prevention efforts targeting the factors identified above may need to be incorporated into the care and treatment of older individuals with diabetes.
authors.affiliation: Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands. e.pijpers@mumc.nl
authors.forename: Evelien
authors.initials: E
authors.lastname: Pijpers
authors.forename: Isabel
authors.initials: I
authors.lastname: Ferreira
authors.forename: Renate T
authors.initials: RT
authors.lastname: de Jongh
authors.forename: Dorly J
authors.initials: DJ
authors.lastname: Deeg
authors.forename: Paul
authors.initials: P
authors.lastname: Lips
authors.forename: Coen D A
authors.initials: CD
authors.lastname: Stehouwer
authors.forename: Arie C
authors.initials: AC
authors.lastname: Nieuwenhuijzen Kruseman
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control / Q000706:statistics & numerical data*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D016009:Chi-Square Distribution; D048909:Diabetes Complications / Q000453:epidemiology*; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors