title: Factors associated with recognition and prioritization for falling, and the effect on fall incidence in community dwelling older adults.
abstract: BACKGROUND
  Recent trials have shown that multifactorial fall interventions vary in effectiveness, possibly due to lack of adherence to the interventions. The aim of this study was to examine what proportion of older adults recognize their falls risk and prioritize for fall-preventive care, and which factors are associated with this prioritization.
  
  
  METHODS
  Observational study within the intervention arm of a cluster randomized controlled trial (RCT) on the effect of preventive interventions for geriatric problems in older community-dwellers at risk of functional decline.
  
  
  METHODS
  general practices in the Netherlands. Participants were community dwellers (70+) in whom falling was identified as a condition. A comprehensive geriatric assessment (CGA) was performed by a registered community care nurse. Participants were asked which of the identified conditions they recognized and prioritized for in a preventive care plan, and subsequent interventions were started. Multivariable logistic regression was performed to identify which factors were associated with this prioritization. Fall-incidence was measured during one-year follow-up.
  
  
  RESULTS
  The RCT included 6668 participants, 3430 were in the intervention arm. Of those, 1209 were at risk of functional decline, of whom 936 underwent CGA. In 380 participants (41 %), falling was identified as a condition; 62 (16 %) recognized this and 37 (10 %) prioritized for it. Factors associated with prioritization for falls-prevention were: recurrent falls in the past year (OR 2.2 [95 % CI 1.1-4.4]), severe fear-of-falling (OR 2.7 [1.2-6.0]) and use of a walking aid (2.3 [1.1-5.0]). Sixty participants received a preventive intervention for falling; 29 had prioritized for falling. Incidence of falls was higher in the priority group than the non-priority group (67 % vs. 37 % respectively) during first six months of follow-up, but similar between groups after 12 months (40.7 % vs. 44.4 %).
  
  
  CONCLUSIONS
  The proportion of community-dwellers at risk of falls that recognizes this risk and prioritizes for preventive care is small. Recurrent falls in the past year, severe fear-of-falling and use of a walking aid were associated with prioritization. Prioritization was associated with a greater fall-risk during first six months, which appeared to level out at one-year follow-up. These results could aid in the identification of community-dwellings likely to benefit from fall-preventive interventions.
  
  
  BACKGROUND
  NTR2653 , 17 December 2010.
authors.affiliation: Department of Internal Medicine, section of Geriatric Medicine, Academic Medical Center, Meibergdreef 9, 1105, Amsterdam, AZ, The Netherlands. s.jansen@amc.uva.nl.
authors.forename: Sofie
authors.initials: S
authors.lastname: Jansen
authors.affiliation: Department of Internal Medicine, section of Geriatric Medicine, Academic Medical Center, Meibergdreef 9, 1105, Amsterdam, AZ, The Netherlands.
authors.forename: Jolanda
authors.initials: J
authors.lastname: Schoe
authors.affiliation: Department of Internal Medicine, section of Geriatric Medicine, Academic Medical Center, Meibergdreef 9, 1105, Amsterdam, AZ, The Netherlands.
authors.forename: Marjon
authors.initials: M
authors.lastname: van Rijn
authors.affiliation: Department of Medical Informatics, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Ameen
authors.initials: A
authors.lastname: Abu-Hanna
authors.affiliation: Department of General Practice, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Eric P
authors.initials: EP
authors.lastname: Moll van Charante
authors.affiliation: Department of Internal Medicine, section of Geriatric Medicine, Academic Medical Center, Meibergdreef 9, 1105, Amsterdam, AZ, The Netherlands.
authors.forename: Nathalie
authors.initials: N
authors.lastname: van der Velde
authors.affiliation: Department of Internal Medicine, section of Geriatric Medicine, Academic Medical Center, Meibergdreef 9, 1105, Amsterdam, AZ, The Netherlands.|Department of Geriatric Medicine, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Sophia E
authors.initials: SE
authors.lastname: de Rooij
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology / Q000523:psychology; D005239:Fear; D005260:Female; D015577:Geriatric Assessment; D006299:Health Services for the Aged; D006801:Humans; D015994:Incidence; D057187:Independent Living / Q000523:psychology / Q000706:statistics & numerical data; D008297:Male; D009426:Netherlands; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D011314:Preventive Health Services; D021641:Recognition, Psychology / Q000502:physiology*; D018570:Risk Assessment; D040242:Risk Reduction Behavior