Abstract
The aim of this prospective cohort study was to identify the risk factors involved in falls in 190 elderly residents of two geriatric centres in Granada (Andalusia, Spain). Because different types of falls may be associated with different factors, falls were classified according to the precipitating cause, either extrinsic or intrinsic. The incidence density and the ratios for crude and adjusted density were calculated. Cox proportional risk analysis was used to calculate adjusted incidence density ratios. Of the 121 falls identified, 63 (52.1%) had a extrinsic precipitating cause, 43 (35.5%) had an intrinsic precipitating cause, and no precipitating cause was determined in 15 falls. The rate of falls with an extrinsic precipitating cause was 0.39 per person per year, while falls with an intrinsic precipitating cause showed a frequency of 0.27 per person per year. For falls with an extrinsic precipitating cause, the most significant risk factors were: age, diabetes mellitus, a history of falling, and treatment with neuroleptics or oral bronchodilators. The number of illnesses acted as a protective factor. For falls with an intrinsic precipitating cause, the independent risk factors were: age, diabetes, dementia, alterations of gait and balance, previous falls, and treatment with digitalins, neuroleptics or antidepressants. These results suggest that the susceptibility to a fall with an intrinsic precipitating cause is easier to identify and has a greater potential for being controlled.
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Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med 1988; 319: 1701–1707.
Nevitt MC, Cummings SR, Kidd S, Black D. Risk factors for recurrent nonsyncopal falls. JAMA 1989; 261: 2663–2668.
Hoskin AF. Fatal falls: Trends and characteristics. Stat Bull Metrop Insur Co 1998; 79: 10–15.
Rizzo JA, Friedkin R, Williams CS, Nabors J, Acampora D, Tinetti ME. Health care utilization and cost in a Medicare population by fall status. Med Care 1998; 36: 1174–1188.
Tinetti ME, Baker DI, McAvay G, Claus EB, Garrett P, Gottschalk M. A multifactorial intervention to reduce the risk of falling among elderly people living in the community. N Engl J Med 1994; 331: 821–827.
Tinetti ME, Speechley M. Multiple risk factors approach to prevention of falls. In: Weindruch RW, Hadley EC, Ory MG (eds), Reducing Frailty and Falls in Older Persons, Illinois: Charles C. Thomas, 1991: 126–131.
Rubenstein LZ, Josephson KR, Robbins AS. Falls in the nursing home. Ann Intern Med 1994; 121: 442–451.
Lach HW, Reed AT, Arfken CL, et al. Falls in the elderly: Reliability of a classification system. J Am Geriatr Soc 1991; 39: 197–202.
Cummings SR, Nevitt MC. Falls. N Engl J Med 1994; 331: 872–873.
Tinetti ME. Factors associated with serious injury falls by ambulatory nursing home residents. J Am Geriatr Soc 1987; 35: 644–648.
Ray WA, Griffin MR, Schaffner W, Baugh DK, Melton LJ. Psychotropic drug use and the risk of hip fracture. N Engl J Med 1987; 316: 363–369.
Grisso JA, Kelsey JL, Strom BL, et al. Risk factors for falls as a cause of hip fractures in women. N Engl J Med 1991; 324: 1326–1331.
Lord SR, McLean D, Stathers G. Physiological factors associated with injurious falls in older people living in the community. Gerontology 1992; 38: 338–346.
Koski K, Luukinen H, Laippala P, Kivela SL. Risk factors for major injurious falls among the home-dwelling elderly by functional abilities. A prospective population-based study. Gerontology 1998; 44: 232–238.
Lipsitz LA, Jonsson PV, Kelley MM, Koestner JS. Causes and correlates of recurrent falls in ambulatory frail elderly. J Gerontol 1991; 46: M114-M122.
Ryynänen OP, Kivelä SL, Honkanen R, Laippala P. Recurrent elderly fallers. Scand J Prim Health Care 1992; 10: 277–283.
Tinetti ME, Liu WL, Claus EB. Predictors and prognosis of inability to get up after falls among elderly persons. JAMA 1993; 269: 65–70.
O'Loughlin JL, Boivin JF, Robitaille Y, Suissa S. Falls among the elderly: Distinguishing indoor and outdoor risk factors in Canada. J Epidemiol Com Health 1994; 48: 488–491.
Folstein MF, Folstein SE, McHugh PR. “Mini-Mental State”. A practical method for grading the cognitive state of patients for the clinician. J Psychiat Res 1975; 12: 189–198.
Sheikh JS, Yesavage J. Geriatric Depression Scale (GDS): Recent evidence and development of a shorter version. Clin Gerontologist 1986; 5: 165–173.
Yesavage J. Differential diagnosis between depression and dementia. Am J Med 1993; 94 (5A Suppl): S23-S28.
Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW. Studies of illness in the aged. The index of ADL: A standardized measure of biological and psychosocial function. JAMA 1963; 185: 914–919.
Katz S, Downs TD, Cash HR, Grotz RC. Progress in development of the index of ADL. Gerontologist 1970; 10: 20–30.
Tinetti ME. Performance-oriented assessment of mobility problems in elderly patients. J Am Geriatr Soc 1986; 34: 119–126.
Tinetti ME, Ginter SF. Identifying mobility disfunctions in elderly patients. Standard neuromuscular examination or direct assessment? JAMA 1988; 259: 1190–1193.
Buchner DM, Hornbrook MC, Kutner NG, et al. Development of the common data base for the FICSIT Trials. J Am Geriatr Soc 1993; 41: 297–308.
McPhee A, Crowther JA, McAlpine CH. A simple screening test for hearing impairment in elderly patients. Age Ageing 1988; 17: 347–351.
Lipsitz LA. Orthostatic hypotension in the elderly. N Engl J Med 1989; 321: 952–957.
Kleinbaum DG, Kupper LL, Morgenstern H. Epidemiologic Research. Belmont: Lifetime Learning Publications, 1982.
Cox DR. Regression model and life tables. J Roy Statist Soc B 1972; 34: 187–220.
Dixon WL (ed). BMDP Statistical Software Manual (Release 7:C), Vols 1 and 2. Berkeley: University of California Press, 1992.
Bueno A, Padilla F, Peinado C, Espigares M, Gálvez R. Factores de riesgo de caídas en una población anciana institucionalizada [Risk factors associated with falls in institutionalized elderly persons. Prospective cohort study]. Med Clin (Barc) 1999; 112: 10–15.
King MB, Tinetti ME. Falls in community-dwelling older persons. J Am Geriatr Soc 1995; 43: 1146–1154.
Cumming RG, Kelsey JL, Nevitt MC. Methodological issues in the study of frequent and recurrent health problems. Falls in the elderly. Ann Epidemiol 1990; 1: 49–56.
Kellog International Work Group. The prevention of falls in later life. Dan Med Bul 1987; 34 (4 Suppl): 1–24.
Myers AH, Baker SP, Van Natta ML, Abbey H, Robinson EG. Risk factors associated with falls and injuries among elderly institutionalized persons. Am J Epidemiol 1991; 133: 1179–1190.
Kiely DK, Kiel DP, Burrows AB, Lipsitz LA. Identifying nursing home residents at risk for falling. J Am Geriatr Soc 1998; 46: 551–555.
Dunn JE, Rudberg MA, Furner SE, Cassel CK. Mortality, disability and falls in older persons: The role of underlying disease and disability. Am J Public Health 1992; 82: 395–400.
Campbell AJ, Borrie MJ, Spears GF. Risk factors for falls in a community-based prospective study of people 70 years and older. J Gerontol 1989; 44: M112-M117.
Yasumura S, Haga H, Harumi N, Suzuki T, Amano H, Shibata H. Rate of falls and the correlates among elderly people living in an urban community in Japan. Age Ageing 1994; 23: 323–327.
Luukinen H, Koski K, Hiltunen L, Kivelä SL. Incidence rate of falls in an aged population in northern Finland. J Clin Epidemiol 1994; 47: 843–850.
Tinetti ME, Williams TF, Mayewski R. Fall risk index for elderly patients based on number of chronic disabilities. Am J Med 1986; 80: 429–434.
Tinetti ME, Inouye SK, Gill TM, Doucette JT. Shared risk factors for falls, incontinence and functional dependence. JAMA 1995; 273: 1348–1353.
Méndez JI, Zunzunegui MV, Béland F. Prevalencia y factores asociados a las caídas en las personas mayores que viven en la comunidad [The prevalence of and factors associated with falls in older persons living in the community]. Med Clin (Barc) 1997; 108: 128–132.
Prudham D, Evans JG. Factors associated with falls in the elderly: A community study. Age Ageing 1981; 10: 141–146.
Sudarsky L, Ronthal M. Gait disorders among elderly patients. Arch Neurol 1983; 40: 740–743.
Tideiksaar R, Kay AD. What causes falls? A logical diagnostic procedure. Geriatrics 1986; 41: 32–50.
Granek E, Baker SP, Abbey H, et al. Medication and diagnoses in relation to falls in a long-term care facility. J Am Geriatr Soc 1987; 35: 503–511.
Thapa PB, Gideon P, Cost TW, Milan AB, Ray WA. Antidepressants and the risk of falls among nursing home residents. N Engl J Med 1998; 339: 875–882.
Liu B, Anderson G, Mittmann N, To T, Axcell T, Shear N. Use of selective serotonin-reuptake inhibitors of trycyclic antidepressants and risk of hip fractures in elderly people. Lancet 1998; 351: 1303–1307.
Sorock GS, Shimkin EE. Benzodiazepine sedative and the risk of falling in a community-dwelling elderly cohort. Arch Inter Med 1988; 148: 2441–2444.
Leipzig RM, Cumming RG, Tinetti ME. Drugs and falls in older people: A systematic review and meta-analysis: I. Psychotropic drugs. J Am Geriatr Soc 1999; 47: 30–39.
Weiner DK, Hanlon JT, Studenski SA. Effects of central nervous system polypharmacy on falls liability in community-dwelling elderly. Gerontology 1998; 44: 217–221.
Leipzig RM, Cumming RG, Tinetti ME. Drugs and falls in older people: A systematic review and meta-analysis: II. Cardiac and analgesic drugs. J Am Geriatr Soc 1999; 47: 40–44.
Gales BJ, Menard SM. Relationship between the ad-ministration of selected medications and falls in hospitalized elderly patients. Ann Pharmacother 1995; 29: 354–358.
Sattin RW, Rodriguez JG, DeVito CA, Wingo PA. Home environmental hazards and the risk of fall injury events among community-dwelling older persons. Study to Assess Falls Among the Elderly (SAFE) Group. J Am Geriatr Soc 1998; 46: 669–676.
Kerschan K, Alacamlioglu Y, Kollmitzer J, et al. Functional impact of unvarying exercise program in 858 women after menopause. Am J Phys Med Rehabil 1998; 77: 326–332.
Pereira MA, Kriska AM, Day RD, Cauley JA, LaPorte RE, Kuller LH. A randomized walking trial in post-menopausal women: Effects on physical activity and health 10 years later. Arch Intern Med 1998; 158: 1695–1701.
Gregg EW, Cauley JA, Seeley DG, Ensrud KE, Bauer DC. Physical activity and osteoporotic fracture risk in older women. Study of Osteoporotic Fractures Research Group. Ann Intern Med 1998; 129: 81–88.
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Bueno-Cavanillas, A., Padilla-Ruiz, F., Jiménez-Moleón, J. et al. Risk factors in falls among the elderly according to extrinsic and intrinsic precipitating causes. Eur J Epidemiol 16, 849–859 (2000). https://doi.org/10.1023/A:1007636531965
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DOI: https://doi.org/10.1023/A:1007636531965