FALLS IN THE ELDERLY - A PROSPECTIVE-STUDY OF RISK-FACTORS AND RISK PROFILES

xIn this prospective study, the authors determined intrinsic risk fact ors for falls and recurrent falls and constructed a risk profile that indicated the relative contribution of each risk factor and also estim ated the probabilities of falls and recurrent falls, In 1992, over a 2 8-week period, falls were recorded among 354 elderly subjects aged 70 years or over who were living in homes or apartments for the elderly i n Amsterdam and the vicinity, During the study period, 251 falls were reported by 126 subjects (36%), and recurrent falls (greater than or e qual to 2 falls) were reported by 57 subjects (16%). Associations of f alls and recurrent falls with potential risk factors were identified i n logistic regression models. Mobility impairment regarding one or mor e of the tested items (i.e., impairment of balance, leg-extension stre ngth, and gait) was associated with falls (adjusted odds ratio (OR) = 2.6) and was strongly associated with recurrent falls (OR = 5.0). Dizz iness upon standing was associated with falls (OR = 2.1) and recurrent falls (OR = 2.1). However, several risk factors were associated with recurrent falls only: history of stroke (OR = 3.4), poor mental state (OR = 2.4), and postural hypotension (OR = 2.0). The authors construct ed a risk profile for recurrent falls that included the five risk fact ors mentioned above. Inclusion of all risk factors in the profile impl ied an 84% probability of recurrent falls over a period of 28 weeks, c ompared with 3% when no risk factor was present. The probability of re current falls ranged only from 11% to 29% when predicted by number of falls occurring in the previous year. Physical activity, use of high-r isk medication, and the use of vitamin D-3, which was randomly allocat ed to the participants, were not strongly related to either falls or r ecurrent falls. In conclusion, a large range of probabilities of falls , especially of recurrent falls, was estimated by the risk profiles, i n which mobility impairment was the major risk factor. Recurrent falle rs may therefore be especially amenable to prevention based on mobilit y improvement.