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Unintentional Falls in Older Adults: A Methodological Historical Review

Published online by Cambridge University Press:  01 March 2011

Mark Speechley
Mark Speechley*
Affiliation:
The University of Western Ontario
*
*Correspondence and requests for offprints should be sent to / La correspondance et les demandes de tirés-à-part doivent être adressées à: Mark Speechley, Ph.D. Dept. of Epidemiology & Biostatistics Room K201, Kresge Bldg. The University of Western Ontario London, ON N6A 5C1 ([email protected])
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Abstract

PubMed lists over 6,000 references (700 reviews) on unintentional falls in older adults. This article traces key methodological milestones in the application of epidemiologic methods since the earliest publications in the late 1940s. Within the context of advances in case definition, sampling, measurement, research design, and statistical analysis, the article reviews estimates of frequency of occurrence, risk factor associations, morbidity and mortality consequences, demonstration of the multiple risk factor theory of falls using fall prevention interventions, and the challenges of fall risk prediction models. Methodological explanations are provided for observed heterogeneities, and the case is presented for moving beyond undifferentiated lists of risk factors by focusing on balance and gait as the factors through which the mechanistic effects of distal risk factors can be understood. Moreover, the case is made to advance our statistical analyses by looking at interactions among intrinsic risk factors and between intrinsic, extrinsic, and environmental factors.

Résumé

PubMed fournit plus de 6,000 références (700 critiques) sur les chutes accidentelles des personnes âgées. Cet article retrace les jalons principaux et méthodologiques dans l’application de méthodes épidémiologiques depuis les premières publications dans ce domaine, à la fin des années quarante. Dans le contexte des avances faites en définition des cas médicaux, échantillonnage, mesure, conception de la recherche et l’analyse statistique, l’article passe en revue les estimations de fréquence d’apparition, les associations de facteurs de risque, les conséquences de la morbidité et de la mortalité, la démonstration de la théorie des facteurs multirisques à l’aide des interventions sur la prévention des chutes et les défis de modèles de prédiction des risques de chutes. Les explications méthodologiques sont fournies pour les hétérogénéités observées et le cas médical est présenté en faveur d’aller au-delà des listes indifférenciées des facteurs de risque, en mettant l’accent sur l’équilibre et la démarche comme les facteurs par lesquels on peut mieux comprendre les effets mécanistes des facteurs de risque distaux. En outre, l’affaire est faite pour faire avancer nos analyses statistiques en examinant les interactions parmi les facteurs de risque intrinsèques et entre les facteurs intrinsèques, extrinsèques et environnementaux.

Keywords

chutes accidentellesprévention des chutespersonnes âgéesméthodologieépidémiologieaccidental fallsfall preventionolder adultsmethodologyepidemiology
Type
Special Section: Falls Prevention / Section spéciale: Prévention des chutes
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 30 , Issue 1 , March 2011 , pp. 21 - 32
Copyright
Copyright © Canadian Association on Gerontology 2011

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References

Agran, P.F., Anderson, C., Winn, D., Trent, R., Walton-Haynes, L., & Thayer, S. (2003). Rates of pediatric injuries by 3-month intervals for children 0 to 3 years of age. Pediatrics, 111(6 Pt 1), e683–e692.CrossRefGoogle Scholar
American Geriatrics Society, British Geriatrics Society, and American Academy of Orthopaedic Surgeons Panel on Falls Prevention. (2001). Guideline for the prevention of falls in older persons. Journal of the American Geriatrics Society, 49(5), 664–672.CrossRefGoogle Scholar
Bellinger, D.C. (2000). Effect modification in epidemiologic studies of low-level neurotoxicant exposures and health outcomes. Neurotoxicology and Teratology. 22(1), 133–140. Review.CrossRefGoogle ScholarPubMed
Cameron, I.D., Murray, G.R., Gillespie, L.D., Robertson, M.C., Hill, K.D., Cumming, R.G., et al. . (2010). Interventions for preventing falls in older people in nursing care facilities and hospitals. Cochrane Database of Systematic Reviews, (1), CD005465.Google ScholarPubMed
Campbell, A.J., Borrie, M.J., & Spears, G.F. (1989). Risk factors for falls in a community-based prospective study of people 70 years and older. Journal of Gerontology, 44(4), M112–M117.CrossRefGoogle Scholar
Campbell, A.J., Reinken, J., Allan, B.C., & Martinez, G.S. (1981). Falls in old age: A study of frequency and related clinical factors. Age and Ageing, 10(4), 26470.CrossRefGoogle ScholarPubMed
Campbell, A.J., & Robertson, M.C. (2009). Not a retreat, but advancing on numerous fronts. Journal of the American Geriatrics Society, 57(3), 565–566. Author reply 566–567.CrossRefGoogle Scholar
Carter, N.D., Kannus, P., & Khan, K.M. (2001). Exercise in the prevention of falls in older people: a systematic literature review examining the rationale and the evidence. Sports Medicine, 31(6), 427–438. Review.CrossRefGoogle ScholarPubMed
Centers for Disease Control in the United States. Retrieved 26 January 2010, fromhttp://www.cdc.gov/ncipc/duip/spotlite/falls.htmGoogle Scholar
Cowdry, E.V., & Steinberg, F.U. (Eds.). (1971). The care of the geriatric patient (4th ed.). Saint Louis, MO: CV Mosby.Google Scholar
Cumming, R.G., Kelsey, J.L., & Nevitt, M.C. (1990). Methodologic issues in the study of frequent and recurrent health problems. Falls in the elderly. Annals of Epidemiology. 1(1), 49–56.CrossRefGoogle Scholar
Cummings, S.R., Nevitt, M.C., & Kidd, S. (1988). Forgetting falls. The limited accuracy of recall of falls in the elderly. Journal of the American Geriatrics Society, 36(7), 613–616. SR.CrossRefGoogle ScholarPubMed
Droller, H. (1955). Falls among elderly people living at home. Geriatrics, 10, 239–244.Google ScholarPubMed
Faulkner, K.A., Cauley, J.A., Studenski, S.A., Landsittel, D.P., Cummings, S.R., Ensrud, K.E., et al. ; for the Study of Osteoporotic Fractures Research Group. (2009). Lifestyle predicts falls independent of physical risk factors. Osteoporosis International. 20, 2025–034.CrossRefGoogle ScholarPubMed
Fine, W. (1959). An analysis of 277 falls in hospital. Gerontologia Clinica, 1, 292–300.CrossRefGoogle Scholar
Fortinsky, R.H., Baker, D., Gottschalk, M., King, M., Trella, P., & Tinetti, M.E. (2008).Extent of implementation of evidence-based fall prevention practices for older patients in home health care. Journal of the American Geriatrics Society, 56(4), 737–743.CrossRefGoogle ScholarPubMed
Friedman, S.M., Munoz, B., West, S.K., Rubin, G.S., & Fried, L.P. (2002). Falls and fear of falling: which comes first? A longitudinal prediction model suggests strategies for primary and secondary prevention. Journal of the American Geriatrics Society, 50(8), 1329–1335.CrossRefGoogle Scholar
Gates, S., Fisher, J.D., Cooke, M.W., Carter, Y.H., & Lamb, S.E. (2008). Multifactorial assessment and targeted intervention for preventing falls and injuries among older people in community and emergency care settings: systematic review and meta-analysis. BMJ, 336(7636), 130–133.CrossRefGoogle ScholarPubMed
Gates, S., Smith, L.A., Fisher, J.D., & Lamb, S.E. (2008). Systematic review of accuracy of screening instruments for predicting fall risk among independently living older adults. Journal of Rehabilitation Research and Development, 45(8), 1105–1116. Review.CrossRefGoogle ScholarPubMed
Gill, D.P., Zou, G.Y., Jones, G.R., & Speechley, M. (2009). Comparison of regression models for the analysis of fall risk factors in older veterans. Annals of Epidemiology, 19(8), 523–530.CrossRefGoogle ScholarPubMed
Gillespie, L.D., Gillespie, W.J., Robertson, M.C., Lamb, S.E., Cumming, R.G., & Rowe, B.H. (2003). Interventions for preventing falls in elderly people. Cochrane Database of Systematic Reviews, (4), CD000340. Review.Google ScholarPubMed
Gillespie, L.D., Robertson, M.C., Gillespie, W.J., Lamb, S.E., Gates, S., Cumming, R.G., et al. . (2009). Interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews, (2), 1–254. Art. No.: CD007146.Google ScholarPubMed
Gryfe, C.I., Amies, A., & Ashley, M.J. (1977). A longitudinal study of falls in an elderly population: I. Incidence and morbidity. Age and Ageing, 6(4), 201–210.CrossRefGoogle Scholar
Härlein, J., Dassen, T., Halfens, R.J., & Heinze, C. (2009). Fall risk factors in older people with dementia or cognitive impairment: A systematic review. Journal of Advanced Nursing, 65(5), 922–933. Review.CrossRefGoogle ScholarPubMed
Hauer, K., Lamb, S.E., Jorstad, E.C., Todd, C., & Becker, C.; PROFANE-Group. (2006). Systematic review of definitions and methods of measuring falls in randomised controlled fall prevention trials. Age and Ageing, 35(1), 5–10. Review.CrossRefGoogle ScholarPubMed
Health Canada-Public Health Agency of Canada. (2006). Seniors and aging – preventing falls in and around your home. Retrieved 26 January 2010, fromhttp://www.hc-sc.gc.ca/hl-vs/iyh-vsv/life-vie/fp-pc-eng.phpGoogle Scholar
Isaccs, B. (1978). Are falls a manifestation of brain failure? Age and Ageing, 7(Suppl. 98), 105.Google Scholar
Kellogg International Work Group on the Prevention of Falls by the Elderly. (1987). The prevention of falls in later life. Danish Medical Bulletin, 34(Suppl. 4), 1–24.Google Scholar
Khambalia, A., Joshi, P., Brussoni, M., Raina, P., Morrongiello, B., & Macarthur, C. (2006). Risk factors for unintentional injuries due to falls in children aged 0-6 years: A systematic review. Injury Prevention, 12(6), 378–381. Review.CrossRefGoogle ScholarPubMed
Kleinbaum, D.G., Kupper, L.L., & Morgenstern, H. (1982). Epidemiologic research: Principles and quantitative methods. New York: Van Nostrand Reinhold.Google Scholar
Kool, B., Ameratunga, S., Robinson, E., Crengle, S., & Jackson, R. (2008). The contribution of alcohol to falls at home among working-aged adults. Alcohol, 42(5), 383–388.CrossRefGoogle Scholar
Latt, M.D., Lord, S.R., Morris, J.G., & Fung, V.S. (2009). Clinical and physiological assessments for elucidating falls risk in Parkinson’s disease. Movement Disorders, 24(9), 1280–1289.CrossRefGoogle ScholarPubMed
Levinson, M.R., & Clay, F.J. (2009). Barriers to the implementation of evidence in osteoporosis treatment in hip fracture. Internal Medicine Journal. 39(3), 199–202.CrossRefGoogle Scholar
Lord, S.R., Menz, H.B., & Tiedemann, A. (2003). A physiological profile approach to falls risk assessment and prediction. Physical Therapy, 83(3), 237–252.CrossRefGoogle Scholar
Lucht, U. (1971). A prospective study of accidental falls and resulting injuries in the home among elderly people. Acta socio-medica Scandinavica, 3(2), 105–120.Google ScholarPubMed
Masud, T., & Morris, R.O. (2001). Epidemiology of falls. Age and Ageing, 30(Suppl. 4), 3–7. Review.CrossRefGoogle ScholarPubMed
Murphy, S.L., Dubin, J.A., & Gill, T.M. (2003). The development of fear of falling among community-living older women: Predisposing factors and subsequent fall events. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 58(10), M943–M947.CrossRefGoogle ScholarPubMed
Murphy, T.E., Tinetti, M.E., & Allore, H.G. (2008). Hierarchical models to evaluate translational research: Connecticut collaboration for fall prevention. Contemporary Clinical Trials. 29(3), 343–350.CrossRefGoogle ScholarPubMed
Nevitt, M.C., Cummings, S.R., & Hudes, E.S. (1991). Risk factors for injurious falls: A prospective study. Journal of Gerontology, 46(5), M164–M170.CrossRefGoogle ScholarPubMed
Nevitt, M.C., Cummings, S.R., Kidd, S., & Black, D. (1989). Risk factors for recurrent nonsyncopal falls. A prospective study. JAMA, 261(18), 2663–2668.CrossRefGoogle ScholarPubMed
O’Loughlin, J.L., Robitaille, Y., Boivin, J.F., & Suissa, S. (1993). Incidence of and risk factors for falls and injurious falls among the community-dwelling elderly. American Journal of Epidemiology, 137(3), 342–354.CrossRefGoogle ScholarPubMed
Prudham, D., & Evans, J.G. (1981). Factors associated with falls in the elderly: A community study. Age and Ageing, 10(3), 141–146.CrossRefGoogle ScholarPubMed
Reelick, M.F., van Iersel, M.B., Kessels, R.P., & Rikkert, M.G. (2009). The influence of fear of falling on gait and balance in older people. Age and Ageing, 38(4), 435–440. Published Online First: May 18, 2009.CrossRefGoogle ScholarPubMed
Rivara, F.P., & Thompson, D.C. (2000). Prevention of falls in the construction industry: Evidence for program effectiveness. American Journal of Preventive Medicine, 18(Suppl. 4), 23–26. Review.CrossRefGoogle ScholarPubMed
Robertson, M.C., Campbell, A.J., & Herbison, P. (2005). Statistical analysis of efficacy in falls prevention trials. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 60(4), 530–534.CrossRefGoogle Scholar
Roshanaei-Moghaddam, B., Katon, W.J., & Russo, J. (2009). The longitudinal effects of depression on physical activity. General Hospital Psychiatry. 31(4), 306–315. Published Online First: May 13, 2009. Review.CrossRefGoogle ScholarPubMed
Rubenstein, L.Z. (2006). Falls in older people: Epidemiology, risk factors and strategies for prevention. Age and Ageing, 35(Suppl. 2), ii37–ii41. Review.CrossRefGoogle ScholarPubMed
Rubenstein, L.Z., & Josephson, K.R. (2006). Falls and their prevention in elderly people: What does the evidence show? The Medical Clinics of North America, 90(5), 807–824. Review.CrossRefGoogle Scholar
Sheldon, J.H. (1948). The social medicine of old age. London: Oxford University Press.Google Scholar
Sheldon, J.H. (1960). On the natural history of falls in old age. British Medical Journal, 2, 1685–1690.CrossRefGoogle ScholarPubMed
Skelton, D.A., & Todd, C.J.; ProFaNE Group. (2007) Prevention of Falls Network Europe: A thematic network aimed at introducing good practice in effective falls prevention across Europe. Four years on. Journal of Musculoskeletal & Neuronal Interactions, 7(3), 273–278. Review.Google Scholar
Statistical Report on the Health of Canadians. (1999). Cat. No. H39–467/1999E ISBN 0-662-27623-X. Statistics Canada. Catalogue Number: 82-570-X1E. Retrieved 26 January 2010, from http://www.statcan.gc.ca/pub/82-570-x/4227734-eng.pdfGoogle Scholar
Tinetti, M.E. (2003). Clinical practice. Preventing falls in elderly persons. The New England Journal of Medicine, 348(1), 42–49. Review.CrossRefGoogle ScholarPubMed
Tinetti, M.E. (2008). Multifactorial fall-prevention strategies: time to retreat or advance. Journal of the American Geriatrics Society, 56(8), 1563–1565.CrossRefGoogle ScholarPubMed
Tinetti, M.E., Baker, D.I., McAvay, G., Claus, E.B., Garrett, P., Gottschalk, M., et al. . (1994). A multifactorial intervention to reduce the risk of falling among elderly people living in the community. The New England Journal of Medicine, 331(13), 821–827.CrossRefGoogle ScholarPubMed
Tinetti, M.E., Baker, D.I., King, M., Gottschalk, M., Murphy, T.E., Acampora, D., et al. . (2008). Effect of dissemination of evidence in reducing injuries from falls. The New England Journal of Medicine, 359(3), 252–261.CrossRefGoogle ScholarPubMed
Tinetti, M.E., Doucette, J.T., & Claus, E.B. (1995) The contribution of predisposing and situational risk factors to serious fall injuries. Journal of the American Geriatrics Society. 43(11), 1207–1213.CrossRefGoogle ScholarPubMed
Tinetti, M.E., Doucette, J., Claus, E., & Marottoli, R. (1995). Risk factors for serious injury during falls by older persons in the community. Journal of the American Geriatrics Society, 43(11), 1214–1221.CrossRefGoogle ScholarPubMed
Tinetti, M.E., & Kumar, C. (2010). The patient who falls: “It’s always a trade-off”. JAMA, 303(3), 258–266.CrossRefGoogle Scholar
Tinetti, M.E., McAvay, G., & Claus, E. (1996). Does multiple risk factor reduction explain the reduction in fall rate in the Yale FICSIT Trial? Frailty and Injuries Cooperative Studies of Intervention Techniques. American Journal of Epidemiology. 144(4), 389–399.CrossRefGoogle ScholarPubMed
Tinetti, M.E., Speechley, M., & Ginter, S.F. (1988). Risk factors for falls among elderly persons living in the community. The New England Journal of Medicine, 319(26), 1701–1707.CrossRefGoogle ScholarPubMed
Weerdesteyn, V., de Niet, M., van Duijnhoven, H.J., & Geurts, A.C. (2008). Falls in individuals with stroke. Journal of Rehabilitation Research and Development, 45(8), 1195–1213. Review.CrossRefGoogle ScholarPubMed
Zecevic, A.A., Salmoni, A.W., Speechley, M., & Vandervoort, A.A. (2006). Defining a fall and reasons for falling: comparisons among the views of seniors, health care providers, and the research literature. Gerontologist, 46(3), 367–376. Review.CrossRefGoogle ScholarPubMed