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Falls Risk Factors: Assessment and Management To Prevent Falls and Fractures*

Published online by Cambridge University Press:  03 May 2011

Finbarr C. Martin
Finbarr C. Martin*
Affiliation:
Consultant Geriatrician
*
†Correspondence and requests for offprints should be sent to / La correspondance et les demandes de tirés-à-part doivent être adressées à: Finbarr C. Martin, M.D. Consultant Geriatrician Guys and St Thomas’ NHS Foundation Trust and King’s College London Institute of Gerontology St Thomas’ Hospital Westminster Bridge Road London, ON SE1 7EH ([email protected])
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Abstract

Falls and fragility fractures are common, dangerous, and important public health challenges. They are best understood as geriatric syndromes with close relation to frailty and other aging-related health problems. They are associated with many risk factors, in all health domains – physical, psychological, social, and environmental. At a population level, the challenge is to improve the health and well-being of all older people to reduce the incidence of falls. At a clinical level, the challenge is to assess the individual risk factors and apply evidence-based individually tailored, multifactorial interventions. The most powerful component is strength-and-balance exercise training.

Résumé

Les chutes et les fractures pathologiques sont des défis communs, dangereux et importants de la santé publique. Ils sont mieux compris comme des syndromes gériatriques étroitement liés à la fragilité et d’autres problèmes de la santé liés à l’âge. Ils sont associés à de nombreux facteurs de risque, dans tous les domaines de la santé – physiques, psychologiques, sociaux et environnementaux. Au niveau de la population, le défi consiste à améliorer la santé et le bien-être de toutes les personnes âgées à réduire l’incidence des chutes. Au niveau clinique, le défi consiste à évaluer les facteurs de risque individuels et d’appliquer des interventions multifactorielles factuelles sur mesure. » La composante plus puissante est l’entraînement physique de l’équilibre et de la résistance.

Keywords

chutes, fractures pathologiquesfacteurs de risquefragilitésyndrome gériatriquepréventionfallsfragility fracturesrisk factorsfrailtygeriatric syndromeprevention
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. 33 - 44
Copyright
Copyright © Canadian Association on Gerontology 2011

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Footnotes

*

Sincere thanks to my patients and to my many research and clinical collaborators over the 28 years during which I have been privileged to work with frail older people in the England National Health Service.

References

Alexander, N.B., & Hausdorff, J.M. (2008). Guest editorial: Linking thinking, walking, and falling. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 63(12), 1325–1328.CrossRefGoogle ScholarPubMed
Alexopoulos, G.S., Meyers, B.S., Young, R.C., Campbell, S., Silbersweig, D., & Charlson, M. (1997). ‘Vascular depression’ hypothesis. Archives of General Psychiatry, 54(10), 915–922.CrossRefGoogle ScholarPubMed
Allcock, L.M., Rowan, E.N., Steen, I.N., Wesnes, K., Kenny, R.A., & Burn, D.J. (2009). Impaired attention predicts falling in Parkinson’s disease. Parkinsonism & Related Disorders, 15(2), 110–115.CrossRefGoogle ScholarPubMed
Allen, N.E., Sherrington, C., Canning, C.G., & Fung, V.S. (2010). Reduced muscle power is associated with slower walking velocity and falls in people with Parkinson’s disease. Parkinsonism & Related Disorders, 16(4), 261–264.CrossRefGoogle ScholarPubMed
American Geriatrics Society and British Geriatrics Society (AGS/BGS). (2009). Clinical Practice Guideline: Prevention of Falls in Older Persons. Retrieved February 20, 2010, from http://www.americangeriatrics.org/education/prevention_of_falls.shtmlGoogle Scholar
Ashburn, A., Fazakarley, L., Ballinger, C., Pickering, R., McLellan, L.D., & Fitton, C. (2007). A randomised controlled trial of a home-based among people with Parkinson’s disease exercise programme to reduce the risk of falling. Journal of Neurology, Neurosurgery, and Psychiatry, 78(7), 678–684.CrossRefGoogle ScholarPubMed
Baldwin, R., Jeffries, S., Jackson, A., Sutcliffe, C., Thacker, N., Scott, M., et al. . (2005). Neurological findings in late-onset depressive disorder: Comparison of individuals with and without depression. The British Journal of Psychiatry, 186, 308–313.CrossRefGoogle ScholarPubMed
Barra, J., Bray, A., Sahni, V., Golding, J.F., & Gresty, M.A. (2006). Increasing cognitive load with increasing balance challenge: Recipe for catastrophe. Experimental Brain Research, 174, 734–745.CrossRefGoogle ScholarPubMed
Bhattacharyya, N., Baugh, R.F., Orvidas, L., Barrs, D., Bronston, L.J., Cass, S., et al. . (2008). Clinical practice guideline: Benign paroxysmal positional vertigo. Otolaryngology and Head and Neck Surgery, 139(5 Suppl. 4), S47–S81.CrossRefGoogle ScholarPubMed
Brignole, M. (2006). Distinguishing syncopal from non-syncopal causes of fall in older people. Age and Ageing, 35(Suppl. 2), ii46–ii50.CrossRefGoogle ScholarPubMed
Campbell, A.J., & Buckner, D.M. (1997). Unstable disability and the fluctuations of frailty. Age and Ageing, 26(4), 315–318.CrossRefGoogle ScholarPubMed
Campbell, A.J., & Robertson, M.C. (2007). Rethinking individual and community fall prevention strategies: A meta-regression comparing single and multifactorial interventions. Age and Ageing, 36, 656–662.CrossRefGoogle ScholarPubMed
Campbell, A.J., Robertson, M.C., Gardner, M.M., Norton, R.N., & Buchner, D.M. (1999). Psychotropic medication withdrawal and a home-based exercise program to prevent falls: A randomized, controlled trial. Journal of the American Geriatrics Society, 47, 850–853.CrossRefGoogle Scholar
Campbell, A.J., Spears, G.F.S., & Borrie, M.J. (1990). Examination by logistic regression modeling of the variables which increase the relative risk of elderly women falling compared to elderly men. Journal of Clinical Epidemiology, 43, 1415–1420.CrossRefGoogle ScholarPubMed
Clemson, L. (1997). Home fall hazards: A guide to identifying fall hazards in the homes of elderly people and an accompaniment to the assessment tool, the Westmead Home Safety Assessment (WeHSA). West Brunswick, Victoria: Co-ordinates Publications.Google Scholar
Clemson, L., Mackenzie, L., Ballinger, C., Close, J.C., & Cumming, R.G. (2008). Environmental interventions to prevent falls in community-dwelling older people: A meta-analysis of randomized trials. Journal of Aging and Health, 20(8), 954–971.CrossRefGoogle ScholarPubMed
Close, J., Ellis, M., Hooper, R., Glucksman, E., Jackson, S., & Swift, C. (1999). Prevention of falls in the elderly trial (PROFET): A randomised controlled trial. Lancet, 353, 93–97.CrossRefGoogle ScholarPubMed
Close, J.C.T., Hooper, R., Glucksman, E., Jackson, S.H.D., & Swift, C.G. (2003). Predictors of falls in a high risk population: Results from the prevention of falls in the elderly trial (PROFET). Emergency Medicine Journal, 20, 421–425.CrossRefGoogle Scholar
Davison, J., Bond, J., Dawson, P., Steen, I.N., & Kenny, R.A. (2005). Patients with recurrent falls attending Accident & Emergency benefit from multifactorial intervention – a randomised controlled trial. Age and Ageing, 34, 162–168.CrossRefGoogle ScholarPubMed
Day, L., Fildes, B., Gordon, I., Fitzharris, M., Flamer, H., & Lord, S. (2002). Randomised factorial trial of falls prevention among older people living in their own homes. BMJ, 325(7356), 128–134.CrossRefGoogle ScholarPubMed
Donaldson, L.J., Reckless, I.P., Scholes, S., Mindell, J.S., & Shelton, N.J. (2008). The Epidemiology of Fractures in England. Journal of Epidemiology and Community Health, 62(2), 174–180.CrossRefGoogle ScholarPubMed
Edwards, B.J., Bunta, A.D., Simonelli, C., Bolander, M., & Fitzpatrick, L.A. (2007). Prior fractures are common in patients with subsequent hip fractures. Clinical Orthopaedics and Related Research, 461, 226–230.CrossRefGoogle ScholarPubMed
Fleming, J., Matthews, F.E., & Brayne, C.; Cambridge City over-75s Cohort (CC75C) study collaboration. (2008). Falls in advanced old age: Recalled falls and prospective follow-up of over-90-year-olds in the Cambridge City over-75s Cohort study. BMC Geriatrics, 8, 6.CrossRefGoogle ScholarPubMed
Freeman, R. (2008). Neurogenic Orthostatic Hypotension. The New England Journal of Medicine, 358, 615–624.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, 1329–1335.CrossRefGoogle Scholar
Ganz, D.A., Bao, Y., Shekelle, P.G., & Rubenstein, L.Z. (2007). Will my patient fall? JAMA, 297, 77–86.CrossRefGoogle ScholarPubMed
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
Genever, R.W., Downes, T.W., & Medcalf, P. (2005). Fracture rates in Parkinson’s disease compared with age- and gender-matched controls: A retrospective cohort study. Age and Ageing, 34, 21–24.CrossRefGoogle ScholarPubMed
Gillespie, L.D., Gillespie, W.J., & Parker, M.J. (2010). Hip protectors for preventing hip fractures in older people. Cochrane Database of Systematic Reviews, (10). Art. No.: CD001255. doi:10.1002/14651858.CD001244.pub4.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). Art. No.: CD000340. doi:10.1002/14651858.CD000340.CrossRefGoogle ScholarPubMed
Gillespie, L.D., Robertson, M.C., Gillespie, W.J., Lamb, S.E., Gates, S., Cumming, R.G., & Rowe, B.H. (2009). Interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews, (2), Art. No.: CD007146. doi:10.1002/14651858.CD007146.pub2.CrossRefGoogle ScholarPubMed
Hanlon, J.T., Boudreau, R.M., Roumani, Y.F., Newman, A.B., Ruby, C.M., Wright, R.M., et al. . (2009). Number and dosage of central nervous system medications on recurrent falls in community elders: The Health, Aging and Body Composition study. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 64(4), 492–498. Published Online First: Feb 4, 2009.CrossRefGoogle Scholar
Hartikainen, S.A., Lonnroos, E., & Louhivuori, K. (2007). Medication as a risk factor for falls: Critical systematic review. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 62A, MS1172–M1181.CrossRefGoogle Scholar
Help the Aged. (2005). Don’t Mention the F- Word. Retrieved, from http://www.helptheaged.org.ukGoogle Scholar
Inouye, S.K., Studenski, S., Tinetti, M.E., & Kuchel, G.A. (2007). Geriatric syndromes: Clinical, research, and policy implications of a core geriatric concept. Journal of the American Geriatrics Society, 55, 780–791.CrossRefGoogle ScholarPubMed
Ismail, A.A., Pye, S.R., Cockerill, W.C., Lunt, M., Silman, A.J., Reeve, J., et al. . (2002). Incidence of limb fracture across Europe: Results from the European Prospective Osteoporosis Study (EPOS). Osteoporosis International, 13(7), 565–571.CrossRefGoogle ScholarPubMed
Järvinen, T.L., Sievänen, H., Khan, K.M., Heinonen, A., & Kannus, P. (2008). Shifting the focus in fracture prevention from osteoporosis to falls. BMJ, 336, 124–126.CrossRefGoogle ScholarPubMed
Kamata, N., Matsuo, Y., Yoneda, T., Shinohara, H., Inoue, S., & Abe, K. (2007). Overestimation of stability limits leads to a high frequency of falls in patients with Parkinson’s disease. Clinical Rehabilitation, 21(4), 357–361.CrossRefGoogle ScholarPubMed
Kanis, J.A., Johnell, O., De Laet, C., Jonsson, B., Oden, A., & Ogelsby, A.K. (2002). International variations in hip fracture probabilities: Implications for risk assessment. Journal of Bone and Mineral Research, 17, 1237–1244.CrossRefGoogle ScholarPubMed
Kannus, P., Parkkari, J., Koskinen, S., Niemi, S., Palvanen, M., Järvinen, M., et al. . (1999). Fall-induced injuries and deaths among older adults. JAMA, 281, 1895–1899.CrossRefGoogle ScholarPubMed
Lamb, S.E., Jorstad-Stein, E.C., Hauer, K., & Becker, C.on behalf of the Prevention of Falls Network Europe and Outcomes Consensus Group. (2005). Development of a common outcome data set for fall injury prevention trials: The Prevention of Falls Network Europe Consensus. Journal of the American Geriatrics Society, 53, 1618–1622.CrossRefGoogle ScholarPubMed
Lawlor, D., Patel, R., & Ebrahim, S. (2003). Association between falls in elderly women and chronic diseases and drug use: Cross sectional study. BMJ, 327, 712–717.CrossRefGoogle ScholarPubMed
Lee, J.S.W., Twok, T., Leung, P.C., & Woo, J. (2006). Medical illnesses are more important than medications as risk factors of falls in older community dwellers? A cross-sectional study. Age and Ageing, 35, 246–251.CrossRefGoogle ScholarPubMed
Lord, S.R., Menz, H.B., & Tiedemann, A. (2003). A physiological profile approach to falls risk assessment and prevention. Physical Therapy, 83(3), 237–252.CrossRefGoogle ScholarPubMed
Lord, S.R., Sambrook, P.N., Gilbert, C., Kelly, P.J., Nguyen, T., Webster, I.W., et al. . (1994). Postural stability, falls and fractures in the elderly: Results from the Dubbo Osteoporosis Epidemiology Study. The Medical Journal of Australia, 160(11), 684–685, 688–691.CrossRefGoogle ScholarPubMed
Mak, M.K., & Pang, M.Y. (2009). Fear of falling is independently associated with recurrent falls in patients with Parkinson’s disease: A 1-year prospective study. Journal of Neurology, 256(10), 1689–1695. Published Online First: May 28, 2009.CrossRefGoogle ScholarPubMed
Marshall, D., Johnell, O., & Wedel, H. (1996). Meta-analysis of how well measures of bone mineral predict fractures. British Medical Journal, 312, 1254–1259.CrossRefGoogle ScholarPubMed
Martin, F.C. (2009). Next steps for falls and fracture reduction. Age and Ageing, 38, 640–643.CrossRefGoogle ScholarPubMed
Martin, F.C., Hart, D.J., Spector, T.D., Doyle, D., & Harari, D. (2005). Fear of falling limiting activity in young-old women is associated with reduced functional mobility rather than psychological factors. Age and Ageing, 34(3), 281–287.CrossRefGoogle ScholarPubMed
Masud, T., & Morris, R.O. (2001). Epidemiology of Falls. Age and Ageing, 30(Suppl. 4), 3–7.CrossRefGoogle ScholarPubMed
Mehrholz, J., Friis, R., Kugler, J., Twork, S., Storch, A., & Pohl, M. (2010). Treadmill training for patients with Parkinson’s disease. Cochrane Database of Systematic Reviews. (1), CD007830.CrossRefGoogle ScholarPubMed
Melin, A.L., Wilske, J., Ringertz, H., & Sääf, M. (1999). Vitamin D status, parathyroid function and femoral bone density in an elderly Swedish population living at home. Aging (Milan, Italy), 11(3), 200–207.Google Scholar
Morris, V., & Wagg, A. (2007). Lower urinary tract symptoms, incontinence and falls in elderly people: Time for an intervention study. International Journal of Clinical Practice, 61(2), 320–323.CrossRefGoogle ScholarPubMed
Nandy, S., Parsons, S., Cryer, C., Underwood, M., Rashbrook, E., Carter, Y., et al. . (2004). Development and preliminary examination of the predictive validity of the Falls Risk Assessment Tool (FRAT) for use in primary care. Journal of Public Health (Oxford, England), 26(2), 138–143.CrossRefGoogle ScholarPubMed
National Institute for Clinical Excellence (NICE). (2004). Clinical practice guideline for the assessment and prevention of falls in older people. Royal College of Nursing. London: National Institute for Clinical Excellence.Google Scholar
Nikolaus, T., & Bach, M. (2003). Preventing falls in community-dwelling frail older people using a home intervention team (HIT): Results from the randomized Falls-HIT trial. Journal of the American Geriatrics Society, 51(3), 300–305.CrossRefGoogle ScholarPubMed
Nowak, A., & Hubbard, R. (2009). Falls and frailty: Lessons from complex systems. Journal of the Royal Society of Medicine, 102, 98–102.CrossRefGoogle ScholarPubMed
Nyman, S.R. (2011). Psychosocial issues in engaging older people with physical activity interventions for the prevention of falls. Canadian Journal on Aging, 30(1), 45–55.CrossRefGoogle ScholarPubMed
Oliver, D., Connelly, J.B., Victor, C.R., Shaw, F.E., Whitehead, A., Genc, Y., et al. . (2007). The prevention of falls and fractures in hospitals and care homes. Systematic review and meta-analyses of clinical studies of prevention strategies, with an exploration of cognitive impairment as an effect modifier. BMJ, 334(7584), 82.CrossRefGoogle Scholar
Parry, S.W., Frearson, R., Steen, N., Newton, J., Tryambake, P., & Kenny, R.A. (2008). Evidence-based algorithms and the management of falls and syncope presenting to acute medical services. Clinical Medicine, 8(2), 157–162.CrossRefGoogle ScholarPubMed
Parry, S.W., Steen, I.N., Baptist, M., & Kenny, R.A. (2005). Amnesia for loss of consciousness in carotid sinus syndrome: Implications for presentation with falls. Journal of the American College of Cardiology, 45, 1840–1843.CrossRefGoogle ScholarPubMed
Peel, N.M., Kassulke, D.J., & McClure, R.J. (2002). Population based study of hospitalized fall related injuries in older people. Injury Prevention, 8, 280–283.CrossRefGoogle ScholarPubMed
Podsiadlo, D., & Richardson, S. (1991). The timed ‘up and go’ a test of basic functional mobility for frail elderly persons. Journal of the American Geriatrics Society, 39, 142–148.CrossRefGoogle Scholar
Ray, W.A., Taylor, J.A., Meador, K.G., Thapa, P.B., Brown, A.K., Kajihara, H.K., et al. . (1997). A randomized trial of a consultation service to reduce falls in nursing homes. JAMA, 278, 557–562.CrossRefGoogle ScholarPubMed
Rockwood, K., Awalt, E., Carver, D., & Macknight, C. (2000). Feasibility and measurement properties of the functional reach and the timed up and go tests in the Canadian Study of Health and Aging. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 5, M70–M73.Google Scholar
Royal College of Physicians Clinical Effectiveness and Evaluation Unit. (2007). National Clinical Audit of Falls and Bone Health in Older People, 2007. Retrieved from: http://www.rcplondon.ac.uk/clinical-standards/ceeu/Current-work/Pages/Falls-and-Bone-Health-in-Older-People.aspxGoogle Scholar
Royal College of Physicians of London, Clinical Effectiveness and Evaluation Unit. (2007). National Clinical Audit of Falls and Bone Health in Older People. (National Report, 2007). Retrieved from http://www.rcplondon.ac.uk/clinical-standards/ceeu/Current-work/Pages/Falls-and-Bone-Health-in-Older-People.aspx#nationalGoogle Scholar
Rubenstein, L.Z. (2006). Falls in older people: Epidemiology, risk factors and strategies for prevention. Age and Ageing, 35(Suppl. 2), ii37–ii41.CrossRefGoogle ScholarPubMed
Sakakibara, R., Hattori, T., Uchiyama, T., & Yamanishi, T. (1999). Urinary function in elderly people with and without leukoariosis: Relation to cognitive and gait function. Journal of Neurology, Neurosurgery, and Psychiatry, 67, 658–660.CrossRefGoogle Scholar
Sander, B., Elliot-Gibson, V., Beaton, D.E., Bogoch, E.R., & Maetzel, A. (2008). A coordinator program in post-fracture osteoporosis management improves outcomes and saves costs. The Journal of Bone and Joint Surgery. American Volume, 90, 1197–1205. PubMed PMID: 18519311.Google ScholarPubMed
Scott, V., Votova, K., Scanlan, A., & Close, J. (2007). Multifactorial and functional mobility assessment tools for fall risk among older adults in community, home-support, long-term and acute care settings. Age and Ageing, 36(2), 130–139.CrossRefGoogle ScholarPubMed
Scuffham, P., & Chaplin, P. (2002). The incidence and costs of accidental falls in the UK. (Final Report). New York: York Health Economic Form Consortium, The University of York.Google Scholar
Shaw, F.E. (2002). Falls in cognitive impairment and dementia. Clinics in Geriatric Medicine, 18, 159–173.CrossRefGoogle ScholarPubMed
Shaw, F.E., & Kenny, R.A. (1997). The overlap between syncope and falls in the elderly. Postgraduate Medical Journal, 73(864), 635–639.CrossRefGoogle ScholarPubMed
Sherrington, C., Whitney, J.C., Lord, S.R., Herbert, R.D., Cumming, R.G., & Close, J.C. (2008). Effective exercise for the prevention of falls: A systematic review and meta-analysis. Journal of the American Geriatrics Society, 56, 2234–2243.CrossRefGoogle Scholar
Shumway-Cook, A., Brauer, S., & Woollacott, M. (2000). Predicting the probability of falls in community-dwelling older adults using the timed up and go test. Physical Therapy, 80, 896–903.CrossRefGoogle Scholar
Stevens, J.A., & Sogolow, E.D. (2005). Gender differences for non-fatal unintentional fall related injuries among older adults. Injury Prevention, 11, 115–119.CrossRefGoogle ScholarPubMed
Stone, K.L., Seeley, D.G., Lui, L.Y., Cauley, J.A., Ensrud, K., Browner, W.S., et al. . (2003). BMD at multiple sites and risk of fracture of multiple types: Long-term results from the study of osteoporotic fractures. Journal of Bone and Mineral Research, 18, 1947–1954.CrossRefGoogle ScholarPubMed
Tang, B.M.P., Eslick, G.D., Nowson, C., Smith, C., & Bensoussan, A. (2007). Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: A meta-analysis. The Lancet, 370(9588), 657–666.CrossRefGoogle ScholarPubMed
Templer, J., & Connell, B.R. (1994). Geriatrics: Environmental and behavioural factors in falls among the elderly. Rehabilitation, 30, 92–93.Google Scholar
The Task Force for the Diagnosis and Management of Syncope of the European Society of Cardiology (ESC). (2009). Guidelines for the diagnosis and management of syncope (version 2009). European Heart Journal, 30(21), 2631–2671. doi:10.1093/eurheartj/ehp298.CrossRefGoogle Scholar
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, 252–261.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, 821–827.CrossRefGoogle ScholarPubMed
Tinetti, M.E., Inouye, S.K., Gill, T.M., & Doucette, J.T. (1995). Shared risk factors for falls, incontinence, and functional dependence. Unifying the approach to geriatric syndromes. JAMA, 273, 1348–1353.CrossRefGoogle ScholarPubMed
Tinetti, M.E., McAvay, G., & Claus, E. (1996). Does multiple risk factor reduction explain the reduction of fall rate in the Yale FICSIT trial. American Journal of Epidemiology, 144, 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, 1701–1707.CrossRefGoogle ScholarPubMed
Tinetti, M.E., & Williams, C.S. (1997). Falls, injuries due to falls, and the risk of admission to a nursing home. The New England Journal of Medicine, 337(18), 1279–1284.CrossRefGoogle ScholarPubMed
van Haastregt, J.C., Diederiks, J.P., van Rossum, E., de Witte, L.P., Voorhoeve, P.M., & Crebolder, J.M. (2000). Effects of a programme of multifactorial home visits on falls and mobility impairments in elderly people at risk: Randomized controlled trial. British Medical Journal, 321, 994–998.CrossRefGoogle Scholar
Vestergaard, P., Rejnmark, L., & Mosekilde, L. (2007). Has mortality after a hip fracture increased? Journal of the American Geriatrics Society, 55(11), 1720–1726. Published Online First: Oct 3, 2007.CrossRefGoogle ScholarPubMed
Wells, G., Cranney, A., Peterson, J., Boucher, M., Shea, B., Robinson, V., et al. . (2008a). Alendronate for the primary and secondary prevention of osteoporotic fractures in postmenopausal women. Cochrane Database of Systematic Reviews, (1). Art. No.: CD001155. doi:10.1002/14651858.CD001155.pub2.Google ScholarPubMed
Wells, G., Cranney, A., Peterson, J., Boucher, M., Shea, B., Robinson, V., et al. . (2008b). Risedronate for the primary and secondary prevention of osteoporotic fractures in postmenopausal women. Cochrane Database of Systematic Reviews, (1). Art. No.: CD004523. doi:10.1002/14651858.CD004523.pub3.Google ScholarPubMed
Wood, B.H., Bilclough, J.A., Bowrin, A., & Walker, R.W. (2002). Incidence and prediction of falls in Parkinson’s disease: A prospective multidisciplinary study. Journal of Neurology, Neurosurgery, and Psychiatry, 72, 721–725.CrossRefGoogle ScholarPubMed
Zermansky, A.G., Alldred, D.P., Petty, D.G., Raynor, D.K., Freemantle, N., Eastaugh, J., et al. . (2006). Clinical medication review by a pharmacist of elderly people living in care homes—randomised controlled trial. Age and Ageing, 35, 586–591.CrossRefGoogle ScholarPubMed