Prevalence and predictors of falls and dizziness in people younger and older than 80 years of age—A longitudinal cohort study
Introduction
One third of older people fall each year and the number of falls increase with age and frailty level (WHO, 2007). Of all falls in older adults 10–20% results in injury, hospitalisation and/or death (Rubenstein, 2006). Many studies have investigated risk factors for falls in older people and as many as 400 have been revealed (NICE, 2004). Longitudinal studies investigating predictors for falls also showed the importance of a variety of factors including a history of falling, gait problems, vertigo and drug use (Deandrea et al., 2010). The large number of risk factors indicates the complexity of the problem and that the risk factors identified differ depending on study design and study population. Common risk factors for falls are more frequent at higher ages and the risk of falling rises with the number of risk factors for falls present. This may imply that the predictors for falls differ in different age cohorts.
In a recent meta-analysis of risk factors for falls in community-dwelling older people, the strongest predictors for falls were found to be a history of falls, gait problems, use of a walking aid, vertigo, Parkinson disease and antiepileptic drug use (Deandrea et al., 2010). Most studies that investigate risk factors for falls include people 65+ years but a few studies have investigated associated factors and predictors for falls in people 80+ years (Iinattiniemi et al., 2009, Grundstrom et al., 2012). A study in 555 people 85+ years showed history of recurrent falls, poor vision, antipsychotic drugs and feelings of anxiety, nervousness or fear to be independent risk factors for falls (Iinattiniemi et al., 2009). Another study comparing risk factors for falls in people younger and older than 85+ years revealed that even though many risk factors for falls were similar between the groups, higher age as well as male gender and general health status were more strongly associated with an increased fall risk in those 85 years and older (Grundstrom et al., 2012). Those differences might indicate that predictors of falls differ according to age but, to our knowledge, no study has investigated predictors for falls in different age cohorts. This knowledge might reveal specific age-related predictors, which could be useful when screening for people at risk for subsequent falls and when designing fall preventive interventions for people of various ages.
The strategy for preventing falls is elimination of the risk factors for falls. Dizziness is a known risk factor for falls (Deandrea et al., 2010) and predictors for dizziness are indirect predictors for falls. Various studies report the prevalence of dizziness in older people as being between 11 and 31% with an increase with age (Gassman and Rupprecht, 2009, Stevens et al., 2008, Tinetti et al., 2000a). The most common major contributory causes of dizziness in elderly (65+ years) patients were cardiovascular disease, peripheral vestibular disease and psychiatric illness (Maarsingh et al., 2010) and although falls may be the most disabling consequence of dizziness (Mendel, Bergenius, & Langius-Eklöf, 2010) it is also associated with poor self-related health (Gassman & Rupprecht, 2009) and reduced quality of life (Ekwall, Lindberg, & Magnusson, 2009), indicating the importance of prevention. A prospective cohort study in 620 people 65+ years showed higher age, female gender, comorbidity, polypharmacy, poor subjective health status, falls and mobility problems to be predictors of dizziness (Gassman & Rupprecht, 2009). To our knowledge no study has investigated predictors for dizziness stratified by age and this knowledge may identify age-specific factors that ought to be eliminated to prevent dizziness and thereby falls. The objectives of this study were to investigate the prevalence and predictors for falls and dizziness among people younger and older than 80 years of age in a longitudinal cohort study with 3- and 6-year follow-ups.
Section snippets
Sample
The sample was drawn from the SNAC, a national, longitudinal, multidisciplinary study involving four research centers (Lagergren et al., 2004). The present study used data from the sub-study of the County of Blekinge (SNAC-B) with baseline data collection in 2001–2003 on 1402 people 60–96 years of age. SNAC-B focused on one municipality with approximately 60 000 inhabitants, located in the south-eastern part of Sweden including both urban and rural areas. The four youngest age cohorts (60, 66,
Prevalence of falls and associated factors
At baseline a total of 23.2% of subjects reported falls, those under aged 80 reported a prevalence of 16.5% and those 80+ years 31.7% (Fig. 1). Many of the baseline variables were significantly associated in the expected direction and with higher prevalence rates in those 80+ years except dizziness that showed the same prevalence rate in younger and older fallers, i.e. 26% (Table 2).
In those under aged 80 a fall was significantly associated with higher age, ADL dependency, reduced grip
Discussion
Approximately 23% of subjects experienced falls or dizziness with an almost doubled prevalence rate the older age cohort compared to the younger (Fig. 1). The high prevalence of associated factors showed that people that fall or have dizziness are strongly affected, signifying the importance of preventive interventions. A history of falling and dizziness were predictors in people with falls and dizziness respectively, in both those under and above 80 years of age, indicating that these
Conclusions
This study showed that younger and older age cohorts reveal similar patterns concerning associated factors. Nevertheless, the predictors for the age cohorts differ and it is therefore important to develop strategies differentiated according to age to prevent falls and dizziness. In those under aged 80 specific factors such as neuroleptics, PADL dependency, visual acuity and feelings of nervousness are important factors in predicting falls and dizziness. The results in those 80+ years show that
Conflict of interest statement
None.
Acknowledgements
The SNAC (http://www.snac.org) is supported financially by the Swedish Ministry of Health and Social Affairs, and by the participating county councils, municipalities and university departments. We are grateful to the subjects and staff of SNAC-Blekinge for their engagement in the study. We also wish to thank Pat Shrimpton for revising the English.
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