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Falls in very old people: the population-based Umeå 85+ Study
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
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2009 (English)In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 49, 390-396 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to describe incidences of falls and fall-related injuries, and to identify predisposing factors for falls in very old people in a prospective population-based follow-up study for falls. The study is part of the Umeå 85+ Study which includes half of the population aged 85, and the total population aged 90 and ≥95 (−103), in Umeå, Sweden. Of the 253 people interviewed, 220 (87%) were followed up for falls for 6 months, of whom 109 lived in ordinary and 111 in institutional housing. A comprehensive geriatric baseline assessment was made through interviews and testing during home visits. Forty percent of the participants did fall a total 304 times, corresponding to 2.17 falls per Person Year (PY). It occurred 0.83 injuries per PY, including 0.14 fractures per PY. In a Cox regression analysis, the independent explanatory risk factors for time to first fall were dependency in activities of daily living (ADL), thyroid disorders, treatment with selective serotonin reuptake inhibitors (SSRIs) and occurrence of falls in the preceding year. It could be predicted that every seventh participant and every third of the people who did fall would suffer a fracture within 1 year. ADL, thyroid disorders and treatment with SSRIs should be considered in fall prevention programmes.

Place, publisher, year, edition, pages
Clare: Elsevier, 2009. Vol. 49, 390-396 p.
Keyword [en]
Aged, 80 and over, Accidental falls, Incidence of falls, Risk factors, Geriatric assessment
National Category
Geriatrics
Research subject
Physiotherapy
Identifiers
URN: urn:nbn:se:umu:diva-5336DOI: 10.1016/j.archger.2008.12.005ISI: 000270472300014PubMedID: 19144414OAI: oai:DiVA.org:umu-5336DiVA: diva2:144822
Available from: 2006-09-25 Created: 2006-09-25 Last updated: 2016-02-29Bibliographically approved
In thesis
1. Health, physical ability, falls and morale in very old people: the Umeå 85+ Study
Open this publication in new window or tab >>Health, physical ability, falls and morale in very old people: the Umeå 85+ Study
2006 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The very old, aged 80 years and over, is the fastest growing age group today, and the demands for healthcare and services will be even higher in the future. It is, therefore, of great importance to advance our knowledge about this group. The main purpose of this thesis was to describe living conditions and health, with a special focus on physical ability, falls and morale, in women and men in three different age groups of very old people in northern Sweden.

Half the population aged 85, and the total population aged 90 and ≥95 (-103) in the municipality of Umeå were selected for participation (n=348) in this population-based cross-sectional study, entitled the Umeå 85+ Study. Structured interviews and assessments were performed with the participants in their homes, and data were also collected from next-of-kins, caregivers and medical charts. Cognition was screened for using the Mini-Mental State Examination (MMSE), depressive symptoms using the Geriatric Depression Scale-15 (GDS-15), and nutritional status using the Mini Nutritional Assessment (MNA). Activities of Daily Living (ADL) were assessed using the Staircase of ADL (including the Katz Index of ADL) and morale using the Philadelphia Geriatric Center Morale Scale (PGCMS). Participants also rated their own health and answered a questionnaire about symptoms. Physical ability was assessed using a gait speed test over 2.4 meters (8 feet), three consecutive chair stands, and the Berg Balance Scale (BBS). A follow-up study for falls was performed during a period of six months with fall calendars and telephone calls.

The very old people in this northern population have more depression, hypertension and hip fractures, as well as a higher consumption of drugs than comparable, more southern populations. In general, younger participants had lower rates of diagnoses and prescribed drugs, were less dependent in ADL and other functional variables than older participants, and men had lower rates of diagnoses and reported symptoms than women. However, there were no age or sex differences in self-rated health or morale, which were both rated as good by the majority of the participants.

There was a wide range of physical ability among these very old people, especially in women, where an age-related decline was seen. The results also demonstrate that men had greater physical ability than women. The BBS had no floor or ceiling effects in the present sample. In contrast, a large proportion was unable to perform the gait speed and chair stands test, resulting in a floor effect for the timed performances, especially in women.

Falling is a major public health problem in very old people. From the results of the present study, it could be predicted that every seventh participant and every third of the people who did fall would suffer a fracture over a period of one year. The independent explanatory risk factors for time to first fall in this sample of very old people were dependency in personal (P-) ADL but not bedridden, thyroid disorders, treatment with Selective Serotonin Reuptake Inhibitors (SSRIs) and occurrence of fall/s in the preceding year. These factors should all be considered in fall prevention programmes.

The morale of very old people was found in this study to be rather high, with similar scores among age groups and sexes. The most important factors for high morale were the absence of depressive symptoms, living in ordinary housing, having previously had a stroke and yet still living in ordinary housing, not feeling lonely and having few symptoms. The PGCMS seems applicable in the evaluation of morale in very old people.

In conclusion, there were wide variations in health status and physical ability in this northern population of very old people. Women had poorer health and physical ability than men. Falls and fractures were common and serious health problems. Morale seemed to be high, despite the fact that a large proportion of the participants suffered from many diseases and functional decline.

Place, publisher, year, edition, pages
Umeå: Samhällsmedicin och rehabilitering, 2006. 89 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1038
Keyword
Aged, 80 and over, accidental falls, epidemiological studies, geriatric assessment, health status, morale, physical ability, population characteristics, reference values
National Category
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-871 (URN)91-7264-130-4 (ISBN)
Public defence
2006-10-28, Aulan, Vårdvetarhuset, Umeå Universitet, Umeå, 10:00 (English)
Opponent
Supervisors
Available from: 2006-09-25 Created: 2006-09-25 Last updated: 2009-10-30Bibliographically approved

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