AAR  Vol.2 No.3 , August 2013
Risk assessment of and targeted intervention for falls in the elderly based on the relationship between physical function levels and risk factors for falls
ABSTRACT
Although fall experience is an important predictor of future falls, clinicians place too much emphasis on this factor during risk assessment of falls. This study aimed to determine individuals with high and low fall risk on the basis of the relationship between physical function levels [competence in performing activities of daily living (ADL)] and risk factors for falls (fall experience, locomotive organ impairment, and potential for falling). Participants were 1057 independent community-dwelling elderly individuals. ADL competence and the status of risk factors for falls were evaluated using a questionnaire and the relationship between the two was determined. We calculated the cumulative relative frequency curves for ADL scores after categorizing the participants into several groups according to combinations of risk factors and analyzed those combinations that showed wide individual differences in the cumulative relative frequency curves. Intergroup differences when the participants were categorized on the basis of fall experience alone were small; however, those when the participants were categorized on the basis of locomotive impairment and potential for falling were much greater. On classifying the participants into eight groups on the basis of locomotive organ health, fall risk, and fall experience, we found that fallers with locomotive impairment and a high fall risk exhibited the lowest ADL scores while fallers without locomotive impairment and with a low fall risk exhibited the highest ADL scores. Fall risk assessments that are overtly dependent on fall experience are fundamentally limited. Grouping key risk factors can help in determining target groups, including highrisk fallers, low-risk fallers, and high-risk nonfallers, which require primary preventive measures among the community-dwelling elderly.

Cite this paper
Sato, S. , Demura, S. and Uchiyama, M. (2013) Risk assessment of and targeted intervention for falls in the elderly based on the relationship between physical function levels and risk factors for falls. Advances in Aging Research, 2, 87-93. doi: 10.4236/aar.2013.23012.
References
[1]   Health, Labour and Welfare Ministry (2012) The 21st life tables, Complete life table. www.mhlw.go.jp/english/database/db-hw/lifetb21th/index.html

[2]   World Health Organization (2011) World Health Statics 2010.

[3]   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, 664-672. doi:10.1046/j.1532-5415.2001.49115.x

[4]   Tinetti, M.E., Speechley, M. and Ginter, S.F. (1988) Risk factors for falls among elderly persons living in the community. The New England Journal of Medicine, 319, 17011707. doi:10.1056/NEJM198812293192604

[5]   Nakamura, K. (2009) Locomotive syndrome: Disabilityfree life expectancy and locomotive organ health in a “super-aged” society. Journal of Orthopaedic Science, 14, 1-2. doi:10.1007/s00776-008-1302-y

[6]   Gates, S., Smith, L.A., Fisher, J.D. and Lamb, S.E. (2008) Systematic review of accuracy of screening instruments for predicting fall risk among independently living older adults. Journal of Rehabilitation Research & Development, 45, 1105-1116. doi:10.1682/JRRD.2008.04.0057

[7]   Gregg, E.W., Pereira, M.A. and Caspersen, C.J. (2000) Physical activity, falls, and fractures among older adults: A review of the epidemiologic evidence. Journal of the American Geriatrics Society, 48, 883-893.

[8]   Lord, S.R., Tiedemann, A., Chapman, G.K., et al. (2005) The effect of an individualized fall prevention program on fall risk and falls in older people: A randomized, controlled trial. Journal of the American Geriatrics Society, 53, 1296-1304. doi:10.1111/j.1532-5415.2005.53425.x

[9]   Stalenhoef, P.A., Diederiks, J.P., Knottnerus, J.A., Kester, A.D. and Crebolder, H.F. (2002) A risk model for the prediction of recurrent falls in community-dwelling elderly: A prospective cohort study. The New England Journal of Medicine, 55, 1088-1094. doi:10.1016/S0895-4356(02)00502-4

[10]   Nakamura, K. (2011) The concept and treatment of locomotive syndrome: Its acceptance and spread in Japan. Journal of Orthopaedic Science, 16, 489-491. doi:10.1007/s00776-011-0108-5

[11]   Ministry of Health, Labour and Welfare (2010) Comprehensive survey of living conditions in 2010. http://www.mhlw.go.jp/toukei/saikin/hw/k-tyosa/k-tyosa10/.

[12]   Demura, S., Sato, S., Yokoya, T., et al. (2010) Examination of useful items for the assessment of fall risk in the community-dwelling elderly Japanese population. Environmental Health and Preventive Medicine, 15, 169-179. doi:10.1007/s12199-009-0124-7

[13]   Demura, S., Kasuga, K., Sato, S., et al. (2013) Determination of persons at a high risk of falling in a population of healthy community-dwelling elderly Japanese. International Journal of Gerontology, 7, 13-16. doi:10.1016/j.ijge.2012.05.007

[14]   Sato, S., Demura, S., Shin, S., et al. (2012) Assessing a personal and population fall risk profile in Japanese community-dwelling elderly. Japan Journal of Test Evaluation and Physical Education Sports, 12, 49-55.

[15]   Ministry of Education, Culture, Sports, Science and Technology (1999) Guideline for physical functional test. http://www.mext.go.jp/a_menu/sports/stamina/03040901.htm

 
 
Top