The impact of neurological disorders on the risk for falls in the community dwelling elderly: a case-controlled study

Abstract

Objectives: Owing to a lack of data, our aim was to evaluate and compare the impact of various common neurological diseases on the risk for falls in independent community dwelling senior citizens.

Design: Prospective case-controlled study.

Setting: General hospital.

Participants: Of 298 consecutive patients and 214 controls enrolled, 228 patients (aged 74.5±7.8; 61% women) and 193 controls (aged 71.4±6.8; 63% women) were included. The exclusion criteria were as follows: for patients, severe disability, disabling general condition or severe cognitive impairment; for controls, any history of neurological disorders or disabling medical conditions; and for both, age below 60 years. A matching process led to 171 age-matched and gender-matched pairs of neurological patients and healthy controls.

Main outcome measures: A 1-year incidence of falls based on patients' 12-month recall; motor and non-motor function tests to detect additional risk factors.

Results: 46% of patients and 16% of controls fell at least once a year. Patients with stroke (89%), Parkinson's disease (77%), dementia (60%) or epilepsy (57%) had a particularly high proportion of fallers, but even subgroups of patients with the least fall-associated neurological diseases like tinnitus (30%) and headache (28%) had a higher proportion of fallers than the control group. Neuropathies, peripheral nerve lesions and Parkinson's disease were predisposing to recurrent falls. A higher number of neurological comorbidities (p<0.001), lower Barthel Index values (p<0.001), lower Activities-Specific Balance Confidence scores (p<0.001) and higher Center of Epidemiological Studies Depression scores (p<0.001) as well as higher age (p<0.001) and female gender (p=0.003) proved to further increase the risk of falls.

Conclusions: Medical practitioners, allied health professionals and carers should be aware that all elderly neurological patients seen in outpatient settings are potentially at high risk for falls; they should query them routinely about previous falls and fall risks and advise them on preventive strategies.

Keywords: Falls; community dwelling; elderly; fall risk; neurological disorders.

Figure 1

Frequency of falls in neurological patients according to their neurological disorder. Fall frequency index (FFI) category I=1–2 falls in the last 12 months, category II=3–5, category III=6–10, category IV=11–20, and category V=more than 20.

Figure 2

Difference in frequency of having at least one fall within the 12-month period for patients suffering from the 13 most commonly encountered neurological disorders.

Figure 3

Differences in ABC 6 scores (A) and number of NDs (B) of neurological patients with and without falls indicate that fallers as compared to non-fallers have lower confidence in their balance and a higher number of concomitant NDs. (ABC 6%, percentage scores of the 6-item version of the Activities-Specific Balance Confidence scale, number of ND, number of neurological diseases a patient is afflicted with).