Strategies to reduce the risk of falling: Cohort study analysis with 1-year follow-up in community dwelling older adults

Abstract

Background: According to the CDC, falls rank among the leading causes of accidental death in the United States, resulting in significant health care costs annually. In this paper we present information about everyday lifestyle decisions of the older adult that may help reduce the risk of falling. We pursued two lines of inquiry: first, we identify and then test known mutable fall risk factors and ask how the resolution of such problems correlates with changes in fall rates. Second, we identify a series of everyday lifestyle options that persons may follow and then ask, does such engagement (e.g., engagement in exercise programs) lessen the older adult's risk of falling and if it does, will the relationship hold as the count of risk factors increases?

Methods: Using a secondary analysis of lifestyle choices and risk changes that may explain fall rates over one year, we drew on a data set of 13,623 community residing elders in independent housing sites from 24 US states. All older adults were assessed at baseline, and a subset assessed one year later (n = 4,563) using two interRAI tools: the interRAI Community Health Assessment and interRAI Wellness Assessment.

Results: For the vast majority of risk measures, problem resolution is followed by lower rate of falls. This is true for physical measures such as doing housework, meal preparation, unsteady gait, transferring, and dressing the lower body. Similarly, this pattern is observed for clinical measures such as depression, memory, vision, dizziness, and fatigue. Among the older adults who had a falls risk at the baseline assessment, about 20 % improve, that is, they had a decreased falls rate when the problem risk improved. This outcome suggests that improvement of physical or clinical states potentially may result in a decreased falls rate. Additionally, physical exercise and cognitive activities are associated with a lower rate of falls.

Conclusions: The resolution of risk problems and physical and cognitive lifestyle choices are related to lower fall rates in elders in the community. The results presented here point to specific areas, that when targeted, may reduce the risk of falls. In addition, when there is problem resolution for specific clinical conditions, a decreased risk for falls also may occur.

Keywords: Community-dwelling older adults; Strategies to reduce risk of falls; interRAI assessment.

Fig. 1

Fall Rates Based on Movement Related Risk Variables (with time 2 risk odds ratios and % problem resolved)

Fig. 2

Fall Rates Based on Weakness/Debility Related Risk Variables (with Time 2 risk odds ratios and % resolved)

Fig. 3

Fall Rates Based on Cognitive/Mental Related Risk Variables (with Time 2 risk odds ratios and % resolved)

Fig. 4

Fall Rates Based on Physical and General Clinical Complexity Related Risk Variables (with time 2 risk odds ratio and % resolved)

Fig. 5

Time 1 Fall Rates Based on Types of Exercise at Baseline (with time 1 risk odds ratio and % so engaged)

Fig. 6

Time 1 Fall Rates Based on Engagement in Cognitively Stimulating Exercises (with time 1 risk odds ratio and % so engaged)

Fig. 7

Time 1 Fall Rates Based on Exercise and Cognitive Stimulation Life Choices Across Categories of Risk Summary Scale (percent of sample in risk category)