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. 2023 Mar 15;62(2):76-86.
doi: 10.2478/sjph-2023-0011. eCollection 2023 Jun.

Fall Risk in Adult Family Practice Non-Attenders: A Cross-Sectional Study from Slovenia

Nina Ružić-Gorenjec  1   2 , Zalika Klemenc Ketiš  1   3   4 , Rok Blagus  2 , Antonija Poplas Susič  1   3
Affiliations

Fall Risk in Adult Family Practice Non-Attenders: A Cross-Sectional Study from Slovenia

Nina Ružić-Gorenjec et al. Zdr Varst. .

Abstract
in English, Slovenian

Introduction: Not much is known about the fall risk among the adult population of those who rarely visit doctors. We wanted to determine the prevalence of increased fall risk in a population of family practice non-attenders and the factors associated with it.

Methods: We included participants from family medicine practices in this cross-sectional study. To be included in the study, the participants had to be adults living in the community (home-dwelling people) who had not visited their chosen family physician in the last five years (non-attenders). The identification of the eligible persons was done through a search of electronic medical records, which yield 2,025 non-attenders. Community nurses collected data in the participants' homes. The outcome measure was increased fall risk as assessed by the Morse fall scale: increased risk (≥25) vs. no risk.

Results: The sample consisted of 1,945 patients (96.0% response rate) with a mean age of 60.4 years (range 20.5 to 99.7 years). An increased fall risk was determined in 482 or 24.8% (95% CI: [22.9, 26.8]) of the patients. The multivariate model showed a significant association of increased fall risk with higher age (p<0.001), lower systolic blood pressure (p=0.047), poor family function (p=0.016), increased risk of malnutrition (p=0.013), higher number of chronic diseases (p=0.027), higher pain intensity (p<0.001), lower self-assessment of current health (p=0.002), and higher dependence in daily activities (p<0.001).

Conclusion: Non-attenders may have an increased risk of falling which depends on their health status and age. The inclusion of community nurses in primary healthcare teams could be of use not only to identify the non-attenders' health needs, but also to better manage their health, especially the factors that were identified to be associated with greater fall risk.

Uvod: O tveganju za padec med odraslo populacijo, ki redko obiskuje zdravnika, ni znanega veliko. Želeli smo ugotoviti razširjenost povečanega tveganja za padce v populaciji pacientov, ki redko obiskujejo svojega zdravnika družinske medicine, in s tem povezane dejavnike.

Metode: V to presečno študijo smo vključili paciente iz ambulant družinske medicine. Za vključitev v študijo so morali biti udeleženci odrasli, živeči v skupnosti, ki v zadnjih 5 letih niso obiskali svojega izbranega zdravnika družinske medicine. Identifikacija pacientov je potekala preko elektronskega sistema. Kriterijem je ustrezalo 2.025 posameznikov. Patronažne medicinske sestre so zbirale podatke, in sicer na domovih pacientov. Opazovana spremenljivka je bilo povečano tveganje za padec, ocenjeno z Morsejevo lestvico padcev: povečano tveganje.

Rezultati: Vzorec je sestavljalo 1.945 bolnikov (96,0-odstotna stopnja odziva) s povprečno starostjo 60,4 let (razpon od 20,5 do 99,7 let). Povečano tveganje za padec je bilo ugotovljeno pri 482 ali 24,8 % (95 % IZ: [22,9; 26,8]) bolnikov. Multivariatni model je pokazal pomembno povezavo povečanega tveganja za padec z višjo starostjo (p < 0,001), nižjim sistoličnim krvnim tlakom (p = 0,047), slabim družinskim delovanjem (p = 0,016), povečanim tveganjem za podhranjenost (p = 0,013), večjim številom kroničnih bolezni (p = 0,027), višjo intenzivnostjo bolečine (p < 0,001), nižjo samooceno trenutnega zdravja (p = 0,002) in večjo odvisnostjo pri vsakodnevnih aktivnostih (p < 0,001).

Zaključek: Pacienti, ki redko obiskujejo zdravnika, zlasti starejši, imajo lahko povečano tveganje za padec, ki je odvisno od zdravstvenih in socialno-ekonomskih dejavnikov. Vključitev patronažnih medicinskih sester v primarni zdravstveni tim bi lahko bila koristna ne le za ugotavljanje zdravstvenih potreb neodzivnikov, temveč tudi za boljše upravljanje njihovega zdravja, zlasti dejavnikov, za katere je bilo ugotovljeno, da so povezani z večjim tveganjem za padec.

Keywords: Cross-sectional studies; Fall risk; Family practice; Non-attenders; Primary healthcare.

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Figures

Supplementary Figure 1.
Supplementary Figure 1.
Sensitivity analysis − Logarithm of odds for an increased fall risk (black line) with 95% confidence intervals (grey area) in the multivariate logistic model without covariate dependence in daily activities (Supplementary Table 3), where the other variables in the model are fixed to their modes or medians (gender to female, age to 62.7, systolic blood pressure to 130, diastolic blood pressure to 72, self-assessment of current health to 8, and all the others to values indicating a healthy individual).
Figure 1.
Figure 1.
Logarithm of odds for an increased fall risk (black line) with 95% confidence intervals (grey area) in the multivariate logistic model (Table 3).
See this image and copyright information in PMC

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