Preview

Osteoporosis and Bone Diseases

Advanced search

Falls in older patients: characteristics depending on functional status

https://doi.org/10.14341/osteo12936

Abstract

Background: Falls and frailty are associated geriatric syndromes. Knowing the features of falls in patients with different functional status will make it possible to personalize the fall prevention and reduce the progression of frailty.

Aim: To characterise falls in older depending on geriatric status (robust, prefrailty and frailty).

Materials and methods: Included 1002 patients (77,5±8,2) hospitalized in the geriatric department. The frailty was screened on the scale «Age Not Interference». With the score 1–2, frailty was not diagnosed. With the score 3 or more, comprehensive geriatric assessment was carried out and 2 more groups were allocated: with prefrailty (n=199, 19.9%) and with frailty (n=482,48.1%). All patients found out the fact of falls during the year, if there was, they were characterized by falls. To analyze the effect of falls on functional status, it was evaluated in patients with frailty and falls and frailty without falls.

Results: With increasing severity of geriatric status, the prevalence of falls increased, reaching 57% in patients with frailty. 63.7% previously noted falls, 44.7% formed a fear of falls. One in 10 falls resulted in a serious consequence, which caused hospitalization. The risk of falls increased depending on geriatric deficiency: patients with frailty at high risk were 2 times greater compared to robust patients. The findings demonstrate that patients with frailty undergoing falls compared to patients without falls.

In patients with frailty and falls, compared to patients without falls, despite younger age and lower comorbidity, functional status was worse. They had a significantly lower score on the MNA, higher score on the PHQ-9 and anxiety score, and performed the chair stand longer. Multivariate analysis showed that a reduction in the sum of the SPPB by 0.35 and the PHQ-9 scale by 0.77, an increase in SARC-F by 0.68 and a time of performance of the chair stand by 3.39 seconds is associated with a fall in older people with frailty adjusted for age and comorbidity.

Conclusion: Frailty is a conditionally reversible syndrome, and falls is often prevented. Considering the identified features of falls in patients with reduced functioning will allow individualizing the fall prevention plan.

About the Authors

N. O. Khovasova
Department of diseases of aging of The Pirogov Russian National Research Medical University; Laboratory of the Musculoskeletal System Diseases, Russian Gerontology Clinical Research Center
Russian Federation

Natalia O. Khovasova, PhD, associate Professor

Moscow, First Leonova str., 16

SPIN: 7387-7710



A. V. Naumov
Department of diseases of aging of The Pirogov Russian National Research Medical University; Laboratory of the Musculoskeletal System Diseases, Russian Gerontology Clinical Research Center
Russian Federation

Anton V. Naumov, PhD

Moscow

SPIN: 4763-9738



O. N. Tkacheva
Department of diseases of aging of The Pirogov Russian National Research Medical University
Russian Federation

Olga N. Tkacheva, PhD

Moscow

SPIN: 6129-5809



V. I. Moroz
Department of diseases of aging of The Pirogov Russian National Research Medical University; Laboratory of the Musculoskeletal System Diseases, Russian Gerontology Clinical Research Center
Russian Federation

Victoriya I. Moroz, PhD

Moscow

SPIN: 9739-6940



References

1. Samper-Ternent R, Karmarkar A, Graham J, et al. Frailty as a predictor of falls in older Mexican Americans. J Aging Health. 2012;24(4):641-653. doi: https://doi.org/10.1177/0898264311428490

2. Song X, Mitnitski A, Rockwood K. Prevalence and 10- year outcomes of frailty in older adults in relation to deficit accumulation. J Am Geriatr Soc. 2010;58(4):681-687. doi: https://doi.org/10.1111/j.1532-5415.2010.02764.x

3. Eeles EM, White SV, O’Mahony SM, et al. The impact of frailty and delirium on mortality in older inpatients. Age Ageing. 2012;41(3):412-416. doi: https://doi.org/10.1093/ageing/afs021.

4. Cheng MH, Chang SF. Frailty as a Risk Factor for Falls Among Community Dwelling People: Evidence From a Meta-Analysis. J Nurs Scholarsh. 2017 Sep;49(5):529-536. doi: 10.1111/jnu.12322.

5. Tkacheva ON, Kotovskaya YV, Runikhina NK, et al. Clinical guidelines on frailty. Russ J Geriatr Med. 2020;12(1):11-46. (In Russ.). doi: https://doi.org/10.37586/2686-8636-1-2020-11-46

6. Tkacheva ON, Kotovskaya Y V., Runikhina NK, et al. Clinical guidelines frailty. Part 2. Russ J Geriatr Med. 2020;12(2):115-130. (In Russ.). doi: https://doi.org/10.37586/2686-8636-2-2020-115-130

7. Vertkin AL. Comorbidity: history, recent views, prevention and treatment. Cardiovasc Ther Prev. 2015;14(2):74-79. (In Russ.). doi: https://doi.org/10.15829/1728-8800-2015-2-74-79

8. Morley JE, Vellas B, van Kan GA, et al. Frailty consensus: a call to action. J Am Med Dir Assoc. 2013;14(6):392-397. doi: https://doi.org/10.1016/j.jamda.2013.03.022

9. Collard RM, Boter H, Schoevers RA, Oude Voshaar RC. Prevalence of frailty in community-dwelling older persons: a systematic review. J Am Geriatr Soc. 2012;60(8):1487-1492. doi: https://doi.org/10.1111/j.1532-5415.2012.04054.x

10. Ma L, Chhetri JK, Chan P. Frailty in China: From Research to Practice. J Nutr Health Aging. 2021;25(4):479-483. doi: https://doi.org/10.1007/s12603-021-1593-7

11. Alves EVC, Flesch LD, Cachioni M, et al. The double vulnerability of elderly caregivers: multimorbidity and perceived burden and their associations with frailty. Rev Bras Geriatr Gerontol. 2018;21(3):301-11. doi: https://doi.org/10.1590/1981-22562018021.180050Alves

12. Carneiro JA, Cardoso RR, Durães MS, et al. Frailty in the elderly: prevalence and associated factors. Rev Bras Enferm. 2017;70(4):747-752. doi: https://doi.org/10.1590/0034-7167-2016-0633

13. Santos-Eggimann B, Cuénoud P, Spagnoli J, Junod J. Prevalence of frailty in middle-aged and older community-dwelling Europeans living in 10 countries. J Gerontol A Biol Sci Med Sci. 2009;64(6):675-681. doi: https://doi.org/10.1093/gerona/glp012

14. Fried LP, Hadley EC, Walston JD, et al. From bedside to bench: research agenda for frailty. Sci Aging Knowledge Environ. 2005;2005(31):pe24. doi: https://doi.org/10.1126/sageke.2005.31.pe24

15. Vorobyeva NM, Khovasova NO, Tkacheva ON, et al. Falls and fractures in subjects over 65 years old and their associations with geriatric syndromes: Russian epidemiological study EVKALIPT. Russ J Geriatr Med. 2021;14(2):219-229. (In Russ.). doi: https://doi.org/10.37586/2686-8636-2-2021-209-219

16. Gómez Jiménez E, Avendaño Céspedes A, Cortés Zamora EB, et al. Prevalencia de fragilidad en adultos mayores hospitalizados. Revisión sistemática [Frailty prevalence in hospitalized older adults. A systematic review.]. Rev Esp Salud Publica. 2021;95:e202110158.

17. Xue QL, Bandeen-Roche K, Tian J, et al. Progression of Physical Frailty and the Risk of All-Cause Mortality: Is There a Point of No Return? J Am Geriatr Soc. 2021;69(4):908-915. doi: https://doi.org/10.1111/jgs.16976

18. González-Vaca J, de la Rica-Escuín M, Silva-Iglesias M, et al. Frailty in INstitutionalized older adults from ALbacete. The FINAL Study: rationale, design, methodology, prevalence and attributes. Maturitas. 2014;77(1):78-84. doi: https://doi.org/10.1016/j.maturitas.2013.10.005

19. Mitchell R, Ting HP, Draper B, et al. Frailty and risk of rehospitalisation and mortality for aged care residents following a fall injury hospitalisation. Australas J Ageing. 2021;40(1):e44-e53. doi: https://doi.org/10.1111/ajag.12847

20. Bartosch PS, Kristensson J, McGuigan FE, Akesson KE. Frailty and prediction of recurrent falls over 10 years in a community cohort of 75-year-old women. Aging Clin Exp Res. 2020;32(11):2241-2250. doi: https://doi.org/10.1007/s40520-019-01467-1

21. Gopinath B, McMahon CM, Burlutsky G, Mitchell P. Hearing and vision impairment and the 5-year incidence of falls in older adults. Age Ageing. 2016;45(3):409-414. doi: https://doi.org/10.1093/ageing/afw022

22. Almada M, Brochado P, Portela D, et al. Prevalence of Falls and Associated Factors among Community-Dwelling Older Adults: A Cross-Sectional Study. J Frailty Aging. 2021;10(1):10-16. doi: https://doi.org/10.14283/jfa.2020.44

23. Jehu DA, Davis JC, Falck RS, et al. Risk factors for recurrent falls in older adults: A systematic review with meta-analysis. Maturitas. 2021;144:23-28. doi: https://doi.org/10.1016/j.maturitas.2020.10.021

24. Stubbs B, Binnekade T, Eggermont L, et al. Pain and the risk for falls in community-dwelling older adults: systematic review and meta-analysis. Arch Phys Med Rehabil. 2014;95(1):175-187. doi: https://doi.org/10.1016/j.apmr.2013.08.241

25. Alcolea-Ruiz N, Alcolea-Ruiz S, Esteban-Paredes F, et al. Prevalencia del miedo a caer y factores asociados en personas mayores que viven en la comunidad [Prevalence of fear of falling and related factors in communitydwelling older people]. Aten Primaria. 2021;53(2):101962. doi: https://doi.org/10.1016/j.aprim.2020.11.003

26. Fhon JRS, Rodriguez MMP, Morote GAG, et al. Risk of falls i the elderly to come to day two centers. Horiz Med. 2014;14(3):12-18.

27. Balzer K, Bremer M, Schramm S, et al. Falls prevention for the elderly. GMS Health Technol Assess. 2012;8:Doc01. doi: https://doi.org/10.3205/hta000099

28. Kojima G. Frailty significantly increases the risk of fractures among middle-aged and older people. Evid Based Nurs. 2017;20(4):119-120. doi: https://doi.org/10.1136/eb-2017-102769

29. Middleton R, Poveda JL, Orfila Pernas F, et al. Mortality, falls and fracture risk are positively associated with frailty: a SIDIAP cohort study of 890,000 patients. J Gerontol A Biol Sci Med Sci. 2021;77(1):148-154. doi: https://doi.org/10.1093/gerona/glab102

30. Bartosch P, Malmgren L, Kristensson J, et al. In communitydwelling women frailty is associated with imminent risk of osteoporotic fractures. Osteoporos Int. 2021;32(9):1735-1744. doi: https://doi.org/10.1007/s00198-021-05886-7

31. Walston J, Hadley EC, Ferrucci L, et al. Research agenda for frailty in older adults: toward a better understanding of physiology and etiology: summary from the American Geriatrics Society/ National Institute on Aging Research Conference on Frailty in Older Adults. J Am Geriatr Soc. 2006;54(6):991-1001. doi: https://doi.org/10.1111/j.1532-5415.2006.00745.x

32. Eeles EM, White SV, O’Mahony SM, et al. The impact of frailty and delirium on mortality in older inpatients. Age Ageing. 2012;41(3):412-416. doi: https://doi.org/10.1093/ageing/afs021

33. Cameron ID, Gillespie LD, Robertson MC, et al. Interventions for preventing falls in older people in care facilities and hospitals. Cochrane Database Syst Rev. 2012;12:CD005465. doi: https://doi.org/10.1002/14651858.CD005465.pub3


Supplementary files

Review

For citations:


Khovasova N.O., Naumov A.V., Tkacheva O.N., Moroz V.I. Falls in older patients: characteristics depending on functional status. Osteoporosis and Bone Diseases. 2022;25(1):4-13. (In Russ.) https://doi.org/10.14341/osteo12936

Views: 1976


ISSN 2072-2680 (Print)
ISSN 2311-0716 (Online)