Table 1-1 Risk factors for the elderly falls by multivariate analysis.
Author Tsai, Y.J.[15] Lin, M.R.[16] Huang, S.C.[17] Tinetti, M.E.[18] Cesari, M.[19] Rekeneire, N.[20]
Title The prevalence and risk factor assessment of the fall of the community
Risk factors for elderly falls in a rural
community of central Taiwan
Cumulative incident rate and associated factors of falls among the elderly in Shih-Pai, Taiwan
Risk factors for falls among elderly persons living in the community
Prevalence and risk factors for falls in an older community-dwelling population
Correlates of falling in healthy older persons
Journal (Year)
Project Report, D.O.H (1997)
Taiwan J Public Health (2002)
Taiwan J Public Health (2005)
above 65 years old n=368
above 65 years old n=2045 Methods cross-sectional prospective cross-sectional prospective observational cross-sectional
Risk factor health condition 2.0 (1.1~3.8)
Cognitive impairment 5.0
Longer duration of timed UP & Go
2.0 (1.0~4.0)
Depression 1.5 (1.1~2.3)
Disability of the lower extremities
Balance impairment 2.3 (1.3~3.8)
Othostatic hypotension
1.4 (1.0~1.9)
Palmomental reflex 3.0
Lived in an unsafe place 1.5 (1.3~1.7)
Inability to do 5 chair stands1.7(1.3~1.9)
Table 1-2 Risk of fall-related injury by multivariate analysis in the elder.
Author Grisso JA[6] Herndon JG[21] Colon-Emeric CS[22] Wei T-S[23] Liu W-L[24]
Title Risk factors for falls as a cause of hip fracture
in women.
Risk of fall injury events at home in older
adults
Predict Fractures in Older Adults
Risk Factors of Hip Fracture in the Elderly
Serious Fall-Related Injury in an Eldery (III)
Year 1991 1997 2002 2001 1999
Journal New Engl J Med J Am Griatr Soc Osteoporosis Int Osteoporosis Int Department of Health, Executive Yuan Method Case-control Case-control Cohort study Case-control 1st year: cross sectioal
2nd year: prospective Factor1
femoral neck BMD 1.7 (1.0~2.8)
Gait impairment 1.5 (1.0~2.3)
Table 1-3 Risks of fall related injury in stroke patients.
Author Melton LJ[25] Sze KH[26] Yates JS[27] Lamb SE[28] Tong P-F[29] Ta-Sen Wei[30]
Title Fracture risk
of falls in ambulatory stroke patients Journal Osteoporosis Int Arch phys med
rehabil
J Rehabil Res Dev
Stroke NHRI PLOS One
Method Retro-cohort Cohort Cohort Prospective 1 y Cohort Prospective
Factor 1
Use quadricane the asymmetry ratio of single support
the level of spasticity in the gastrocnemius
Table 1-4 Interventions for preventing falls in elder people living in the community.
Multiple-component group exercise 0.71 (0.63~0.82) 0.85 (0.76~ 0.96)
Tai Chi 0.72 (0.52~1.00) 0.71 (0.57~ 0.87)
Multiple-component home-based exercise 0.68 (0.58~0.80) 0.78 (0.64 ~ 0.94)
Balance training 0.72 (0.55~0.94) 0.81 (0.62~1.07)
Strength/ Resistance training 3.6 (1.5~8.0)
Medication
Vitamin D 1.00 (0.90~1.11) 0.96 (0.89~1.03)
Withdrawal of psychotropic medication 0.34 (0.16~0.73) 0.61 (0.32~1.17) Prescribing modification programme for
primary care physicians 0.61 (0.41~0.91)
Surgery
Pacemakers 0.73 (0.57~0.93) 0.78 (0.18~3.39)
First eye cataract surgery 0.66 (0.45~0.95) 0.95 (0.68~1.33) Oral nutritional supplementation 0.95 (0.83~1.08) Cognitive behavioural interventions 1.00 (0.37~2.72) 1.11 (0.80~1.54)
Environment/assistive technology
Home safety assessment and modification 0.81 (0.68~0.97) 0.88 (0.80~0.96)
Anti-slip shoe device 0.42 (0.22~0.78)
Multifactorial Interventions 0.76 (0.67~0.86) 0.93 (0.86~1.02)
*Rate ratio (RaR): to compare the rate of falls between intervention and control groups.
Risk ratio (RR): the number of people falling (fallers) in each group to assess the risk of falling.
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Gait Asymmetry, Ankle Spasticity, and Depression as Independent Predictors of Falls in Community-Dwelling
Ambulatory Stroke Patients
Introduction
A fall is the common injury in stroke patients. Fall occurrence in stroke survivors is 25–37% within 6 months and 23–50% 6 months post-stroke [1–6]. Accidental falls
and fall-related injuries, such as hip fracture, often lead to serious disability and affect the patient’s overall health. Many studies have attempted to identify fall risk factors as
predictors and established a sensitive prediction model for stroke patients. Therefore, early interventions for preventing falls may be beneficial to stroke patients.
The causes of fall are complicated, and several factors may result in falls, including impaired balance and gait, declining cognition, muscle weakness, and presence of neurological diseases. Previous studies have demonstrated that balance, walking ability, and physical performance assessments are useful predictors of fall occurrence in stroke patients post-discharge from rehabilitation units [7–9]. These studies have demonstrated that physical performance assessments, including asymmetrical gait pattern, Berg Balance Score (score≦29 at admission), Fall Efficacy Scale (score ≥ 33), and spasticity, predicted the risk of fall in stroke patients to a certain accuracy
[10–13].
These findings also suggest that existing predictors of falls exhibit some
limitations, especially gait and balance assessments. For example, clinical measures typically assign numerical values to determine the level of performance on tests (e.g., Berg Balance Scale, Performance-Oriented Mobility Assessment, and Dynamic Gait Index). These measurements depend on expert ratings and subjective judgments, and the tests are mostly skill orientated without direct connection to the physiological mechanisms of temporal and spatial characteristics. Therefore, quantified assessments have been developed, and these measurements are more objective than the
measurements mentioned above.
A previous study associated impaired balance and gait to increased risk of falls in stroke survivors using quantified measurements [14]. However, the models used for this study did not provide high sensitivity or specificity. Another study also
demonstrated that gait and postural variability predicted accidental falls in nursing home residents [10]. The Interactive Balance System correlated with physiological mechanisms of fall, but the predictive ability in this study was limited [10].
Psychological factors may also play an important role in fall occurrence in stroke
patients. This concept was supported by results that impaired balance and gait
negatively affected psychological distress in stroke survivors [15]. Another study also demonstrated that 30% of stroke patients suffered depression in the early- or late-stage post-stroke [16]. Depression was also a risk related to falls in stroke patients in a previous study [17].
No comprehensive analyses integrate the identified fall risk factors. Quantified gait and balance measurements are more objective and should be used for clinical
evaluations. Psychological factors may also be important risk factors for predicting falls in stroke patients. However, studies of fall prediction using objective, quantified gait and balance assessments and psychological evaluations after stroke are limited.
Therefore, a prediction model for falls in stroke patients should be developed using a multidimensional assessment to increase prediction accuracy. The present study used physical assessments, including objective computerized gait and balance
measurements, and psychological evaluation to identify risk factors related to falls in stroke patients after discharge from hospital and develop a fall prediction model with high sensitivity and specificity.
Materials and Methods
The Institutional Review Board of a tertiary medical center, Changhua Christian
Hospital, approved this prospective cohort study, which was performed in a rehabilitation ward and patients’ homes.