Eva Nordell

Accidental falls, health-related quality of life and life satisfaction: A prospective study of the general elderly population.

As the physical consequences of accidental falls in the elderly are well-researched, the long-term associations between falls and quality of life and related concepts are less known. The aim of this study was to prospectively examine the long-term relations between falls and health-related quality of life (HRQoL) and life satisfaction (LS) over six years in the general elderly population. One thousand three hundred and twenty-one subjects (aged 60-93 years), from the general population in the south of Sweden, were included in a baseline assessment and a follow-up after six years. HRQoL was measured with the SF-12 and LS with the life satisfaction index A (LSI-A). The differences in mean scores between fallers at baseline (n=113) and non-fallers were statistical analyzed. Furthermore, the prediction of falls on the outcomes was analyzed using a multivariate linear regression model adjusted for multiple confounding factors. Fallers scored significant lower in HRQoL and LS at baseline and after six years, compared to non-fallers, especially in the SF-12 physical component (p=<0.001). In the linear regression analysis, one or more falls at the baseline predicted a significant reduction in the SF-12 physical component at the follow-up assessment (B-Coefficient -1.8, 95% CI -3.4 to -0.2). In conclusion, falls predict a long-term reduction in the physical component of HRQoL in the general elderly population. Over six years, fallers had a notable chronic lowered score in both HRQoL and LS, compared to non-fallers. This long-term depression of elderly fallers in these aspects may be more extent than previous assumed.

Falls in the general elderly population: a 3- and 6- year prospective study of risk factors using data from the longitudinal population study 'Good ageing in Skane'.

BackgroundAccidental falls in the elderly are a major health problem, despite extensive research on risk factors and prevention. Only a limited number of multifactorial, long-term prospective studies have been performed on risk factors for falls in the general elderly population. The aim of this study was to identify risk factors predicting falls in a general elderly population after three and six years, using a prospective design.MethodsThe prevalence of 38 risk factors was recorded at a baseline assessment of 1763 subjects (aged 60–93 years). The incidence of one or more falls was recorded after three and six years. The predicted risk of falling, after exposure to the various risk factors, was analysed in a multiple logistic regression model, adjusted for age and sex, and presented as odds ratios (OR). A principal component analysis (PCA), including the statistical significant factors, was also performed to identify thematic, uncorrelated components associated with falls.ResultsThe use of neuroleptics (OR 3.30, 95% CI: 1.15–9.43), heart failure with symptoms (OR 1.88, 95% CI: 1.17–3.04) and low walking speed (OR 1.77, 95% CI: 1.28–2.46) were prominent individual risk factors for falls. In the PCA, three main components predicting falls were identified: reduced mobility, OR 2.12 (95% CI 1.54–2.91), heart dysfunction, OR 1.66 (95% CI 1.26–2.20) and functional impairment including nocturia, OR 1.38 (95% CI 1.01-1.88).ConclusionsThree main components predicting falls were identified in a general elderly population after three and six years: reduced mobility, heart dysfunction and functional impairment including nocturia. The use of neuroleptic drugs was also a prominent individual risk factor, although the prevalence was low. Heart failure with symptoms was a significant risk factor for falls and may be of clinical importance as the prevalence of this condition in the elderly is increasing worldwide. There is need for further research on the relation between heart failure and falls in the elderly, as the treatment for this condition is poorly documented in this demographic. The findings of this study may be valuable in the development of intervention programmes aimed at sustainable, long-term reduction of falls in the elderly.

Observation of Vestibular Asymmetry in a Majority of Patients over 50 Years With Fall-Related Wrist Fractures

Previously, we have observed vestibular asymmetry in about one-third of healthy senior citizens and in about two-thirds of subjects with previous hip fractures and no other significant ailments. Wrist fractures are considered a harbinger of hip fractures. If vestibular asymmetry is correlated with falls and fractures among the elderly then it should also be reflected among subjects with wrist fractures. Sixty-six consecutive patients (mean age 67.8 years) who had sustained a fall-related wrist fracture during a 10-month period were included in the study. The frequency of head shake nystagmus among the patients was compared to that found among 49 healthy senior citizens (mean age 74.9 years). Nystagmus after head shaking, indicating asymmetric vestibular function, was found in 50 participants (76%) (p <0.001). Thirty-eight of these were graded with distinct or prominent nystagmus responses. Sixty percent of the subjects with horizontal nystagmus had a wrist fracture coinciding with the slow phase of nystagmus. Twenty-three subjects reported 30 previous fall-related fractures during the previous 10 years. Subjects with nystagmus after head shaking sustained 26 of these fractures. The frequency of signs of vestibular asymmetry was significantly higher (p <0.001) among the subjects than among healthy senior citizens. These findings suggest that an asymmetric vestibular function could be an epidemiologically important contributory factor to falls and wrist fractures among the elderly population.Previously [The abstract has been shortened somewhat, and the headings removed, in order to conform to journal style], we have observed vestibular asymmetry in about one-third of healthy senior citizens and in about two-thirds of subjects with previous hip fractures and no other significant ailments. Wrist fractures are considered a harbinger of hip fractures. If vestibular asymmetry is correlated with falls and fractures among the elderly then it should also be reflected among subjects with wrist fractures. Sixty-six consecutive patients (mean age 67.8 years) who had sustained a fall-related wrist fracture during a 10-month period were included in the study. The frequency of head shake nystagmus among the patients was compared to that found among 49 healthy senior citizens (mean age 74.9 years). Nystagmus after head shaking, indicating asymmetric vestibular function, was found in 50 participants (76%) (p <0.001). Thirty-eight of these were graded with distinct or prominent nystagmus responses. Sixty percent of the subjects with horizontal nystagmus had a wrist fracture coinciding with the slow phase of nystagmus. Twenty-three subjects reported 30 previous fall-related fractures during the previous 10 years. Subjects with nystagmus after head shaking sustained 26 of these fractures. The frequency of signs of vestibular asymmetry was significantly higher (p < 0.001) among the subjects than among healthy senior citizens. These findings suggest that an asymmetric vestibular function could be an epidemiologically important contributory factor to falls and wrist fractures among the elderly population.

Evaluating the Swedish version of the Falls Efficacy Scale-International (FES-I)

A number of instruments measuring psychological outcomes of falling exist, e.g. the Falls Efficacy Scale (FES). An extended version of the FES, the Falls Efficacy Scale-International (FES-I), has been developed and translated into several European languages. The aims of this study were to evaluate internal reliability, examine the internal structure of the FES-I(S) (the Swedish version of the FES-I), and to examine the correlation between fear of falling and health-related quality of life measured with Short Form 12 (SF-12). Eighty-six participants, aged 50–85 years (88% women), recruited from the Orthopaedic Department, Lund University Hospital, and treated for a fall-related fracture, answered the FES-I(S), SF-12 and a questionnaire of background factors. The FES-I(S) showed a high internal reliability (Cronbachs α=0.95) and an inter-item correlation averaging 0.55. Factor analyses discriminated two factors dominated by items of less and more demanding physical activities, respectively. All items loaded strongly on a unitary underlying dimension There were significant correlations (p=0.01) between the FES-I(S) and SF-12 physical component score and the FES-I(S) and SF-12 mental component score with Spearmans rank correlation coefficient of −0.591 and −0.402, respectively. The FES-I(S) will be useful to assess fear of falling in Sweden in rehabilitation research and in clinical trials. Further studies are suggested to verify FES-I(S) validity.

Hip Fractures in Primary Health Care: Evaluation of a rehabilitation programme

The routine follow-up of hip fracture patients was transferred from the Orthopaedic Department, Lund University Hospital, to the primary health care districts in 1985. The medical state and social functions of all 298 patients during the first 12 months of the follow-up rehabilitation programme were registered. Before fracture, 61% lived in their own homes, 22% in old peoples homes, and 14% in geriatric hospitals or nursing homes. Four months after fracture, 13% were dead, 47% were living in their own homes, 14% were in old peoples homes, 25% in geriatric hospitals or nursing homes, while the rest were in other types of institutional residence. Of patients coming from their own homes, 75% were back at home four months after fracture and their social and functional status were as good as before fracture. The study has shown that routine check-ups at the orthopaedic department can be omitted. Follow-up in primary health care without radiography and orthopaedic expertise gives equally good functional results as in previous studies, provided that patients with pain and walking problems from the hip are guaranteed rapid specialist treatment.

Outcome after Hip Fracture in Different Health Care Districts: Rehabilitation of 837 consecutive patients in primary care 1986–88

The social and functional outcome for 837 consecutive hip fracture patients rehabilitated in primary care was studied during 1986-1988. Of patients coming from their own home (59%) the majority (76%) were back at home four months after fracture and had a good functional status, while 9% were dead. Predictors of managing ADL (dressing/personal hygiene) four months after hip fracture were age, type of fracture, sex, and having regular social contacts outside the home before fracture. Health care districts differed in the incidence of hip fractures, the patients hospital stay, housing, type of fracture, and age. These differences had consequences on costs. Total costs per patient were lowest in districts where most of the patients were discharged to their own homes. No significant differences in fracture incidence were seen between rural and urban primary health care districts.

Older patients with distal forearm fracture. A challenge to future fall and fracture prevention.

Background and aims: Falls and fractures in older people are a common health problem. Patients with distal forearm fracture are at risk of sustaining new fractures. The aim of this work was to describe the characteristics of this patient group. Methods: Sixty women and six men, mean age 68 years (50–86), with a recent fall-related distal forearm fracture, filled in a questionnaire about medical history, previous falls and fractures. Handgrip strength on the non-fractured side, one-leg standing, walking tests, and test of vibration sensation were measured and a video-nystagmoscopy was performed. Results: One-third of the subjects had fallen during the last year, and one-third had had previous fall-related fractures during the last 10 years. Half of the patients took medication and were examined for chronic ailments regularly. Handgrip strength, balance and walking capacity declined with age and were similar to reference values. In three patients, the vibration sensation value was above the threshold value. Fifty patients (76%) had nystagmus, but no relationship between fall direction, physical performance and nystagmus was found. Conclusions: Although apparently healthy, many patients exhibited risk factors for new falls and fractures. Our recommendation is that these patients should be screened for fall and fracture risk and be targeted for preventive measures, besides fracture treatment. Physical therapists must play a major role in increasing and maintaining general physical functions in this patient group.

Family caregivers' assessment of symptoms in persons with dementia using the GBS-scale: differences in rating after psychosocial intervention--an 18-month follow-up study.

The purpose of this study was to examine if psychosocial intervention for family caregivers made any differences in describing symptoms of dementia in the persons they cared for. The study population comprised family caregivers of persons aged 70 years and older receiving social services and diagnosed with dementia disorders. A group of 129 family caregivers underwent psychosocial intervention including education, information, and provision of a support group, while 133 family caregivers did not and these formed the control group. Family caregivers were followed-up every 6 months for a total of 18 months. They rated intellectual, emotional, and activity of daily living (ADL) functions in persons with dementia using the Gottfries-Bråne-Steen scale (GBS-scale). Family caregivers who underwent psychosocial intervention rated the intellectual and emotional symptoms of dementia significantly higher 6 months later compared to controls and the effect was sustained during the 18-month follow-up irrespective of relationship and education. Most notably, decrease in function of recent memory, ability to increase tempo, long-windedness, distractibility, and blunting were better identified. Our findings suggest that the family caregivers who underwent psychosocial intervention achieved better understanding of different symptoms and the behaviors of dementia. These findings may explain earlier findings of positive effects after psychosocial intervention on family caregivers’ sense of burden, satisfaction, and ability to delay nursing home placement.

Both deterioration and improvement in activities of daily living are related to falls: a 6-year follow-up of the general elderly population study Good Aging in Skåne.

Objectives To determine the relationship between long-term change in activities of daily living (ADL) and falls in the elderly and to identify characteristics of groups at risk for falls. Methods This was a 6-year, prospective cohort study using data from the Good Aging in Skåne study in southern Sweden, involving 1,540 elderly subjects, including the oldest-old (age, 60–93 years). The subjects were recruited from the general population. ADL was measured at a baseline and follow-up assessment, using Sonn and Åsberg’s revised scale and the ADL staircase. Falls were recorded in a period of 6 months before the follow-up assessment. The association between falls and change in ADL was calculated using adjusted, multiple logistic regression analysis and presented in odds ratios (ORs). Results Thirteen percent of the study population reported one or several falls in the measured period. Over the course of 6 years, one in four participants changed their ADL status, and parts of this category had an increased risk for falls compared with those who stayed independent in ADL or who had no change in the ADL staircase. Groups with different characteristics had a prominent risk for falls: those with a reduction of two to eight steps in the ADL staircase (OR, 4.05; 95% confidence interval [CI], 1.62–10.11) and those becoming independent from dependency in instrumental ADL (OR, 4.13; 95% CI, 1.89–9.00). The former group had advanced age with a greater burden of cognitive impairment, gait disability, arrhythmia, and fall risk medications. The latter group had a higher prevalence of ischemic heart disease and low walking speed. Conclusion Both deterioration and improvement in ADL over the course of 6 years increased the risk for falls in a general elderly population. Interventional efforts may require different strategies, as groups with different characteristics were at risk. Those at risk with improved ADL function may have a history of sufficient burden of comorbidity combined with obtained mobility for exposure to a fall event.

Decrease in Physical Function after Fall-related Distal Forearm Fracture in Elderly Women

Fractures occur in about every tenth of accidental falls and a distal forearm fracture is one of the commonest fractures. People who have sustained a distal forearm fracture are at risk of sustaining other fractures later in life. The purpose of this study was to describe physical performance regarding handgrip strength, one leg standing and walking speed over time in women after a fall-related distal forearm fracture. Forty-three women, mean age 68 years (50–84), were followed for a mean period of 13 months. The women were interviewed and bone mass density was measured. Handgrip strength, walking speed and one leg stance were measured. Twenty-three women (53%) had osteopenia or osteoporosis. The handgrip strength of the non-fractured hand declined with 4.2 kg (p<0.001) the first year after the fracture. Comfortable and fast walking speed decreased with 0.09 m/s (p=0.001 and p<0.001, respectively). The fall-related distal forearm fracture led to reduction of physical performance, shown by decline of handgrip strength and walking speed. Our results indicate that physical therapy treatment after a distal forearm fracture also has to focus on physical capacity. This should be further explored for this group of patients.