Keijo Koski

Risk factors for major injurious falls among the home-dwelling elderly by functional abilities. A prospective population-based study.

Background: In order to identify the risk factors essential for preventing major injurious falls, the associations between injurious falls and certain factors were assessed among disabled and independent elderly, respectively, who had fallen during a 2-year period. Methods: A prospective population-based study was conducted in five rural northern Finnish municipalities. The series consisted of all inhabitants aged 70 years or over, initially 979 persons. During a 2-year follow-up period, all injurious falls were recorded on the basis of telephone contacts, diary reporting and a review of the medical records of the participants. Results: Thirty percent of the subjects having fallen sustained a major injury. The multivariate model applied to the disabled elderly showed the following variables to be related to a high risk for major injurious falls: divorced, widowed or unmarried marital status (odds ratio = 2.2), a low body mass index (odds ratio = 3.1), incomplete step continuity (odds ratio = 2.2), poor distant visual acuity (odds ratio = 2.3) and the use of long-acting benzodiazepines (odds ratio = 2.4). Among the independent elderly, the risk of a fall resulting in major injury was high among the subjects who had peripheral neuropathy (odds ratio = 2.5) or were suffering from insomnia (odds ratio = 4.1). Conclusions: The risk factors for major injuries in fall occurrences differ between the disabled and independent elderly. Preventive measures should be targeted according to the disabilities of the population.

Risk factors for recurrent falls in the elderly in long-term institutional care.

All the persons aged 70 years or older and living in long-term institutional care in five rural northern Finnish municipalities (N = 145) were followed up for two years, and all their fall incidents were recorded through diary reporting by the nursing staff and by examining the medical records in hospitals, health centres and nursing homes. The study population was examined halfway through the follow-up period by two nurses, a physiotherapist and a physician. Of the 93 ambulatory subjects, 57% of the men and 56% of the women experienced at least two falls in six months (recurrent falls): 10% of the recurrent falls resulted in a major soft tissue injury and 5% in a fracture. Logistic regression analyses showed the independent risk factors for recurrent falls to be slow walking speed, a change in living conditions during the previous two years, reduced quadriceps strength and existence of an ophthalmic disease. Many of the risk factors are potentially remediable, and they should be minimized by optimizing the care and by improving or maintaining the functional abilities of the elderly.

Social status, life changes, housing conditions, health, functional abilitiesand life-style as risk factors for recurrent falls among the home-dwelling elderly

OBJECTIVE To define the risk factors for recurrent falls in the home-dwelling elderly. DESIGN A prospective population-based study covering two years. SETTING Five rural municipalities around the city Oulu, northern Finland. PARTICIPANTS All home-dwelling elderly persons (N = 1,016) aged 70 years or older living in the municipalities. OUTCOME MEASURES The risk factors of recurrent falling by variables related to social status, life changes, housing conditions, health, functional abilities and life style, using cross-tabulations and multivariate analyses. RESULTS The recurrent fallers (at least two falls within 365 days after the examination day) consisted of 17 men (6% of the men) and 71 women (14%). Logistic regression analyses showed female sex, urinary urgency, frequent fear of falling, dizziness, a poor pulse rate rise 30 seconds after standing up and falling during the previous year to be risk factors for recurrent falls. After the variable representing previous falls had been removed from the analysis, urinary incontinence and a change in housing conditions during the past two years emerged and urinary urgency dropped out of the model. CONCLUSIONS Women particularly are a target group for the prevention of falls among the elderly. Urinary urgency and urinary incontinence, fear of falling, dizziness and changes in the housing conditions should be inquired about to identify the elderly at risk for falling and to take preventive interventions. In addition to testing blood pressure changes after standing up, the changes in pulse rate should be determined to identify and treat elderly people who have orthostatic conditions.

Orthostatic Hypotension and Cognitive Decline in Older People

OBJECTIVES: To establish the role of orthostatic hypotension (OH) as a risk factor for cognitive decline among home‐dwelling and institutionalized older people and to describe other predictors of cognitive decline.

Early loss of mother or father predicts depression in old age

The independent predictive roles of early losses, personality traits, acute losses and long‐term stress situations for the occurrence of depression in elderly Finns were described using a longitudinal design. The persons non‐depressed in an epidemiological study in 1984–85 were interviewed in 1989–90 (N=679) and the occurrence of depression was determined according to DSM III‐criteria. Logistic regression models were used to assess the independent roles of the hypothesized factors as predictors. An early loss of the mother among men and an early loss of the father among women independently predicted the occurrence of depression in logistic regression models. Older age in men, and a higher number of symptoms, the occurrence of previous depression and not living alone in women were also independent predictors. In men, impaired functional abilities and poor self‐perceived health tended to predict depression. In conclusion, the psychological trauma which develops upon the experience of an early parental loss contributes to the development of depression even in old age. The role of stressors in life as independent predictors of depression in old age was also ascertained.

Marital and family relations and depression in married elderly Finns

BACKGROUND The aim was to describe the relationships between poor marital and family relations and depression, and the predictive value of these factors for the subsequent occurrence of depression. METHODS The population for the cross-sectional study consisted of the married elderly (N = 498) living in Ahtäri, Finland, in 1989. The series of the longitudinal study was composed of married persons nondepressed in the epidemiological study in 1984-1985, and followed up until 1989-1990 (N = 347). RESULTS In men, impaired functional abilities (OR 5.0) and poor family relations (OR 2.9), and in women, impaired functional abilities (OR 3.9), family violence (OR 4.2), age 70 years or over (OR 3.0) and a loss of father in childhood or youth (OR 2.5) were independently related to depression. Poor marital relations tended to be related to depression in both men (OR 2.1) and women (OR 2.2). In both sexes, poor self-appreciation (OR men 3.9; women 7.1) and age 70 years or over (OR men 2.9; women 4.2), and in women, a loss of father in childhood or youth (OR 4.5) were independent predictors of subsequent depression. CONCLUSIONS The poor marital or family relations experienced by many depressed elderly persons are usually consequences rather than predictors of depression. Family violence may be a consequence of depression or even a risk factor for depression. CLINICAL IMPLICATIONS Problems in spouse pairs and families should be inquired and solved when treating depressed elderly persons. LIMITATIONS OF THE STUDY Due to the unknown validity of the measure concerning marital relations, the results are suggestive.

Predictors of coronary heart diseases among children and adolescents in families with premature coronary heart diseases in central eastern Finland

OBJECTIVE To describe coronary heart disease (CHD) predictors in children and adolescents (aged from 7 to 16 years) in families with premature CHD. DESIGN A cross-sectional cohort study. SETTING Part of a family-oriented preventive intervention programme concerning CHD risk factors in central eastern Finland (FOPIC study). SUBJECTS 473 participants in families with premature CHD and 371 in control families. MAIN OUTCOME MEASURES Traditional CHD predictors. RESULTS Offspring in families with premature CHD had significantly higher concentrations of total cholesterol (TC, 4.7 vs 4.5 mmol/l, p < 0.01) and low-density lipoprotein cholesterol (LDL-C, 2.8 vs 2.6 mmol/l, p < 0.01) than the control children, and higher diastolic blood pressure (DBP, p < 0.01). According to this cross-sectional screening of children in high-CHD-risk families in the Kainuu region, 75% of those with adverse cholesterol values could be found. After adjusting for confounding factors, associations between TC, LDL-C, body mass index, DBP and the offspring of families with a history of premature CHD found. CONCLUSIONS The results indicated strong associations between CHD predictors and offspring with a family history of premature CHD. The findings confirm the usability of familial premature CHD in screening for early prevention in primary health care.Objective - To describe coronary heart disease (CHD) predictors in children and adolescents (aged from 7 to 16 years) in families with premature CHD. Design - A cross-sectional cohort study. Setting - Part of a family-oriented preventive intervention programme concerning CHD risk factors in central eastern Finland (FOPIC study). Subjects - 473 participants in families with premature CHD and 371 in control families. Main outcome measures - Traditional CHD predictors. Results - Offspring in families with premature CHD had significantly higher concentrations of total cholesterol (TC, 4.7 vs 4.5 mmol/l, pp<0.01) and low-density lipoprotein cholesterol (LDL-C, 2.8 vs 2.6 mmol/l, p<0.01) than the control children, and higher diastolic blood pressure (DBP, p<0.01). According to this cross-sectional screening of children in high-CHD-risk families in the Kainuu region, 75% of those with adverse cholesterol values could be found. After adjusting for confounding factors, associations between TC, LDL-C, body mass index, DBP and the offspring of families with a history of premature CHD were found. Conclusions - The results indicated strong associations between CHD predictors and offspring with a family history of premature CHD. The findings confirm the usability of familial premature CHD in screening for early prevention in primary health care.