Saskia M. F. Pluijm

A risk profile for identifying community-dwelling elderly with a high risk of recurrent falling: results of a 3-year prospective study

IntroductionThe aim of the prospective study reported here was to develop a risk profile that can be used to identify community-dwelling elderly at a high risk of recurrent falling.Materials and methodsThe study was designed as a 3-year prospective cohort study. A total of 1365 community-dwelling persons, aged 65 years and older, of the population-based Longitudinal Aging Study Amsterdam participated in the study. During an interview in 1995/1996, physical, cognitive, emotional and social aspects of functioning were assessed. A follow-up on the number of falls and fractures was conducted during a 3-year period using fall calendars that participants filled out weekly. Recurrent fallers were identified as those who fell at least twice within a 6-month period during the 3-year follow-up.ResultsThe incidence of recurrent falls at the 3-year follow-up point was 24.9% in women and 24.4% in men. Of the respondents, 5.5% reported a total of 87 fractures that resulted from a fall, including 20 hip fractures, 21 wrist fractures and seven humerus fractures. Recurrent fallers were more prone to have a fall-related fracture than those who were not defined as recurrent fallers (11.9% vs. 3.4%; OR: 3.8; 95%xa0CI: 2.3–6.1). Backward logistic regression analysis identified the following predictors in the risk profile for recurrent falling: two or more previous falls, dizziness, functional limitations, weak grip strength, low body weight, fear of falling, the presence of dogs/cats in the household, a high educational level, drinking 18 or more alcoholic consumptions per week and two interaction terms (high education×18 or more alcohol consumptions per week and two or more previous falls × fear of falling) (AUC=0.71).DiscussionAt a cut-off point of 5 on the total risk score (range 0–30), the model predicted recurrent falling with a sensitivity of 59% and a specificity of 71%. At a cut-off point of 10, the sensitivity and specificity were 31% and 92%, respectively. A risk profile including nine predictors that can easily be assessed seems to be a useful tool for the identification of community-dwelling elderly with a high risk of recurrent falling.

Balance and mobility performance as treatable risk factors for recurrent falling in older persons

BACKGROUND AND OBJECTIVESnThe purpose of this study was to examine whether easily measurable measures for balance and muscle strength predicted recurrent falling as well as sophisticated measurements, and to examine which of the modifiable risk factors were strongest associated with recurrent falling.nnnMETHODSnThe study was performed in a subsample (n=439, aged 69-92 years) of the Longitudinal Aging Study Amsterdam (LASA). Balance, muscle strength, physical activity, and performance tests were assessed. Falls were recorded during 1 year. The outcome measure was recurrent falls (>/=2 falls within 1 year).nnnRESULTSnThe area under the curve (AUC) of mediolateral sway (AUC=0.67; 95% CI:0.57-0.77), tandem stand (AUC=0.61; 95% CI:0.49-0.73), leg extension strength (AUC=0.58; 95% CI:0.51-0.64), and handgrip strength (AUC=0.57; 95% CI:0.51-0.64) for recurrent falling were not significantly different. In a multivariate model, mediolateral sway (OR=2.8; 95% CI:1.1-6.9), tandem stand (OR=2.1; 95% CI:1.1-3.8), and walking test (OR=2.2; 95% CI:1.1-4.1) were significantly associated with recurrent falling.nnnCONCLUSIONSnThe easily measurable tandem stand and handgrip strength predicted recurrent falling as well as the sophisticated measures. Mediolateral sway was strongest associated with recurrent falling.

Homocysteine and Vitamin B12 Status Relate to Bone Turnover Markers, Broadband Ultrasound Attenuation, and Fractures in Healthy Elderly People

Hyperhomocysteinemia may contribute to the development of osteoporosis. The relationship of Hcy and vitamin B12 with bone turnover markers, BUA, and fracture incidence was studied in 1267 subjects of the Longitudinal Aging Study Amsterdam. High Hcy and low vitamin B12 concentrations were significantly associated with low BUA, high markers of bone turnover, and increased fracture risk.

A classification tree for predicting recurrent falling in community-dwelling older persons

Objectives: To develop a classification tree for predicting the risk of recurrent falling in community‐dwelling older persons using tree‐structured survival analysis (TSSA).

Different aspects of visual impairment as risk factors for falls and fractures in older men and women

Visual impairment has been implicated as a risk factor for falling and fractures, but results of previous studies have been inconsistent. The relationship between several aspects of vision and falling/fractures were examined in a prospective cohort study in 1509 older men and women. The analyses showed that impaired vision is an independent risk factor for both recurrent falling and fractures.

Late-life anemia is associated with increased risk of recurrent falls

Objectives: To examine whether anemia is associated with a higher incidence of recurrent falls.

Physical activity as a determinant of change in mobility performance : the Longitudinal Aging Study Amsterdam

OBJECTIVES: This study examined the association of (change in) physical activity and decline in mobility performance in older men and women.

The association of sex hormone levels with poor mobility, low muscle strength and incidence of falls among older men and women

Objectiveu2002 The objective of this study was to examine whether low levels of oestradiol and testosterone are associated with impaired mobility, low muscle strength and the incidence of falls in a population‐based sample of older men and women.

Insulin-like growth factor I (IGF-I) and cognitive decline in older persons

Insulin-like growth factor I (IGF-I) deficiency may be involved in cognitive deficits seen with aging, and in neurodegenerative diseases such as Alzheimers disease. The objective of this study was to investigate whether IGF-I is associated with cognitive performance and 3-year cognitive decline in 1318 subjects, aged 65-88 years. Cross-sectionally, IGF-I was directly related to information processing speed, memory, fluid intelligence, and Mini-Mental State Examination (MMSE) score, but these associations did not remain significant after adjustment for age and other factors. Analysis in quintiles of IGF-I revealed a threshold effect of low IGF-I on information processing speed, with lower speed in subjects in the lowest quintile of IGF-I (<9.4 nmol/l)(1) versus those in the other four quintiles (fully adjusted B=-0.89; 95% CI, -1.72 to -0.05). This threshold of low IGF-I was also observed for 3-year decline in information processing speed (adjusted RR=1.78; 95% CI, 1.19-2.68). In summary, this study suggests that IGF-I levels below 9.4 nmol/l are negatively associated with both the level and decline of information processing speed.

Different cognitive functions in relation to falls among older persons immediate memory as an independent risk factor for falls

It is not clear which specific cognitive function is strongest related to falls. To investigate this, not only general cognitive functioning, but also nonverbal and abstract reasoning, information processing speed, and immediate memory were related to falls. Furthermore, relevant effect modifiers, confounders, and mediators were identified. This study was performed within the Longitudinal Aging Study Amsterdam (LASA), a multidisciplinary, prospective cohort study. In this study (n = 1437), an interaction between immediate memory and age was found. In persons aged 75 years and over, immediate memory, as measured by the 15 Words Test, showed to be an independent risk factor for falls. Part of this relationship was explained by the mediating effects of activity, mobility, and grip strength. The association between the other cognitive functions and falls was only statistically significant in univariate analysis. We conclude that immediate memory is an independent risk factor for recurrent falls in persons aged 75 years and older.