Falls risk factors in community-dwelling older Australians

Abstract

Introduction Falls by older adults often have serious health consequences for those who fall and economic consequences that are of concern to governments and private health care providers. With the number of adults over the age of 65 years increasing as a proportion of the population, and with greater life expectancy, the number of falls occurring annually will escalate unless effective intervention occurs. Through better understanding of current falls risk assessment tools and intrinsic falls risk factors that potentially predict falls, it may be possible to proactively dampen the anticipated increase in the occurrence of falls within community-dwelling older adults. The aim of this thesis was to explore intrinsic falls risk factors in community-dwelling older Australians and assess their impact on falls risk assessment measures. Methods Over 275 community-dwelling older adults, aged 60-92 years, volunteered throughout the course of this research program. Each of the five empirical studies, presented as part of this thesis, utilised a variety of falls risk assessment tools; self-assessment - the Falls Efficacy Scale-International (FES-I) and the Activities-specific Balance Confidence (ABC),and objective - Physiological Profile Assessment (PPA) and the Berg Balance Scale (BBS). In addition, combinations of the following intrinsic falls risk factor assessment measures were also utilised: Short Performance Physical Battery (SPPB) or Continuous Scale Physical Functional Performance-10 (CS-PFP10); Six-Item Cognitive Test (6-CIT); 12-Item Short- Form Health Survey (SF12); Physical Activity Survey for Elderly (PASE); dual X-ray absorptiometry (DXA); and the Dietary Questionnaire for Epidemiological Studies Version 2 (DQES v2). Using these measures it was possible to evaluate the contribution of physical function, cognition, general health, physical activity, body composition and diet as falls risk factors and examine their relationships with the self-assessment and objective falls risk tools. Statistical analysis was undertaken using a variety of methods, including: One-Way Analysis of Variance, Pearson Product-Moment Correlation, and Multiple Regression analysis. Results Three major findings have emerged from this research: 1) The importance of sex when assessing falls risk - an individual’s sex has been identified, not just as an independent falls risk factor but also as a contributor to other predictor characteristics (functional, body composition or health-related); 2) The complexity of the relationship between falls risk and physical function - the nature of the relationship between physical function and falls risk was revealed as bidirectional. Whilst impaired physical function is confirmed as a falls risk factor, the reverse is also true: heightened falls risk impairs physical function; and 3) The need for population-appropriate assessment tools – the FES-I is more appropriate than the ABC for use when self-assessing falls risk in community-dwelling older adults. The BBS is better suited for objectively assessing older, less-functioning adults, whereas the PPA is the objective tool of choice when assessing higher functioning females. Conclusion The body of research highlights significant interactions between numerous intrinsic falls risk factors, falls risk measures and their inherent complex interrelationships. This thesis contributes to knowledge regarding falls risk, not only by strengthening the evidence for known intrinsic risk factors (age, sex, history of falls) but also by identifying additional potential risk factors (fat mass, bone density and diet quality). Finally, the important finding of the differences between sexes, observed in aspects of falls risk, physical function and diet quality, highlights the need for the development and implementation of sex specific falls prevention programs, to enable both male and female community-dwelling older adults to benefit equally from programs.

Date of Award	2015
Original language	English
Supervisor	Helen Berry (Supervisor), Judith Anson (Supervisor), Roger Adams (Supervisor) & Gordon WADDINGTON (Supervisor)