Abstract

Objective

To analyze the factors associated with recurrent falls in community-dwelling older adults from Cuiabá.

Methods

This is an epidemiological, prospective, concurrent cohort study with a two-year follow-up. In-home surveys were conducted in 2012 and 2013. The data were treated by the software Epi Info and SPSS. Bivariate analysis investigated associations between risk factors and recurrent falls by calculating the relative risk (RR) of the cumulative incidences with a confidence interval of 95% (95%CI). Multiple analysis with Poisson regression included all variables with p < 0.20 in the crude analyses. The significance level of 5% (p < 0.05) was adopted as significant association for remaining in the final model.

Results

Most older adults (77.6%) had recurrent falls. The variables significantly associated with recurrent falls were older adult’s income of up to two minimum salaries (RR = 1.62; 95%CI 1.04-1.77), absence of arthritis or arthrosis (RR = 1.32; 95%CI 1.10-1.48), having regular to very bad self-perceived health (RR = 1.44; 95%CI 1.12-2.04), and having visual impairment (RR = 1.23; 95%CI 1.01 -1.69).

Conclusions

Falls in older adults are associated with low education levels, regular to very bad self-perceived health, visual impairment, and recurrent falls.

Accidents by falls; Older adults; Risk factors

Introduction

Falls are a serious public health problem with direct implications on the quality of life and wellbeing of older adults¹1. Tinetti ME, Kumar C. The patient who falls. JAMA 2010; 303(3):258-266.^,22. Ribeiro AP, Souza ER, Atie S, Souza AC, Schilithz AO. A influência das quedas na qualidade de vida de idosos. Cien Saude Colet 2008; 13(4):1265-1273.. The risk of falls increases significantly with age, making this geriatric syndrome one of the great public health problems because of its high incidence, morbidity, and mortality, and the social and economic costs of the consequent injuries³3. Cruz DT, Ribeiro LC, Vieira MT, Teixeira MTB, Bastos RR, Leite ICG. Prevalência de quedas e fatores associados em idosos. Rev Saude Publica 2012; 46(1):138-146.

4. Pinho TAM, Silva AO, Tura LFR, Moreira MASP, Gurgel SN, Smith AAF, Bezerra VP. Avaliação do risco de quedas em idosos atendidos em Unidade Básica de Saúde. Rev Esc Enferm USP 2012; 46(2):320-327.^-55. Abreu HCA, Reiners AAO, Azevedo RCS, Silva AMC, Abreu DROM. Incontinência urinária na predição de quedas em idosos hospitalizados. Rev esc enferm USP 2014; 48(5):851-856.. Roughly 30% of community-dwelling adults fall yearly, 50% of these have recurrent falls, and this proportion increases between 32% and 42% in individuals aged more than 70 years¹1. Tinetti ME, Kumar C. The patient who falls. JAMA 2010; 303(3):258-266..

Fall is defined as a nonintentional dropping to a lower level without possibility of correction in due time and determined by multifactorial circumstances that compromise stability⁶6. World Health Organization (WHO). Injuries and violence: the facts. Geneva: WHO; 2010.. These circumstances stem from intrinsic and extrinsic factors. Intrinsic factors include age-related physiological changes; poor balance and gait; visual and auditory impairment; and presence of diseases. The extrinsic factors include environmental risks, such as poor lighting and slippery floor; risk behaviors, such as climbing chairs or ladders; and behaviors related to activities of daily living²2. Ribeiro AP, Souza ER, Atie S, Souza AC, Schilithz AO. A influência das quedas na qualidade de vida de idosos. Cien Saude Colet 2008; 13(4):1265-1273.^,66. World Health Organization (WHO). Injuries and violence: the facts. Geneva: WHO; 2010.. However, most falls result from the interaction of all these factors.

Falls have significant consequences because of the vulnerability of older adults in addition to the factors cited above, such as: less mobility and functionality, higher disease susceptibility, bruising, contusions, fractures, institutionalization, fear of falling again, and repercussion on the lives of family members. Moreover, there is evidence of a strong association between mortality in older adults who experienced falls and fall-related injuries, since these are long lasting, even after treatment³3. Cruz DT, Ribeiro LC, Vieira MT, Teixeira MTB, Bastos RR, Leite ICG. Prevalência de quedas e fatores associados em idosos. Rev Saude Publica 2012; 46(1):138-146.^,77. Maia BC, Viana PC, Arantes PMM, Alencar MA. Consequências das quedas em idosos vivendo na comunidade. Rev Bras Geriatr Gerontol 2011; 14(2):381-393.

8. Siqueira FV, Facchini LA, Silveira DS, Piccini RX, Tomasi E, Thume E, Silva SM, Dilélio A. Prevalence of falls in elderly in Brazil: a countrywide analysis. Cad Saude Publica 2011; 27(9):1819-26.

9. Tinetti ME, Inouye SK, Gill TM, Doucette JT. Shared risk factors for falls, incontinence, and functional dependence: unifying the approach to geriatric syndromes. JAMA 1995; 273(17):1348-1353.^-1010. Abreu DROM, Azevedo RCS, Silva AMC, Reiners AAO, Abreu H. Características e condições de saúde de uma coorte de idosos que sofreram quedas. Rev enferm UFPE online 2015; 9(Supl. 3):7582-7589..

In 2011 in Brazil there were 373,105 fall-related hospitalizations in the Unified Healthcare System (SUS). Women aged 60 years or more fall more than men in the same age group, with fall rates of 43.6 per 10 thousand women and 35.7 per 10 thousand men. Accidental falls prevail at 49.8% of the total, followed by falls from standing at 34.4%. In 2010 24,760 people aged more than 60 years died of falls in Brazil¹¹11. Brasil. Ministério da Saúde (MS). Morbidade por acidentes e violências no Brasil: tendência das hospitalizações no período de 2002 a 2011. [acessado 2014 set 09]. Disponível em: http://portalsaude.saude.gov.br/portalsaude/arquivos/saudebrasil2011_parte1_cap9.pdf
http://portalsaude.saude.gov.br/portalsa... .

Considering that a higher occurrence of falls is common in older adults and that they compromise health, reduce quality of life, and increase public spending with inpatient and outpatient care, recurrent falls worsen the health condition of older adults even more. Since most falls occur outside institutions and hospitals, the objective of this study was to analyze the factors associated with recurrent falls in community-dwelling older adults.

Methods

This is an epidemiological, concurrent, closed cohort study based on a sample of the project “Life and health conditions of older adults from the municipality of Cuiaba-MT”¹²12. Cardoso JDC, Azevedo RCS, Reiners AAO, Louzada CV, Espinosa MM. Poor self-rated health and associated factors among elderly urban residents. Rev Gaucha Enferm 2014; 35(4):35-41..

In the initial project, the sample size was determined considering a confidence coefficient of 95% (z = 1.96); sampling error of 5%; and proportion of value of 0.5 (p = 0.5). The urban population contained 43,096 older adults. The number of census tracts that would be included by district by cluster sampling was given by the formula

where ci is the number of census tracts, Ni is the number of older adults, Ci is the number of tracts, and ni is the number of older adults in the sample of each district. Eleven of the 355 census tracts of Cuiaba were selected, and based on probability criteria with a sample size correction of 50%, the sample should include 573 older adults.

The present study selected all older adults who had had a fall in the three months prior to data collection, totaling 109 participants. These individuals were interviewed again exactly one year after the first in-home survey conducted by the main researcher from January to March 2013. Between the two surveys six older adults died, so the final sample consisted of 103 participants.

The exposure variables included sociodemographic information (gender, age group, marital status, income, and education level) and health status (self-reported diseases, use of medications, self-perceived health, changes in gait and balance, visual and auditory impairments, and level of physical activity). The Katz et al. Index¹³13. Katz S, Downs TD, Cash HR, Grotz RC. Progress in development of the index of all. Gerontologist 1970; 10(1):20-30. assessed the functional skills of the older adults, and Lawton & Brody Scale¹⁴14. Lawton MP, Brody EM. Assessment of older people; self-maintaining and instrumental activities of daily-living. Gerontologist 1969; 9(3):179-186. assessed the instrumental activities of daily living. Recurrent falls between the two surveys was the outcome variable.

The questionnaires were coded and digitized twice. Digitalization errors were compared and corrected by the software Data Compare. The data were treated by the programs Epi Info version 7.0 and SPSS version 20.0. Descriptive, bivariate, and multiple analyses were conducted. Descriptive analysis determined the absolute and relative frequencies of the variables. Bivariate analysis investigated associations between the risk factors and recurrent falls by calculating the relative risk of the cumulative incidences (confidence interval of 95%).

Multiple analysis with Poisson regression included all variables with associations with p-value < 0.20 in the crude analyses. The variables gender and marital status were maintained for better model adjustment. The significance level of 5% (p<0.05) was adopted as a significant association for remaining in the final model.

This project was approved by the local Research Ethics Committee and complied with the guidelines of Resolution 466/2012 of the National Health Council (CNS).

Results

The study sample had a prevalence of recurrent falls of 77.6%. Table 1 shows the sociodemographic variables of the older adults who experienced recurrent falls. Most were females (65%) aged more than 70 years (63.8%). Almost half (47.5%) had partners, 53.7% had up to three years of formal education, and 93.7% had a family income of up to two minimum salaries.

In the bivariate analysis between recurrent falls and sociodemographic variables, recurrent falls was associated with up to seven years of formal education (RR = 1.53; 95%CI 0.95-2.49) (Table 2).

Recurrent falls was also associated with regular to very bad self-perceived health (RR = 1.80; 95%CI 0.86-3.78) (Table 3).

Tables 4 and 5 show the distribution of older adults who experienced recurrent falls according to the presence of some diseases and the results of the multiple Poisson model, respectively. The following variables remained associated with recurrent falls: income of up to two minimum salaries (RR = 1.62; 95%CI 1.04-1.77), absence of arthritis or arthrosis (RR = 1.32; 95%CI 1.10-1.48), having regular to very bad self-perceived health (RR = 1.44; 95%CI 1.12-2.04), and having visual impairment (RR = 1.23; 95%CI 1.01-1.69).

Discussion

This is one of the few Brazilian studies that focused on recurrent falls in community-dwelling older adults, demonstrating the great importance of this phenomenon in this population. Most of the study older adults (77.6%) experienced recurrent falls. The odds of recurrent falls¹⁵15. Motta LB, Aguiar AC, Coutinho ESF, Huf G. Prevalência e fatores associados a quedas em idosos em um município do Rio de Janeiro. Rev Bras Geriatr Gerontol 2010; 13(1):83-91.^,1616. Peeters GMEE, Heymans MW, Vries OJ de, Bouter LM, Lips P, Tulder MW van. Multifactorial evaluation and treatment of persons with a high risk of recurrent falling was not cost-effective. Osteoporos Int 2011; 22(7):2187-2196. were higher in females aged more than 70 years and with low education level. Studies have evidenced that being female is a risk factor for recurrent falls, since women lose more bone mass and have less lean mass and muscle strength than men¹⁷17. Deandrea S, Lucenteforte E, Bravi F, Foschi R, La Vecchia C, Negri E. Risk factors for falls in community-dwelling older people: a systematic review and meta-analysis. Epidemiology 2010; 21(5):658-668.

18. Dantas EL, Brito GEG, Lobato IAF. Prevalência de quedas em idosos adscritos à estratégia de saúde da família do município de João Pessoa, Paraíba. Rev APS 2012; 15(1):67-75.

19. Milat AJ, Watson WL, Monger C, Barr M, Giffin M, Reid M. Prevalence, circumstances and consequences of falls among community- dwelling older people: results of the 2009 NSW Falls Prevention Baseline Survey. New South Wales public health bulletin 2011; 22(3-4):43-48.

20. Stenhagen M, Ekström H, Nordell E, Elmståhl S. 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’. BMC Geriatr 2013; 13:81.^-2121. Grundstrom AC, Guse CE, Layde PM. Risk factors for falls and fall-related injuries in adults 85 years of age and older. Arch Gerontol Geriatr 2012; 54(3):421-428..

More than three-fourths of the studies in a literature review²²22. Gomes ECC, Oliveira Marques AP de, Leal MCC, Barros BP de. Fatores associados ao risco de quedas em idosos institucionalizados: uma revisão integrativa. Cien Saude Colet 2014; 19(8):3543-3551. indicated that older women are at greater risk of falls²³23. Hamra A, Ribeiro MB, Miguel OF. Correlação entre fratura por queda em idosos e uso prévio de medicamentos. Acta Ortop Bras 2007; 15(Supl. 3):143-145. than older men because of their better functional status. Older women perform numerous house chores more frequently and intensely than men, either because they believe house chores are culturally a female role or because they consider that performing such activities spares them from being categorized as older women.

The literature agrees that the prevalence of falls increases with age as senescence promotes progressive and functional changes that may compromise the performance of motor activities and hinder one’s adaptation to the environment, which may explain recurrent falls²⁴24. Rolita L, Spegman A, Tang X, Cronstein BN. Greater number of narcotic analgesic prescriptions for osteoarthritis is associated with falls and fractures in elderly adults. J Am Geriatr Soc 2013; 61(3):335-340.

25. Kelsey JL, Berry SD, Procter-Gray E, Quach L, Nguyen US, Li W, Kiel DP, Lipsitz LA, Hannan MT. Indoor and outdoor falls in older adults are different: The maintenance of balance, independent living, intellect, and Zest in the Elderly of Boston Study. J Am Geriatr Soc 2010; 58(11):2135-2141.^-2626. World Health Organization (WHO). Injuries and violence: the facts. Geneva: WHO; 2010.. Falls are the main cause of injuries and need of medical care in older adults. Older adults aged 80 years or more have much higher fall-related mortality rates than older adults aged 65 to 79 years²⁷27. Cunha AA, Lourenço RA. Quedas em idosos: prevalência e fatores associados. Revista Hospital Universitário Pedro Ernesto 2014; 13(2):21-29.. Some studies suggest that the fear of experiencing new falls with more severe consequences can prevent distinguishing different age groups by the prevalence of recurrent falls²⁸28. Antes DL, Schneider IJC, Benedetti TRB, d’Orsi E. Fear of recurrent falls and associated factors among older adults from Florianópolis, Santa Catarina State, Brazil. Cad Saude Publica 2013; 29(4):758-768.^,2929. Pinheiro MP, Ciconelli RM, Martini LA, Ferraz MB. Risk factors for recurrent falls among Brazilian women and men: the Brazilian Osteoporosis Study (BRAZOS). Cad Saude Publica 2010; 26(1):89-96..

Most older adults who experienced recurrent falls had low income, often from their low retirement pensions. People who live in low-income communities, such as the study sample, experience all environment-related difficulties and face a higher risk of falls, which may stem from the poor environment in which they live, including poor housing conditions and infrastructure²2. Ribeiro AP, Souza ER, Atie S, Souza AC, Schilithz AO. A influência das quedas na qualidade de vida de idosos. Cien Saude Colet 2008; 13(4):1265-1273.

3. Cruz DT, Ribeiro LC, Vieira MT, Teixeira MTB, Bastos RR, Leite ICG. Prevalência de quedas e fatores associados em idosos. Rev Saude Publica 2012; 46(1):138-146.

4. Pinho TAM, Silva AO, Tura LFR, Moreira MASP, Gurgel SN, Smith AAF, Bezerra VP. Avaliação do risco de quedas em idosos atendidos em Unidade Básica de Saúde. Rev Esc Enferm USP 2012; 46(2):320-327.

5. Abreu HCA, Reiners AAO, Azevedo RCS, Silva AMC, Abreu DROM. Incontinência urinária na predição de quedas em idosos hospitalizados. Rev esc enferm USP 2014; 48(5):851-856.

6. World Health Organization (WHO). Injuries and violence: the facts. Geneva: WHO; 2010.

7. Maia BC, Viana PC, Arantes PMM, Alencar MA. Consequências das quedas em idosos vivendo na comunidade. Rev Bras Geriatr Gerontol 2011; 14(2):381-393.

8. Siqueira FV, Facchini LA, Silveira DS, Piccini RX, Tomasi E, Thume E, Silva SM, Dilélio A. Prevalence of falls in elderly in Brazil: a countrywide analysis. Cad Saude Publica 2011; 27(9):1819-26.

9. Tinetti ME, Inouye SK, Gill TM, Doucette JT. Shared risk factors for falls, incontinence, and functional dependence: unifying the approach to geriatric syndromes. JAMA 1995; 273(17):1348-1353.

10. Abreu DROM, Azevedo RCS, Silva AMC, Reiners AAO, Abreu H. Características e condições de saúde de uma coorte de idosos que sofreram quedas. Rev enferm UFPE online 2015; 9(Supl. 3):7582-7589.

11. Brasil. Ministério da Saúde (MS). Morbidade por acidentes e violências no Brasil: tendência das hospitalizações no período de 2002 a 2011. [acessado 2014 set 09]. Disponível em: http://portalsaude.saude.gov.br/portalsaude/arquivos/saudebrasil2011_parte1_cap9.pdf
http://portalsaude.saude.gov.br/portalsa...

12. Cardoso JDC, Azevedo RCS, Reiners AAO, Louzada CV, Espinosa MM. Poor self-rated health and associated factors among elderly urban residents. Rev Gaucha Enferm 2014; 35(4):35-41.

13. Katz S, Downs TD, Cash HR, Grotz RC. Progress in development of the index of all. Gerontologist 1970; 10(1):20-30.

14. Lawton MP, Brody EM. Assessment of older people; self-maintaining and instrumental activities of daily-living. Gerontologist 1969; 9(3):179-186.

15. Motta LB, Aguiar AC, Coutinho ESF, Huf G. Prevalência e fatores associados a quedas em idosos em um município do Rio de Janeiro. Rev Bras Geriatr Gerontol 2010; 13(1):83-91.

16. Peeters GMEE, Heymans MW, Vries OJ de, Bouter LM, Lips P, Tulder MW van. Multifactorial evaluation and treatment of persons with a high risk of recurrent falling was not cost-effective. Osteoporos Int 2011; 22(7):2187-2196.

17. Deandrea S, Lucenteforte E, Bravi F, Foschi R, La Vecchia C, Negri E. Risk factors for falls in community-dwelling older people: a systematic review and meta-analysis. Epidemiology 2010; 21(5):658-668.

18. Dantas EL, Brito GEG, Lobato IAF. Prevalência de quedas em idosos adscritos à estratégia de saúde da família do município de João Pessoa, Paraíba. Rev APS 2012; 15(1):67-75.

19. Milat AJ, Watson WL, Monger C, Barr M, Giffin M, Reid M. Prevalence, circumstances and consequences of falls among community- dwelling older people: results of the 2009 NSW Falls Prevention Baseline Survey. New South Wales public health bulletin 2011; 22(3-4):43-48.

20. Stenhagen M, Ekström H, Nordell E, Elmståhl S. 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’. BMC Geriatr 2013; 13:81.

21. Grundstrom AC, Guse CE, Layde PM. Risk factors for falls and fall-related injuries in adults 85 years of age and older. Arch Gerontol Geriatr 2012; 54(3):421-428.

22. Gomes ECC, Oliveira Marques AP de, Leal MCC, Barros BP de. Fatores associados ao risco de quedas em idosos institucionalizados: uma revisão integrativa. Cien Saude Colet 2014; 19(8):3543-3551.

23. Hamra A, Ribeiro MB, Miguel OF. Correlação entre fratura por queda em idosos e uso prévio de medicamentos. Acta Ortop Bras 2007; 15(Supl. 3):143-145.

24. Rolita L, Spegman A, Tang X, Cronstein BN. Greater number of narcotic analgesic prescriptions for osteoarthritis is associated with falls and fractures in elderly adults. J Am Geriatr Soc 2013; 61(3):335-340.

25. Kelsey JL, Berry SD, Procter-Gray E, Quach L, Nguyen US, Li W, Kiel DP, Lipsitz LA, Hannan MT. Indoor and outdoor falls in older adults are different: The maintenance of balance, independent living, intellect, and Zest in the Elderly of Boston Study. J Am Geriatr Soc 2010; 58(11):2135-2141.

26. World Health Organization (WHO). Injuries and violence: the facts. Geneva: WHO; 2010.

27. Cunha AA, Lourenço RA. Quedas em idosos: prevalência e fatores associados. Revista Hospital Universitário Pedro Ernesto 2014; 13(2):21-29.

28. Antes DL, Schneider IJC, Benedetti TRB, d’Orsi E. Fear of recurrent falls and associated factors among older adults from Florianópolis, Santa Catarina State, Brazil. Cad Saude Publica 2013; 29(4):758-768.

29. Pinheiro MP, Ciconelli RM, Martini LA, Ferraz MB. Risk factors for recurrent falls among Brazilian women and men: the Brazilian Osteoporosis Study (BRAZOS). Cad Saude Publica 2010; 26(1):89-96.^-3030. Freitas MGD, Bonolo PDF, Moraes END, Machado CJ. Elderly patients attended in emergency health services in Brazil: a study for victims of falls and traffic accidents. Cien Saude Colet 2015; 20(3):701-712.. The interaction of these factors may be responsible for the higher recurrence of falls in older adults.

Older adults with low education level experienced more recurrent falls in bivariate analysis, even though this association was not significant in the final predictive model. This effect may have been attenuated by the possible confounder low income. Low education level combined with low income can contribute to social vulnerability and result in a higher recurrence of falls³¹31. Rocha L, Budó MLD, Beuter M, Silva RM, Tavares JP. Vulnerabilidade de idosos às quedas seguidas de fratura. Esc. Anna Nery 2010; 14(4):690-696.. On the other hand, people with higher education level and income are concerned with their own health, so they practice physical activities that help to maintain their physical and organic integrity, which lead to better postural control³²32. Maciel ACC, Guerra RO. Prevalência e fatores associados ao déficit de equilíbrio em idosos. Rev Bras Ciênc Mov. 2005; 13(1):37-44..

Studies on the risk factors for falls in older adults found that arthritis and arthrosis are frequently associated with falls, contrary to the present finding³³33. Siqueira FV, Fachini LA, Silveira DS, Piccini RX, Tomasi E, Thumé E, Dilélio A. Prevalence of falls in elderly in Brazil: a countrywide analysis. Cad Saude Publica 2011; 27(9):1819-1826.

34. Mickle KJ, Munro BJ, Lord SR, Menz HB, Steele JR. Foot pain, plantar pressures, and falls in older people: a prospective study. J Am Geriatr Soc 2010; 58(10):1936-1940.^-3535. Dellaroza MSG, Mattos Pimenta CA, Lebrão ML, Oliveira Duarte YA, Braga PE. Associação entre dor crônica e autorrelato de quedas: estudo populacional - SABE. Cad Saude Publica 2014; 30(3):522-532.. Some studies have found that an increase in chronic diseases occurs simultaneously with loss of functional capacity, and higher immobility and physical dependence¹1. Tinetti ME, Kumar C. The patient who falls. JAMA 2010; 303(3):258-266.^,3636. Cavalcante ALP, Aguiar JB, Gurgell LA. Fatores associados a quedas em idosos residentes em um bairro de Fortaleza, Ceará. Rev Bras Geriatr Gerontol 2012; 15(1):137-146.. Meanwhile, arthrosis, arthritis, and other musculoskeletal disorders result in joint stiffness and pain, leading to unsteady gait, poor balance, and higher probability of falling³⁷37. Rubenstein LZ, Josephson KR. The epidemiology of falls and syncope. Clin Geriatr Med 2002; 18(2):141-158..

A study that investigated the association between the risk factors for falls and arthritis found that people with arthritis are at greater risk of falls, regardless of age, since they also have less muscle strength, postural instability, pain, and fatigue³⁸38. Stanmore EK, Oldham J, Skelton DA, O’Neill T, Pilling M, Campbell AJ, Todd C. Risk factors for falls in adults with rheumatoid arthritis: a prospective study. Arthritis Care Res 2013; 65(8):1251-1258., contrary to the present finding. However, when older adults fall, they tend to reduce their daily activities either because they fear falling again or because their family members and caregivers become protective, which can reduce the risk of new falls³⁹39. Brito TA, Fernandes MH, Coqueiro DS, Jesus CS. Quedas e capacidade funcional em idosos longevos residentes em comunidade. Texto & Contexto Enferm 2013; 22(1):43-51..

There is no consensus in the literature regarding recurrent falls. A study on falls and recurrent falls in a group of community-dwelling older adults from Itu (SP) did not find these associations. Falls probably induce older adults or their caregivers to be more attentive and careful to prevent new falls⁴⁰40. Luiz LC, Rebelatto JR, Coimbra AMV, Ricci NA. Associação entre déficit visual e aspectos clínico-funcionais em idosos da comunidade. Rev Bras Fisioter 2009; 13(5):444-450..

Another study finding was the association between bad self-perceived health and recurrent falls in bivariate analysis. A study of community-dwelling older adults found recurrent falls to be associated with bad self-perceived health, depression symptoms, and social isolation⁴¹41. Perracini MR, Ramos LR. Fatores associados a quedas em uma coorte de idosos residentes na comunidade. Rev Saude Publica 2002; 36(6):709-716.. Other studies indicated that illiterate older adults or those with low education level, similar to the study sample, tend to have worse self-rated health than older adults with higher education levels¹1. Tinetti ME, Kumar C. The patient who falls. JAMA 2010; 303(3):258-266.^,77. Maia BC, Viana PC, Arantes PMM, Alencar MA. Consequências das quedas em idosos vivendo na comunidade. Rev Bras Geriatr Gerontol 2011; 14(2):381-393.. In this sense, falls lead to the loss of autonomy and independence in activities of daily living, feelings of frailty and insecurity, fewer social activities, and low self-esteem²2. Ribeiro AP, Souza ER, Atie S, Souza AC, Schilithz AO. A influência das quedas na qualidade de vida de idosos. Cien Saude Colet 2008; 13(4):1265-1273..

Self-reported visual impairment was associated with recurrent falls in the final model, even though this association did not occur in bivariate analysis. An age effect may probably justify this difference, since very old adults are more likely to have visual impairment. A study in the municipality of Amparo (SP) found a correlation between number of falls and higher visual impairment as individuals with poor vision were older than those with normal vision⁴⁰40. Luiz LC, Rebelatto JR, Coimbra AMV, Ricci NA. Associação entre déficit visual e aspectos clínico-funcionais em idosos da comunidade. Rev Bras Fisioter 2009; 13(5):444-450.. Another study followed community-dwelling adults aged 65 years or more and found that the effect of visual impairment on the daily performance of older adults was an important predictor of falls and recurrent falls⁴¹41. Perracini MR, Ramos LR. Fatores associados a quedas em uma coorte de idosos residentes na comunidade. Rev Saude Publica 2002; 36(6):709-716..

Despite the significant aspects related to recurrent falls in older adults and the associated factors found by the present study, one cannot exclude a possible memory bias as the occurrence of falls was self-reported. Older adults who experienced falls with more severe consequences may have remembered the details more often than older adults with no or mild fall-related consequences. However, the direction and magnitude of these associations may reveal important risk factors that may help to prevent falls in community-dwelling older adults.

This study was one of the first to assess recurrent falls in community-dwelling older adults by following a cohort of older adults. The study results reinforce the importance of preventing recurrent falls and all its negative health outcomes. Understanding the causes of recurrent falls may allow primary healthcare to create educational interventions and activities that minimize their occurrence. Health professionals must remain attentive to these factors in order to create effective interventions that reduce these events in the community.

Conclusion

This study found that low education level, regular to very bad self-perceived health, and visual impairment were associated with recurrent falls in older adults. The present results corroborate other studies, but new studies are appropriate and indicated at this time given the higher life expectancy and participation of older adults in the community.

References

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History