Health, Functional and Nutritional Determinants of Falls Experienced in the Previous Year—A Cross-Sectional Study in a Geriatric Ward
Abstract
1. Introduction
2. Materials and Methods
2.1. Patient Characteristics
2.2. Measurements
2.3. Study Parameters
2.4. Statistical Analysis
2.5. Ethics Approval
3. Results
3.1. Study Cohort Characteristics
3.2. Independent Predictors of Being a Faller
3.3. Study Participants and Nonparticipants
4. Discussion
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
Abbreviations
ACE-I | angiotensin converting enzyme inhibitor |
AChE-I | acetylcholine esterase inhibitor |
AMTS | abbreviated mental test score |
ARB | angiotensin receptor blocker |
BDA | benzodiazepines |
BMI | body mass index |
CFS | Clinical Frailty Scale |
CKD-EPI | Chronic Kidney Disease Epidemiology Collaboration |
CI | confidence interval |
GDS | Geriatric Depression Scale |
GFR | glomerular filtration rate |
IADL | instrumental activities of daily living |
IQR | interquartile range |
KDOQI | Kidney Disease Outcome Quality Initiative |
M | mean |
Me | median |
MNA-SF | Mini Nutritional Assessment Short Form |
NSAIDs | non-steroidal anti-inflammatory drugs |
NYHA | New York Heart Association |
OARS | Older Americans Resources and Services |
OR | odds ratio |
POMA | Performance Oriented Mobility Assessment |
SD | standard deviation |
SSRI | selective serotonin reuptake inhibitors |
TIA | transient ischemic attack |
TUG | Timed Up-and-Go Test |
References
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Characteristic | All | Fallers | Non-Fallers | p1 | Missing Values |
---|---|---|---|---|---|
n (%) | 358 (100.0) | 157 (43.9) | 201 (56.15) | ||
Age (y), Me (IQR) | 82 (76–86) | 82 (77–86) | 82 (76–85) | 0.23 | – |
Age (75+), n (%) | 298 (83.2) | 136 (86.6) | 162 (80.6) | 0.13 | – |
Sex (F), n (%) | 279 (77.9) | 123 (78.3) | 156 (77.6) | 0.86 | – |
Residence (rural), n (%) | 68 (19.0) | 28 (17.8) | 40 (19.9) | 0.68 | – |
Number of chronic diseases, Me (IQR) | 5.0 (3.0–6.0) | 5.0 (3.0–6.0) | 4.0 (3.0–6.0) | 0.02 | – |
Multimorbidity, n (%) | 200 (55.9) | 96 (26.8) | 104 (51.7) | 0.07 | – |
Number of drugs, Me (IQR) | 7.0 (5.0–9.0) | 7.0 (5.5–9.5) | 7.0 (5.0–9.0) | 0.25 | 8 |
Polypharmacy, n (%) | 281 (80.3) | 126 (82.9) | 155 (78.3) | 0.34 | 8 |
Hospitalization in the last year, n (%) | 102 (28.6) | 45 (28.7) | 57 (28.5) | 0.97 | 1 |
Chronic diseases | |||||
Parkinson’s disease, n (%) | 41 (11.5) | 28 (17.8) | 13 (6.5) | <0.001 | – |
Dementia, n (%) | 102 (28.5) | 48 (30.1) | 54 (26.9) | 0.44 | – |
Hypertension, n (%) | 288 (80.5) | 128 (81.5) | 160 (79.6) | 0.64 | – |
Ischemic heart disease, n (%) | 195 (54.5) | 87 (55.4) | 108 (53.7) | 0.75 | – |
Myocardial infarction, n (%) | 36 (10.0) | 17 (10.8) | 19 (9.5) | 0.66 | – |
Atrial fibrillation, n (%) | 82 (22.9) | 36 (22.9) | 46 (22.9) | 0.99 | – |
Chronic cardiac failure, n (%) | 135 (37.7) | 66 (42) | 69 (34.3) | 0.14 | – |
NYHA class I/II, n (%) | 67 (18.7) | 32 (20.4) | 35 (17.4) | ||
NYHA class III/IV, n (%) | 68 (19) | 34 (21.7) | 34 (16.9) | ||
Peripheral arterial disease, n (%) | 75 (20.1) | 42 ( 26.8) | 33 (16.4) | 0.02 | – |
Stroke/ TIA, n (%) | 41 (11.5) | 23 (14.7) | 18 (9.0) | 0.09 | – |
Osteoarthritis, n (%) | 278 (77.7) | 130 (82.8) | 148 (73.6) | 0.04 | – |
Osteoporosis, n (%) | 65 (18.2) | 27 (17.2) | 38 (18.9) | 0.68 | – |
Diabetes, n (%) | 104 (21.9) | 50 (31.9) | 54 (26.9) | 0.30 | – |
Chronic kidney disease, n (%) | 186 (52.0) | 82 (52.2) | 104 (51.7) | 0.93 | – |
Orthostatic hypotension, n (%) | 51 (15.7) | 25 (16.6) | 26 (15.0) | 0.70 | 34 |
Vitamin B12, pg/mL, Me (IQR) | 332.6 (242.2–430.2) | 331.3 (222.1–422.2) | 337.30 (256.9–431.6) | 0.10 | 35 |
Na, mmol/L, Me (IQR) | 140.0 (138.0–141.0) | 140.0 (138.0–141.0) | 140.0 (138.0–141.0) | 0.94 | 10 |
eGFR, mL/min/1.73 m2, M (SD) | 58.3 (16.7) | 58.2 (16.8) | 58.4 (16.7) | 0.91 | 10 |
Serum creatinine, mmol/L, Me (IQR) | 86.6 (74.3–105.2) | 85.75 (72.5–105.2) | 87.52 (76.0–103.4) | 0.76 | 10 |
Hemoglobin, mmol/L, Me (IQR) | 7.8 (7.2–8.5) | 7.9 (7.2–8.4) | 7.93 (7.2–8.5) | 0.83 | 11 |
Anemia, n (%) | 149(42.9) | 72 (46.2) | 77 (40.3) | 0.27 | 11 |
Medications | |||||
α1-blockers, n (%) | 21 (6.0) | 8 (5.3) | 13 (6.6) | 0.60 | 9 |
Thyroid hormones, n (%) | 26 (7.5) | 11 (7.2) | 15 (7.6) | 0.89 | 9 |
Antithyroid drugs, n (%) | 2 (06) | – | 2 (1.0) | 0.51 | 9 |
Quetiapine, n (%) | 38 (10.9) | 22 (14.5) | 16 (8.1) | 0.06 | 9 |
Neuroleptics, n (%) | 49 (14.0) | 25 (16.5) | 24 (12.2) | 0.26 | 9 |
Vitamin D, n (%) | 79 (22.6) | 29 (19.0) | 50 (25.4) | 0.16 | 9 |
ACE-Is/ ARBs, n (%) | 231 (66.2) | 95 (62.5) | 136 (69.0) | 0.21 | 9 |
Memantine, n (%) | 11 (3.2) | 3 (2.0) | 8 (4.0) | 0.27 | 9 |
AChE-Is, n (%) | 35 (10.0) | 17(11.2) | 18 (9.1) | 0.53 | 9 |
ß-blockers, n (%) | 222 (63.6) | 98 (64.5) | 124 (63.0) | 0.77 | 9 |
Calcium channel blockers, n (%) | 102 (29.2) | 46 (30.3) | 56 (28.4) | 0.70 | 9 |
Digoxin, n (%) | 24 (6.9) | 13 (8.6) | 11 (5.6) | 0.28 | 9 |
Diuretics, n (%) | 165 (47.3) | 65 (42.8) | 100 (50.8) | 0.14 | 9 |
Lipid lowering drugs, n (%) | 125 (35.8) | 51 (33.6) | 74 (37.6) | 0.44 | 9 |
BDA, n (%) | 40 (11.4) | 22 (14.4) | 18 (9.1) | 0.13 | 8 |
SSRI, n (%) | 98 (28.0) | 49 (32.2) | 49 (24.9) | 0.13 | 9 |
NSAIDs, n (%) | 24 (6.9) | 12 (7.9) | 12 (6.1) | 0.53 | 9 |
Characteristic | All | Fallers | Non-Fallers | p1 | Missing Values |
---|---|---|---|---|---|
n (%) | 358 (100.0) | 157 (43.9) | 201 (56.15) | ||
Barthel index, Me (IQR) | 95 (80–100) | 90 (75–95) | 95 (85–100) | 0.004 | 6 |
IADL, Me (IQR) | 8.0 (5.0–11.0) | 7.0 (4.0–10.5) | 9.0 (6.0–12.0) | 0.01 | 10 |
AMTS, Me (IQR) | 8.0 (6.0–9.0) | 8.0 (7.0–9.0) | 8.0 (6.0–9.0) | 0.58 | 21 |
GDS, Me (IQR) | 6.0 (3.0–10.0) | 7.0 (3.0–10.0) | 6.0 (3.0–9.0) | 0.34 | 34 |
Handgrip, kg, Me (IQR) | 18.4 (14.1–23.0) | 18.1 (13.9–22.3) | 18.8 (14.3–24.3) | 0.22 | 32 |
men, kg, Me (IQR) | 26 (21.0–32.3) | 26.1 (21.5–29.6) | 30.0 (23.0–35.5) | 0.047 | 12 |
women, kg, Me (IQR) | 16.7 (12.9–20.5) | 16.8 (12.7–19.9) | 17.3 (13.5–21.3) | 0.2 | 20 |
Dynapenia, n (%) | 143 (43.9) | 73 (47.4) | 70 (40.7) | 0.26 | 32 |
Severe dynapenia, n (%) | 95 (32.8) | 48 (36.4) | 47 (29.7) | 0.26 | 68 |
Gait speed, m/s, Me (IQR) | 0.65 (0.40–0.95) | 0.60 (0.37–0.86) | 0.71 (0.43–1.05) | 0.01 | 49 |
Gait speed ≤ 0.8 m/s, n (%) | 200 (64.7) | 103 (71.0) | 97 (59.1) | 0.03 | 49 |
POMA, Me (IQR) | 23.0 (18.0–28.0) | 22.0 (17.0–28.0) | 25.0 (19.0–28.0) | 0.005 | 49 |
TUG, s, Me (IQR) | 17.1 (11.7–27.2) | 17.4 (13.0–28.3) | 16.5 (11.3–25.2) | 0.25 | 64 |
TUG ≥ 20 s, n (%) | 121 (41.2) | 55 (41.7) | 66 (40.7) | 0.91 | 64 |
CFS, Me (IQR) | 4.0 (4.0–5.0) | 5.0 (4.0–5.0) | 4.0 (4.0–5.0) | 0.03 | – |
Severe frailty, n (%) | 58 (16.2) | 31 (19.7) | 27 (13.4) | 0.11 | – |
Urinary incontinence, n (%) | 146 (41.4) | 78 (49.7) | 68 (34.7) | 0.004 | 5 |
BMI, kg/m2, M (SD) | 29.35 (5.99) | 29.33 (5.97) | 29.37 (6.02) | 0.92 | 34 |
BMI < 24 kg/m2, n (%) | 59 (18.2) | 26 (18.7) | 33 (17.9) | 0.84 | 34 |
BMI > 30 kg/m2, n (%) | 136 (42.0) | 57 (41.0) | 79 (42.7) | 0.76 | 34 |
MAC, cm, M (SD) | 28.2 (4.0) | 28.1 (4.0) | 28.3 (3.9) | 0.82 | 47 |
MAC ≤ 22 cm, n (%) | 73 (23.5) | 35 (23.8) | 38 (23.2) | 0.89 | 47 |
CC, cm, M (SD) | 34.8 (4.5) | 34.6 (4.7) | 35.0(4.4) | 0.50 | 47 |
CC < 31 cm, n (%) | 53 (17.0) | 29 (19.7) | 24 (14.6) | 0.23 | 47 |
Albumin, g/L, M (SD) | 39.3 (3.7) | 39.0 (4.0) | 39.5 (4.0) | 0.03 | 24 |
MNA-SF, Me (IQR) | 12.0 (10.0–13.0) | 12.0 (9.0–13.0) | 13.0 (10.0–14.0) | 0.04 | 10 |
MNA-SF score < 8, n (%) | 46 (13.2) | 21 (13.6) | 25 (12.9) | 0.84 | 10 |
Predictors | OR (95% CI) | p |
---|---|---|
Age, 75+ years | 1.17 (0.54–2.53) | 0.69 |
Multimorbidity | 1.01 (0.52–1.98) | 0.97 |
Chronic cardiac failure | 1.67 (0.88–3.14) | 0.12 |
Peripheral arterial disease | 0.90 (0.41–2.00) | 0.80 |
Stroke/TIA | 1.82 (0.71–4.67) | 0.22 |
Parkinson’s disease | 2.82 (1.07–7.45) | 0.04 |
Osteoarthritis | 2.08 (1.02–4.23) | 0.04 |
POMA | 0.95 (0.87–1.02) | 0.16 |
Barthel index | 1.01 (0.98–1.03) | 0.53 |
IADL | 0.99 (0.89–1.12) | 0.96 |
Gait speed | 0.78 (0.18–3.39) | 0.69 |
CFS | 0.76(0.50–1.16) | 0.21 |
Urinary incontinence | 1.37 (0.75–2.49) | 0.31 |
MNA-SF | 1.02 (0.91–1.15) | 0.73 |
Albumin | 1.00 (0.92–1.09) | 0.96 |
Vitamin B12 | 0.99 (0.99–1.00) | 0.12 |
Quetiapine | 1.66 (0.64–4.31) | 0.30 |
Vitamin D | 1.08 (0.54–2.17) | 0.82 |
Diuretics | 0.69 (0.39–1.21) | 0.19 |
BDA | 1.29 (0.54–3.08) | 0.56 |
SSRI | 1.30 (0.69–2.46) | 0.42 |
Parameter | Participants | Nonparticipants | p1 |
---|---|---|---|
No. (%) of patients | 358 (86.1) | 58 (13.9) | |
Age, years, Me (IQR) | 84 (78.8–87.3) | 82 (76–86) | 0.22 |
Age, 75+, n (%) | 298 (83.2) | 52 (89.7) | 0.22 |
Gender, women, n (%) | 279 (77.9) | 43 (74.1) | 0.52 |
Barthel index, Me (IQR) | 95 (80–100) | 42.5 (15–70) | <0.001 |
IADL, Me (IQR) | 8 (5.0–11.0) | 0.0 (0.0–4.0) | <0.001 |
POMA, Me (IQR) | 23 (18–28) | 8.0 (8.0–15.0) | <0.001 |
CFS, Me (IQR) | 4.0 (4.0–5.0) | 6.0 (6.0–7.0) | <0.001 |
Not able to walk, n(%) | 18 (5.2) | 25 (47.2) | <0.001 |
Severe frailty, n (%) | 58 (16.2) | 44 (75.9) | <0.001 |
Sarcopenia, n (%) | 143 (43.9) | 21 (87.5) | <0.001 |
Urinary incontinence, n (%) | 146 (41.4) | 47 (81.0) | <0.001 |
Dementia, n (%) | 102 (28.5) | 31 (53.4) | <0.001 |
AMTS, Me (IQR) | 8 (6.0–9.0) | 6.5 (3.0–8.75) | <0.001 |
Neuroleptics, n (%) | 49 (14.0) | 18 (31.6) | 0.001 |
Parkinson’s disease, n (%) | 41 (11.5) | 14 (24.1) | 0.008 |
TIA/stroke, n (%) | 41 (11.5) | 15 (25.9) | 0.003 |
MNA-SF<8, n (%) | 46 (13.2) | 26 (46.4) | <0.001 |
Albumin, g/L, M (SD) | 36.6 (3.6) | 39.3 (3.7) | <0.001 |
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Magnuszewski, L.; Swietek, M.; Kasiukiewicz, A.; Kuprjanowicz, B.; Baczek, J.; Beata Wojszel, Z. Health, Functional and Nutritional Determinants of Falls Experienced in the Previous Year—A Cross-Sectional Study in a Geriatric Ward. Int. J. Environ. Res. Public Health 2020, 17, 4768. https://doi.org/10.3390/ijerph17134768
Magnuszewski L, Swietek M, Kasiukiewicz A, Kuprjanowicz B, Baczek J, Beata Wojszel Z. Health, Functional and Nutritional Determinants of Falls Experienced in the Previous Year—A Cross-Sectional Study in a Geriatric Ward. International Journal of Environmental Research and Public Health. 2020; 17(13):4768. https://doi.org/10.3390/ijerph17134768
Chicago/Turabian StyleMagnuszewski, Lukasz, Marta Swietek, Agnieszka Kasiukiewicz, Bartlomiej Kuprjanowicz, Jan Baczek, and Zyta Beata Wojszel. 2020. "Health, Functional and Nutritional Determinants of Falls Experienced in the Previous Year—A Cross-Sectional Study in a Geriatric Ward" International Journal of Environmental Research and Public Health 17, no. 13: 4768. https://doi.org/10.3390/ijerph17134768
APA StyleMagnuszewski, L., Swietek, M., Kasiukiewicz, A., Kuprjanowicz, B., Baczek, J., & Beata Wojszel, Z. (2020). Health, Functional and Nutritional Determinants of Falls Experienced in the Previous Year—A Cross-Sectional Study in a Geriatric Ward. International Journal of Environmental Research and Public Health, 17(13), 4768. https://doi.org/10.3390/ijerph17134768