Falls incidence underestimates the risk of fall-related injuries in older age groups: a comparison with the FARE (Falls risk by Exposure)

Astrid Etman, Gert Jan Wijlhuizen, Marieke J. G. van Heuvelen, Astrid Chorus, Marijke Hopman-Rock
2012 Age and Ageing  
up till now, the risk of falls has been expressed as falls incidence (i.e. the number of falls or fallers per 100 person-years). However, the risk of an accident or injury is the probability of having an accident or injury per unit of exposure. The FARE (Falls risk by Exposure) is a measure for falls risk which incorporates physical activity as a measure of exposure. The objective of this study was to compare falls incidence and the FARE when expressing the age-related risk of fall-related
more » ... f fall-related injuries. Methods: data of 21,020 community-dwelling elderly aged ≥55 years (60.3% women) obtained from a national survey (2000-05) were used to compare incidence of fall-related injuries and the FARE. In order to compare both measures, risk ratios (of both outcome measures) were calculated for each age group. Hierarchical regression analyses (linear versus exponential model) were conducted to check the best model fit when expressing falls risk by age for the total study population and for men and women separately. Results: the risk of fall-related injuries, calculated on the basis of the incidence of fall-related injuries, showed a linear relationship with age, whereas the risk calculated on the basis of fall-related injuries corrected for exposure (falls risk by exposure, FARE) showed an exponential relationship. Calculations on the basis of the incidence of fall-related injuries underestimated the risk of fall-related injuries in people aged 70 years and older, and especially in women. Conclusion: calculation of the risk of fall-related injuries based on the incidence of these injuries underestimates the risk of such injuries relative to that calculated on the basis of the FARE. FARE-based calculations enable the early identification of people at high risk of falls and provide a more sensitive outcome measure for studies evaluating falls prevention interventions. Abstract Background: age-related hearing loss is a common chronic condition; hence, it is important to understand its influence on the functional status of older adults. We assessed the association between hearing impairment with activity limitations as assessed by the activities of daily living (ADL) scale. Methods: a total of 1,952 Blue Mountains Hearing Study participants aged ≥60 years had their hearing levels measured using pure-tone audiometry. A survey instrument with questions on functional status as determined by the Older Americans Resources and Services ADL scale was administered. Results: one hundred and sixty-four (10.4%) participants reported ADL difficulty. A higher proportion of hearing impaired than non-impaired adults reported difficulties in performing three out of the seven basic ADL and six out of the seven instrumental ADL tasks. After multivariable adjustment, increased severity of hearing loss was associated with impaired ADL (P trend = 0.001). Subjects with moderate to severe hearing loss compared with those without, had a 2.9-fold increased likelihood of reporting difficulty in ADL, multivariate-adjusted odds ratio (OR): 2.87 [95% confidence interval (CI): 1. 59-5.19]. Participants aged <75 years with hearing loss compared with those without, had 2-fold higher odds of impaired ADL. Having worn or wearing a hearing aid was also associated with a 2-fold increased likelihood of impaired ADL. Conclusion: functional status as measured by a common ADL scale is diminished in older hearing impaired adults. Our findings suggest that severely diminished hearing could make the difference between independence and the need for formal support services or placement.
doi:10.1093/ageing/afr178 pmid:22345295 fatcat:gyzjjxhusjhtbgqsqlbggkclvq