Predictors of falls in the elderly by location

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Abstract
Background and aims: In the elderly, balance and walking impairments are assumed to play an important role in causing falls. We have assessed prospectively the predictive ability of health, function and balance variables regarding falls and their location. Methods: Falls which occurred during one year in a random sample of 307 women aged 75 years and over (mean 80.8 years, response rate 74.5%) living in the community were recorded and related to baseline registrations of health, medication and tests of walking and balance. Results: In all, 155 women (50.5%) reported 308 falls. Outdoor falls were significantly more frequent than indoor falls (57.5 vs 42.5%). The variables having had a fall before the start of the study, osteoporosis, hypertension, feeling depressed, unable to climb 40 cm high steps and walking slowly, all independently predicted a higher number of falls overall. Regarding fall location, having experienced a fall before study start was associated with more falls indoors as well as outdoors. Vision impairment, symptoms of depression, a faster comfortable walking speed, and being able to cope with higher steps were all independent predictors of more outdoor falls also after adjustment for outdoor exposure. A slower comfortable walking speed, a higher amplitude of the center of pressure movements in the frontal plane, a poorer score on the Timed Up & Go test, multi-morbidity, poor cognition and hypertension were independent risk factors for indoor falls. Neither number of drugs used nor any specific medication appeared as independent risk factors for falls in this study. Conclusions: The findings of this study suggest that risk factors for indoor and outdoor falls are different. Location of fall may be an important confounder in studies of predictors of falls in the elderly which should encompass this type of information.