Predictors of long-term functional decline post-fall in older community-dwelling people
Summary
Background: Older people presenting to an Emergency Department after a fall are at high risk of functional decline. However, risk factors for functional decline in this group are relatively unknown. This review investigates the literature for predictors of long-term decline in physical function in older people who sustained a fall, not necessitating hospital admission.
Methods: Cohort studies published till November 2008 were identified through a systematic search in CINAHL, PsycINFO, MEDLINE, EMBASE and Social Sciences Index. Studies reporting on predictors of long-term decline after a fall in older people were included. Results were summarised for follow-up periods of 12 months and 36 months, respectively.
Results: The 7 studies included described 4 samples, testing 34 predictors. Sample size ranged from 93 to 832 subjects. Mean age of the study samples ranged from 70.2 to 78.7 years. The percentage of females varied from 55 to 82%. Most variables were evaluated in one sample only. About 56% of all factors were statistically significant. Variables predictive of long-term decline were female gender, age, baseline disability, sustaining an injurious fall or sustaining multiple falls, and depressive symptoms.
Conclusion: The predictors found to be significant should be confirmed in other samples, using a prospective design. These factors can be used to identify people at higher risk of long-term functional decline. Interventions to optimise level of physical function and to prevent further falls should be developed and evaluated.
Background: Older people presenting to an Emergency Department (ED) after a fall are at high risk of functional decline. However, risk factors for functional decline in this group are relatively unknown. This study investigates predictors of long-term decline in physical function in older people who presented to an ED after a fall, and were discharged directly home.
Methods: A cohort study nested within a randomised controlled trial assessing the effectiveness of a falls prevention intervention was carried out in Melbourne, Australia. The sample included 607 community-dwelling people presenting to an ED after a fall, who were discharged directly home and completed a 12 month follow up assessment. Exclusion criteria were: unable to comply with simple instructions and unable to walk independently indoors. Physical function was measured with the Human Activity Profile post ED discharge and at 12-months follow-up. Multivariate regression was used to investigate predictors of long-term decline in physical function.
Results: - this article will be submitted for publication