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Results of Two Population-Based Studies

Alan S. Robbins, MD; Laurence Z. Rubenstein, MD, MPH; Karen R. Josephson, MPH; Barbara L. Schulman, RN, GNP; Dan Osterweil, MD; Gilbert Fine, MS

Arch Intern Med. 1989;149(7):1628-1633.

Abstract
• A study was performed to identify and rank risk factors for falling among populations of institutionalized (fallers, N=79, nonfallers, N=70) and noninstitutionalized (fallers, N =34, nonfallers, N = 34) elderly persons. Fallers were matched by age, sex, and living location to nonfaller control subjects. A nurse practitioner performed a comprehensive physical assessment in all subjects using a standardized protocol and physician consultation. Fallers in both populations were significantly more physically and functionally impaired than control subjects. Logistic regression identified hip weakness, poor balance, and number of prescribed medications as factors most strongly associated with falling among institutionalized subjects. A fall prediction model was developed from these findings yielding 76% overall predictive accuracy (89% sensitivity, 60% specificity). Using the model, the predicted 1-year risk of falling ranged from 12% for persons with none of the three risk factors to 100% for persons with all three risk factors. Findings among noninstitutionalized subjects were similar. These data support the concept of performing focused fall risk assessments to identify elderly patients at high risk for falling.

(Arch Intern Med. 1989;149:1628-1633)

Author Affiliations
From the Department of Medicine and Geriatric Research Education and Clinical Center, Sepulveda (Calif) Veterans Administration Medical Center (Drs Robbins and Rubenstein, Mss Josephson and Schulman, and Mr Fine); UCLA School of Medicine, Los Angeles, Calif (Drs Robbins, Rubenstein, and Osterweil); and Jewish Homes for the Aging of Greater Los Angeles (Calif) (Drs Rubenstein and Osterweil).

Footnotes
Accepted for publication March 29, 1989.

Presented, in part, at the annual scientific meeting of the American Geriatrics Society, Anaheim, Calif, May 1988.

Reprint requests to Veterans Administration Medical Center (11), Sepulveda, CA 91343 (Dr Robbins).

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