Abstract:

Background: Fall represents a major public health problem among older adults in Nigeria. There is a need for information on the prevalence and the risk factors of fall to ascertain the magnitude of the problem among the elderly in Nigeria.

Objective: To determine the prevalence and factors associated with falls among older adults in Nigerian Urban Community.

Methodology: The study was conducted among older adults in a Nigerian Urban Community. A multi-stage stratified sampling method was used to select persons aged 60 years and above in Ilorin Metropolis, North Central Nigeria.

Result: Falls were reported by 24.2% (prevalence) of the sample (n=1750). The prevalence of falls was 18.6% in males and 25.2 % in females. Among fallers, females were more likely than males to sustain injuries, including fractures (46.8% vs. 33.7%; p < 0.05). Moreover, a gradual and linear increase in the prevalence of falls was seen as the number of risk factors increased. In the multivariate model, women, subjects with cognitive impairment, those reporting urinary incontinence, and those being physically active during the previous year were found to be independently associated with increased risk of falling among older adults.

Conclusion: The present study identified potential risk factors for falls in a representative pop­ulation-based sample of older adults in a Nigerian Urban Community. It is therefore recommended that these risk factors should be addressed in public health policies through awareness and fall prevention programme. The fall prevention program must focus on females and those with chronic health conditions.

Keywords: Falls; Prevalence; Risk Factors; Older persons; Nigeria.

References:

[1].   Abolhassani F., Moayyeri A., Naghavi M., Soltani A., Larijani B., Shalmani H.T. (2006). Incidence and characteristics of falls leading to hip fracture in Iranian population. Bone Vol, 39, pg 408–413.

[2].   Abram W., Beer M., Berkow R., Fletcher A., Chir M.B (1995). Falls and gait disorders; in The Merck Manual of Geriatrics, ed 2. Rahway, Merck Research Laboratories Press, pp 65–78.

[3].   Azevedo M., Alla S. (2008). Diabetes in Sub-Saharan Africa: Kenya, Mali, Mozambique, Nigeria, South Africa and Zambia. Int J Diab Dev Ctries 2008; 28: 101–108.

[4].   American Geriatrics Society, British Geriatrics Society, American Academy of Orthopaedics Surgeons Panel on Falls Prevention. Guideline for the prevention of falls in older persons. J. Am. Geriatr Soc. 2001, Vol. 49(5), pp 664-672.

[5].   Bekibele, C.O., Gureje, O. (2009). Fall Incidence in a Population of Elderly Persons in Nigeria. Gerontology, 2010, Vol.56, pp 278–283.

[6].   Bloch F., Thibaud M., Dugu´e B., Br`eque C., A. Rigaud S., Kemoun K. (2010). “Episodes of falling among elderly people: a systematic review and meta-analysis of social and demographic pre-disposing characteristics,” Clinics, vol. 65 (9), pp. 895– 903.

[7].   Blake A.J., Morgan K, Bendall M.J., Dallosso H., Ebrahim S.B., Arie T.H., Fentem P.H., Bassey E.J. (1988). Falls by elderly people at home: prevalence and associated factors. Age Ageing. Vol.17(6), pp365-372.

[8].   Campbell A.J., Reinken J, Allan BC, Martinez GS. Falls in old age: a study of frequency and related clinical factors. Age Ageing. 1981;10(4):264-270.

[9].   Campbell A.J., Spears G.F., Borrie M.J. Examination by logistic regression modelling of the variables which increase the relative risk of elderly women falling compared to elderly men. J Clin Epidemiol 1990; 43: 1415-20.

[10].  Carlos H. Orces (2013). Prevalence and Determinants of Falls among Older Adults in Ecuador: An Analysis of the SABE I Survey. Current Gerontology and Geriatrics Research, Article ID 495468, 7 pages

http://dx.doi.org/10.1155/2013/495468.

[11].  Chiarelli P. E., Mackenzie L.A., Osmotherly. P.G (2009). “Urinary incontinence is associated with an increase in falls: a systematic review,” Australian Journal of Physiotherapy, vol. 55, no. 2, pp.89–95, 2009.

[12].  Cesari M., Landi F., Torre S., Onder G., Lattanzio F., Bernabei. (2002). R. Prevalence and Risk factors for falls in an older community-dwelling population. J Gerontol a Biol Sci Med Sci, 57, PP M722-6.

[13].  Chu L.W., Chiu A.Y., Chi I. (2008). Falls and subsequent health service utilization in community- dwelling Chinese older adults. Arch Gerontol Geriatr 2008; 46: 125– 135.

[14].  Deandrea S., Lucenteforte E., Bravi F., Foschi R., La Vecchia C., Negri E., (2010). Risk Factors for falls in community-dwelling older people: a systematic review and meta- analysis. Epidemiology, 21, pp 658-68.

[15].  Den Ouden M. E., Schuurmans M.J., Arts.I.A., van der Schouw Y.T. (2013). “Association between physical performance characteristics and independence in activities of daily living in middle-aged and elderly men,” Geriatrics & Gerontology International, Vol 13(2), pp 274-80.

[16].  Deurenberg P., Yap M.D., Wang J., Lin F.P., Schmidt G. (1999). The impact of body builds on the relationship between body mass index and percent body fat. Int J Obes, 23, pp 537–542.

[17].  Deandrea S., Lucenteforte E., Bravi F., Foschi R., La Vecchia C., Negri E. (2010). Risk factors for falls in community-dwelling older people: a systematic review and meta-analysis. Epidemiology, 21pp 658-68.

[18].  Downton J.H. (1991). Andrews K. Prevalence, characteristics and factors associated with falls among the elderly living at home. Aging (Milano). (3), pp.219-228.

[19].  Duncan E., Schofield G., Duncan. S., Kolt. G. (2004) Rush E: Ethnicity and body fatness in New Zealanders. N Z Med J, pp 117: 1195.

[20].  Eun jin Choi., Sun A Kim., Nu Ri Kim., Jung-Ae Rhee., Yong-Woon Yun, and Min-Ho Shin (2014). Risk Factors for Falls in Older Korean Adults: The 2011.

[21].  Community Health Survey. Korean Med Sci, Vol 29, pp 1482-1487 21. Fletcher P.C., Hirdes J.P. (2002). Risk factors for serious falls among community-based seniors: results from the national population health survey. Can J Aging, 21, pp 103-16.

[22].  Ganz D.A, Bao. Y., Shekelle P.G., Rubenstein LZ (2002) Will my patient fall? JAMA, Vol.297, pg. 77–86.

[23].  Gill T, Taylor AW, Pengelly A (2005). A population-based survey of factors relating to the prevalence of falls in older people. Gerontology, Vol. 51, pp 340–345.

[24].  Hedman A.M., Fonad E, Sandmark H (2013). Older people living at home: asso­citations between falls and health complaints in men and women. J Clin Nurs, Vol. 22 pg 2945-52.

[25].  Hegeman J., V. Weerdesteyn, B. J. F. VanDen Bemt, B. Nienhuis, J. Van Limbeek, and J. Duysens (2010). “Even low alcohol concentrations affect obstacle avoidance reactions in healthy senior individuals,” BMC Research Notes, vol. 3, article 243,2010.

[26].  Herman M, Gallagher E., Scott V. (2017). The evolution of seniors' falls prevention in British Columbia. British Columiba, Ministry of Health; 2006. Available from: http://www.health.gov.bc.ca/library/publications/year/2006/falls_report.pdf (accessed October 15, 2017).

[27].  Icaza M. G., and C. Albala. (1999) “MInimental State Examinaitons (MMSE) del studio dela demencia en Chile: An´alisis Estad´ıstico—Serie Investigaciones en Salud P´ublica- Documentos T´ecnicos,” Coordinaci´on de Investigaciones, Divisi´on de Saludy Desarrollo Humano, OPS, 1999, http://www.paho.org.

[28].  Kuh D., Bassey E.J., Butterworth S, Hardy R, Wadsworth MEJ, et al (2005). Grip strength, postural control, and functional leg power in a representative cohort of British men and women: associations with physical activity, health status, and socioeconomic conditions. J Gerontol, Vol. 60A pp 224–231.

[29].  Kish L: Survey Sampling. New York, John Wiley & Sons, 1995.

[30].  Leipzig R.M., Cumming R.G., Tinetti M.E. (1999). Drugs and falls in older people: a systematic review and meta-analysis: I. Psychotropic drugs. J Am Geriatr Soc. 1999;47(1):30-39.

[31].  Leipzig R.M., Cumming R.G., Tinetti M.E. (1999) Drugs and falls in older people: a systematic review and meta-analysis: II. Cardiac and analgesic drugs. J Am Geriatr Soc. 1999;47(1):40-50.

[32].  Lin M.R., Hwang H.F., Lin P.S., Chen C.Y. Relations of osteoporosis and fol­low-up duration to recurrent falls in older men and women. Osteoporos Int 2014; 25: 863-71.

[33].  Lord S.R., Ward J.A., Williams P., Anstey K.J. (1994), “Physiological factors associated with falls in older community-dwelling women,” Journal of the American Geriatrics Society, vol. 42, no. 10, pp. 1110–1117, 1994.

[34].  Lord S.R., Menz H.B., Sherrington C (2006). Home environment risk factors for falls in older people and the efficacy of home modifications. Age Ageing, Vol. 35 Suppl.2, pp: 55-9.

[35].  Malasana G., Brignole M., Daccarett M., Sherwood R., Hamdan M.H. (20110 The prevalence and cost of the faint and fall problem in the state of Utah. Pacing Clin Electrophysiol.Vol.34(3) pp :278-283. doi: 10.1111/j.1540-8159.2010. 02930.x.

[36].  Mart´ınez De La Iglesia J., M. C. On´ıs Vilches, R. Due˜nas Herrero, C. Aguado Tabern´e, C. A. Colomer, and M. C. Arias Blanco. (2005). “Abbreviating the brief. Approach to ultra-short versions of the Yesavage questionnaire for the diagnosis of depression,” Atencion Primaria, vol. 35, no. 1, pp. 14–21.

[37].  Mancini C., Williamson D., Binkin N., Michieletto F., De Giacomi G.V., Gruppo di Lavoro Studio Argento (2005). Epidemiology of falls among the elderly. Ig Sanita Pubbl Vol. 61, pp 117– 132.

[38].  Mota L.B., Aguiar A.C., Coutinho E.S., Huf G. Prevalência e fatores associados a quedas emidosos em um município do Rio de Janeiro. Rev Bras Geriatr Gerontol, Vol. 13:83-91.

[39].  Muir S. W., Gopaul K., Montero-Odasso M. (2012). “The role of cognitive impairment in fall risk among older adults: a systematic review and meta-analysis,” Age and Ageing, vol. 41 (3), pp. 299–308.

[40].  Musich S., Wang S.S., Ruiz J., Hawkins K. (2017). Wicker E. Falls-related drug use and risk of falls among older adults: a study in a U.S. Medicare population. Drugs Aging. 2017;34(7):555-565. doi: 10.1007/s40266-017-0470-x.

[41].  Orces C.H. (2013). Prevalence and determinants of falls among older adults in ecuador: an analysis of the SABE I survey. Curr Gerontol Geriatr Res 2013; 2013: 495468.

[42].  Nevitt M.C., Cummings S.R., Hudes E.S. (1991). Risk factors for injurious falls: a prospective study. J Gerontol. 1991;46(5):M164-M170.

[43].  Perracini M.R., Ramos L.R. (2002) Fall-related factors in a cohort of elderly community residents. Rev Saude Publica 2002; 36: 709–716.

[44].  Prudham D. Evans J.G. (1981). Factors associated with falls in the elderly: a community study. Age Ageing. 1981;10(3):141-146.

[45].  Reyes-Ortiz C.A., Al Snih S., Markides K.S. (2005). Falls among elderly persons in Latin America and the Caribbean and among elderly Mexican-Americans. Rev Panam Salud Pública Vol. 17 pp 362-9.

[46].  Roberts A: Falls. Nurs Times 1989; 85: 45–47.

[47].  Sartorius N: SCAN translation; in Wing J.K., Sartorius N., Ustun TB (eds): Diagnosis and Clinical Measurement in Psychiatry: A Reference Manual for SCAN. Cambridge, Cambridge University Press, 1998, pp 44–57.

[48].  Sattin R. W., Rodriguez J.G., Devito C.A., Wingo P.A. “Home environmental hazards and the risk of fall injury events among community-dwelling older persons,” Journal of the American Geriatrics Society, vol. 46, no. 6, pp. 669–676, 1998.

[49].  Scheffer A.C., Schuurmans M.J., van Dijk N, van der Hooft T., de Rooij S.E. (2008). Fear of falling: measurement strategy, prevalence, risk factors and consequences among older persons. Age Ageing. Vol. 37(1), 19-24.

[50].  Sheahan S.L., Coons S.J., Robbins C.A., Martin S.S., Hendricks J., Latimer M. (1995). Psychoactive medication, alcohol use, and falls among older adults. J Behav Med 1995; 18: 127- 40.

[51].  Siqueira F.V., Facchini L.A., Piccini L.X., Tomasi E., Thumé E., Silveira D.S, et al (207). Prevalência de quedas em idosos e fatores associados. Rev Saúde Pública, Vol.41, pg.749-56.

[52].  Soriano T.A., De Cherrie L.V., iqueira., Thomas D.C., (2007). Falls in the community-dwelling older adult. A review for primary-care providers. Clin Interv Aging, Vol.2(4), pg 545-554.

[53].  Siqueira F.V., Facchini L.A, Piccini R. X., Tomasi E, Thume E, Silveira D.S., Vieira V, Hallal P.C. (2007). Prevalence of falls and associated factors in the elderly. Rev Saude Publica 2007; 41: 749–756.

[54].  Stalenhoef P.A., Diederiks JP, Knottnerus JA, Kester AD, Crebolder HF. A risk model for the prediction of recurrent falls in community-dwelling elderly. J Clin Epidemiol. 2002;55(11):1088-1094.

[55].  Tiesman H., Zwerling C., Peek-Asa C., Sprince N., Cavanaugh J.E (2007) “Non-fatal injuries among urban and rural residents: The National Health Interview Survey, 1997–2001,” Injury Prevention, vol. 13, no. 2, pp. 115–119.

[56].  Tinetti M.E., Speechley M., Ginter S.F. (1988). Risk factors for falls among elderly persons living in the community. N Engl J Med, Vol. 319 (26) pg.1701-1707.

[57].  Tinetti M.E., Kumar C (2006). The patient who falls: “It’s always a trade-off”. JAMA 2010; 303: 258-66.

[58].  Ungar A., Rafanelli M., Iacomelli I., Brunetti M.A., Ceccofiglio A., Tesi F., Marchionni N. (2013). Fall prevention in the elderly. Clin Cases Miner Bone Metab, Vol. 10 (2) pg.91-95.

[59].  Ustun T.B., Chatterji S., Mechbal. A, Murray C.J.L (2003). WHS Collaborating Groups: The World health surveys; in Murray CJL, Evans DB (eds): Health Systems Performance Assessment: Debates, Methods and Empiricism. Geneva, World Health Organization, 2003.

[60].  Walston J, Fried LP: Frailty and the older man. Med Clin North Am 1999; 83: 1173–1194. WHO (2008)? WHO global report on falls prevention in older age. 1st ed. Geneva, Switzerland World Health Organization; 2008. Available from http://www.who.int/ageing/publications/Falls- prevention? March pdf (accessed 24 July 2019).

[61].  Woolcott J.C., Richardson K.J., Wiens M.O., Patel B., Marin J., Khan K.M., Marra C.A. (2009) Meta-analysis of the impact of 9 medication classes on falls in elderly persons. Arch Intern Med, Vo1.69 (21), pg 952-1960.

[62].  Woolf A.D., Akesson K (2003). Preventing fractures in elderly people. BMJ. Vol.327 (7406), pg 89-95.

[63].  Wojszel Z.B., Bień B. Falls amongst older people living in the community. Rocz Akad Med Bialymst 2004; 49: 280-4.

[64].  Yesavage J. A., Brink T.L., Rose T.L. et al (1982)., “Development and validation of a geriatric depression screening scale: a preliminary report,” Journal of Psychiatric Research, vol. 17, no.1, pp. 37–49.

[65].  Yoshida H., Kim H. (2006) Frequency of falls and their prevention. Clin Calcium 2006.Vol. 16, pg.1444–1450.

[66].  Varas-Fabra F., Castro Martin E., Perula de Torres L.A., Fernandez Fernandez M.J., Ruiz Moral R, Enciso Berge I (2006). Falls in the elderly in the community: prevalence, consequences, and associated factors. Aten Primaria, Vol.38, pg.450–455.