On Falls in the Elderly –Epidemiological Studies from the Longitudinal General Population Study ‘Good Aging in Skåne’ (GÅS), Sweden

Abstract: In a ‘greying world’ with aging populations, falls in the elderly are a challenge to the health care system as they are associated with substantial mortality and morbidity. Apart from physical injuries, the consequences of falls are broad, with additional psychological and social consequences. The overall objective of this dissertation was to study falls and related risk factors, predictors, and consequences in a general elderly population, including the oldest-old (individuals aged over 85 years). Data were extracted from the longitudinal population study ‘Good Aging in Skåne’ (GÅS), in southern Sweden. In Paper I, a cross-sectional study, it was concluded that falls were common in the population studied and that the risk was multifactorial. The results indicated that there was an overrepresentation of fallers in a distinct subgroup of the oldest-old, and a frail group with multiple risk factors. The risk of falling appeared to increase in a non-linear, almost exponential way with increasing number of risk factors. Paper II used data from the baseline assessment and a 3- and 6-year follow-up assessment to study factors that could predict falls. Three independent components that predicted future falls were identified: reduced mobility, heart dysfunction, and functional impairment including nocturia. The use of neuroleptic drugs was the single most prominent individual risk factor for falls, although the prevalence was low in the population studied, and the confidence interval overlapped those of other significant predictors. Heart failure with symptoms was also a prominent, significant risk factor. In Paper III, the long-term associations between falls, and the measurements of health-related quality of life (HRQoL), and life satisfaction (LS) were examined, using data from the baseline and 6-year follow-up assessment. Over six years, fallers had a notable, chronically reduced HRQoL and LS, compared to non-fallers. In an analysis adjusted for confounding factors, falls at baseline predicted a long-term reduction in the physical aspect of HRQoL after six years. This long-term deprivation in these aspects in elderly fallers may be more extent than previously assumed. Paper IV used data from the baseline and 6-year follow-up assessment, with the objective of determining the relationship between long-term change in activities of daily living (ADL) and falls, and to identify characteristics of groups at risk of falling. Over six years, one in four had changed ADL status and this category had a higher risk for falls than those with no change in ADL. It was concluded that groups with different characteristics, with both deterioration and improvement in ADL, had an increased risk of falling. Those at risk who have improved ADL function may have a history of sufficient burden of comorbidity, combined with obtained mobility for exposure to a fall event. Falls seem to be a treat to successful and healthy aging as they are associated to a longterm reduction in well-being, especially in the physical aspect of HRQoL. Those prone to falling may therefore be an important target for interventional efforts, rehabilitation, and healthcare resources. Several findings in this dissertation were confirmatory, such as the intimate relationship between falls and advanced age, multimorbidity, frailty, and gait and balance disorders. It is important to highlight these conditions in interventional settings. However, the interplay between physical and functional rehabilitation and the risk for falls may be intricate, as some groups appear to have an increased risk of falling when they regain mobility and function. From a medical point of view, the findings that heart failure, a condition with increasing prevalence, and the use of neuroleptic drugs were prominent, significant predictors for falls in a general elderly population are of clinical interest, and may not have been widely reported.