Skip to main content
Top
Published in: Digestive Diseases and Sciences 10/2012

01-10-2012 | Original Article

Falls and Fall-Related Injury Are Common in Older People with Chronic Liver Disease

Authors: James Frith, Simon Kerr, Lisa Robinson, Chris S. Elliott, Katharine Wilton, David E. J. Jones, Christopher P. Day, Julia L. Newton

Published in: Digestive Diseases and Sciences | Issue 10/2012

Login to get access

Abstract

Background

Improved survival with chronic liver disease (CLD) and increased incidence in the older has led to a rapidly expanding population which faces similar “geriatric syndromes” as the general population. With risk factors such as autonomic dysfunction, cognitive impairment, and muscle abnormalities in CLD it is expected that falls and injury will be common.

Aim

To determine prevalence of falls and injury in chronic liver disease and to identify potential modifiable fall associations.

Methods

Falls prevalence was estimated by providing patients aged ≥65 years with CLD a falls data collection tool, via the post or in the clinic. A younger CLD cohort and age-matched and sex-matched community controls was used for comparison. A sub-group underwent multidisciplinary falls assessment to identify modifiable fall associations.

Results

Falls were significantly more common in older people with CLD (47 % in previous year) than in controls; incidence of injury did not differ. Regression identified orthostatic symptoms, lower-limb strength, and fear of falling as being independently associated with falls in CLD. Those who had fallen had significantly greater difficulty with daily activities.

Conclusion

Falls are prevalent in older people with CLD, and are potentially preventable with multifactorial intervention. Services must prepare for expansion in the older CLD population; here we demonstrate how this expansion may affect falls services and provide a potential therapeutic target.
Literature
1.
go back to reference Office for National Statistics. Health Stat Q. 2008;40:59–60. Office for National Statistics. Health Stat Q. 2008;40:59–60.
2.
go back to reference Regev A, Schiff ER. Liver disease in the elderly. Gastroenterol Clin N Am. 2001;30:547–563. Regev A, Schiff ER. Liver disease in the elderly. Gastroenterol Clin N Am. 2001;30:547–563.
3.
go back to reference Amarapurkar D, Kamani P, Patel N, et al. Prevalence of non-alcoholic fatty liver disease: population based study. Ann Hepatol. 2007;6:161–163.PubMed Amarapurkar D, Kamani P, Patel N, et al. Prevalence of non-alcoholic fatty liver disease: population based study. Ann Hepatol. 2007;6:161–163.PubMed
4.
go back to reference Potter J, James O. Clinical features and prognosis of alcoholic liver disease in respect of advancing age. Gerontology. 1987;33:380–387.PubMedCrossRef Potter J, James O. Clinical features and prognosis of alcoholic liver disease in respect of advancing age. Gerontology. 1987;33:380–387.PubMedCrossRef
5.
go back to reference Parker D, Kingham J. Type 1 autoimmune hepatitis is primarily a disease of later life. QJM. 1997;90:289–296.PubMedCrossRef Parker D, Kingham J. Type 1 autoimmune hepatitis is primarily a disease of later life. QJM. 1997;90:289–296.PubMedCrossRef
7.
go back to reference Newton JL, Davidson A, Kerr S, et al. Autonomic dysfunction in primary biliary cirrhosis correlates with fatigue severity. Eur J Gastroenterol Hepatol. 2007;19:125–132.PubMedCrossRef Newton JL, Davidson A, Kerr S, et al. Autonomic dysfunction in primary biliary cirrhosis correlates with fatigue severity. Eur J Gastroenterol Hepatol. 2007;19:125–132.PubMedCrossRef
8.
go back to reference Hollingsworth KG, Newton JL, Taylor R, et al. Pilot study of peripheral muscle function in primary biliary cirrhosis: potential implications for fatigue pathogenesis. Clin Gastroenterol Hepatol. 2008;6:1041–1048.PubMedCrossRef Hollingsworth KG, Newton JL, Taylor R, et al. Pilot study of peripheral muscle function in primary biliary cirrhosis: potential implications for fatigue pathogenesis. Clin Gastroenterol Hepatol. 2008;6:1041–1048.PubMedCrossRef
9.
go back to reference Pessayre D, Fromenty B, Mansouri A. Mitochondrial injury in steatohepatitis. Eur J Gastroenterol Hepatol. 2004;16:1095–1105.PubMedCrossRef Pessayre D, Fromenty B, Mansouri A. Mitochondrial injury in steatohepatitis. Eur J Gastroenterol Hepatol. 2004;16:1095–1105.PubMedCrossRef
10.
go back to reference Newton JL, Hollingsworth KG, Taylor R, et al. Cognitive impairment in primary biliary cirrhosis: symptom impact and potential etiology. Hepatology. 2008;48:541–549.PubMedCrossRef Newton JL, Hollingsworth KG, Taylor R, et al. Cognitive impairment in primary biliary cirrhosis: symptom impact and potential etiology. Hepatology. 2008;48:541–549.PubMedCrossRef
11.
go back to reference Fattakhova G, Jones D, Frith J, Day C, Newton J. Cognitive symptoms are prevalent in non-alcoholic fatty liver disease and unrelated to the severity of liver disease. Hepatology. 2009;50:S1029.CrossRef Fattakhova G, Jones D, Frith J, Day C, Newton J. Cognitive symptoms are prevalent in non-alcoholic fatty liver disease and unrelated to the severity of liver disease. Hepatology. 2009;50:S1029.CrossRef
12.
go back to reference National Institute of Clinical Excellence. Clinical Practice Guideline for the Assessment and Prevention of Falls in Older People. London: Clinical Guideline 21; 2004. National Institute of Clinical Excellence. Clinical Practice Guideline for the Assessment and Prevention of Falls in Older People. London: Clinical Guideline 21; 2004.
13.
go back to reference Schrezenmaier C, Gehrking JA, Hines SM, Low PA, Benrud-Larson LM, Sandroni P. Evaluation of orthostatic hypotension: relationship of a new self-report instrument to laboratory-based measures. Mayo Clin Proc. 2005;80:330–334.PubMedCrossRef Schrezenmaier C, Gehrking JA, Hines SM, Low PA, Benrud-Larson LM, Sandroni P. Evaluation of orthostatic hypotension: relationship of a new self-report instrument to laboratory-based measures. Mayo Clin Proc. 2005;80:330–334.PubMedCrossRef
14.
go back to reference Tinetti ME. Performance-oriented assessment of mobility problems in elderly patients. J Am Geriatr Soc. 1986;34:119–126.PubMed Tinetti ME. Performance-oriented assessment of mobility problems in elderly patients. J Am Geriatr Soc. 1986;34:119–126.PubMed
15.
go back to reference Shumway-Cook A, Brauer S, Woollacott M. Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go Test. Phys Ther. 2000;80:896–903.PubMed Shumway-Cook A, Brauer S, Woollacott M. Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go Test. Phys Ther. 2000;80:896–903.PubMed
16.
go back to reference Yardley L, Beyer N, Hauer K, et al. Development and initial validation of the Falls Efficacy Scale-International (FES-I). Age Ageing. 2005;34:614–619. Yardley L, Beyer N, Hauer K, et al. Development and initial validation of the Falls Efficacy Scale-International (FES-I). Age Ageing. 2005;34:614–619.
17.
go back to reference Lamb SE, Jorstad-Stein EC, Hauer K, Becker C, Prevention of Falls Network Europe and Outcomes Consensus G. Development of a common outcome data set for fall injury prevention trials: the Prevention of Falls Network Europe consensus. J Am Geriatr Soc. 2005;53:1618–1622.PubMedCrossRef Lamb SE, Jorstad-Stein EC, Hauer K, Becker C, Prevention of Falls Network Europe and Outcomes Consensus G. Development of a common outcome data set for fall injury prevention trials: the Prevention of Falls Network Europe consensus. J Am Geriatr Soc. 2005;53:1618–1622.PubMedCrossRef
18.
go back to reference Soriano G, Román E, Córdoba J, et al. Cognitive dysfunction in cirrhosis is associated with falls. A prospective study. Hepatology. 2012. doi:10.1002/hep.25554. Soriano G, Román E, Córdoba J, et al. Cognitive dysfunction in cirrhosis is associated with falls. A prospective study. Hepatology. 2012. doi:10.​1002/​hep.​25554.
19.
go back to reference Abraldes JG, Iwakiri Y, Loureiro-Silva M, Haq O, Sessa WC, Groszmann RJ. Mild increases in portal pressure upregulate vascular endothelial growth factor and endothelial nitric oxide synthase in the intestinal microcirculatory bed, leading to a hyperdynamic state. Am J Physiol Gastrointest Liver Physiol. 2006;290:G980–G987.PubMedCrossRef Abraldes JG, Iwakiri Y, Loureiro-Silva M, Haq O, Sessa WC, Groszmann RJ. Mild increases in portal pressure upregulate vascular endothelial growth factor and endothelial nitric oxide synthase in the intestinal microcirculatory bed, leading to a hyperdynamic state. Am J Physiol Gastrointest Liver Physiol. 2006;290:G980–G987.PubMedCrossRef
20.
go back to reference Lhuillier F, Dalmas ED, Gratadour PM, et al. Spontaneous baroreflex cardiac sensitivity in end-stage liver disease: effect of liver transplantation. Eur J Anaesthesiol. 2006;23:426–432.PubMedCrossRef Lhuillier F, Dalmas ED, Gratadour PM, et al. Spontaneous baroreflex cardiac sensitivity in end-stage liver disease: effect of liver transplantation. Eur J Anaesthesiol. 2006;23:426–432.PubMedCrossRef
21.
Metadata
Title
Falls and Fall-Related Injury Are Common in Older People with Chronic Liver Disease
Authors
James Frith
Simon Kerr
Lisa Robinson
Chris S. Elliott
Katharine Wilton
David E. J. Jones
Christopher P. Day
Julia L. Newton
Publication date
01-10-2012
Publisher
Springer US
Published in
Digestive Diseases and Sciences / Issue 10/2012
Print ISSN: 0163-2116
Electronic ISSN: 1573-2568
DOI
https://doi.org/10.1007/s10620-012-2193-5

Other articles of this Issue 10/2012

Digestive Diseases and Sciences 10/2012 Go to the issue
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.