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Published in: BMC Geriatrics 1/2017

Open Access 01-12-2017 | Research Article

The association of falls with loneliness and social exclusion: evidence from the DEAS German Ageing Survey

Authors: André Hajek, Hans-Helmut König

Published in: BMC Geriatrics | Issue 1/2017

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Abstract

Background

It remains an open question whether falls are related with social relations, covering subjective (e.g., perceived loneliness) and more objective dimensions (e.g., number of important individuals in regular contact). Consequently, we aimed at examining the association between falls and social ties comprehensively, including loneliness, social exclusion and the number of important people in regular contact.

Methods

Cross-sectional data were used from a population-based sample of community-dwelling individuals aged 40 and over (n = 7808) in Germany. Self-rated loneliness was quantified using a short version of the De Jong Gierveld Loneliness Scale. Perceived social exclusion was measured using a scale developed by Bude and Lantermann. Furthermore and in contrast to the subjective outcome measures, the more objective number of important people in regular contact was also used as outcome variable. The experience of a fall in the preceding 12 months (yes; no) was assessed.

Results

Controlling for various possible confounding variables, linear regressions showed that experiencing a fall in the past 12 months was associated with higher social exclusion (β = .08, p < .001), and increased loneliness (β = .08, p < .001), whereas it was not associated with the number of important people in regular contact.

Conclusions

Findings stress the relation between falls and feelings of loneliness and social exclusion, whereas falls were unrelated to the more objective measure of number of important people in regular contact, suggesting that falls are particularly related to subjective measures of social ties and relations. This underlines the importance of interventions to prevent falls. Preventing falls in turn might help to prevent loneliness and social exclusion.
Literature
1.
go back to reference Rubenstein LZ. Falls in older people: epidemiology, risk factors and strategies for prevention. Age Ageing. 2006;35(suppl 2):ii37–41.PubMed Rubenstein LZ. Falls in older people: epidemiology, risk factors and strategies for prevention. Age Ageing. 2006;35(suppl 2):ii37–41.PubMed
3.
4.
go back to reference Rao SS. Prevention of falls in older patients. Am Fam Physician. 2005;72(1):81–8.PubMed Rao SS. Prevention of falls in older patients. Am Fam Physician. 2005;72(1):81–8.PubMed
5.
go back to reference Biderman A, Cwikel J, Fried AV, Galinsky D. Depression and falls among community dwelling elderly people: a search for common risk factors. J Epidemiol Community Health. 2002;56:631–6.CrossRefPubMedPubMedCentral Biderman A, Cwikel J, Fried AV, Galinsky D. Depression and falls among community dwelling elderly people: a search for common risk factors. J Epidemiol Community Health. 2002;56:631–6.CrossRefPubMedPubMedCentral
6.
go back to reference Downton J, Andrews K. Prevalence, characteristics and factors associated with falls among the elderly living at home. Aging Clin Exp Res. 1991;3(3):219–28.CrossRef Downton J, Andrews K. Prevalence, characteristics and factors associated with falls among the elderly living at home. Aging Clin Exp Res. 1991;3(3):219–28.CrossRef
7.
go back to reference Hallford DJ, Nicholson G, Sanders K, McCabe MP. The association between anxiety and falls: a meta-analysis. J Gerontol B Psychol Sci Soc Sci. 2016:1–13. Hallford DJ, Nicholson G, Sanders K, McCabe MP. The association between anxiety and falls: a meta-analysis. J Gerontol B Psychol Sci Soc Sci. 2016:1–13.
8.
go back to reference Kusano CT, Bouldin ED, Anderson LA, McGuire LC, Salvail FR, Simmons KW, Andresen EM. Adult informal caregivers reporting financial burden in Hawaii, Kansas, and Washington: results from the 2007 Behavioral risk factor surveillance system. Disabil Health J. 2011;4(4):229–37.CrossRefPubMed Kusano CT, Bouldin ED, Anderson LA, McGuire LC, Salvail FR, Simmons KW, Andresen EM. Adult informal caregivers reporting financial burden in Hawaii, Kansas, and Washington: results from the 2007 Behavioral risk factor surveillance system. Disabil Health J. 2011;4(4):229–37.CrossRefPubMed
9.
go back to reference Rubenstein LZ, Josephson KR, Robbins AS. Falls in the nursing home. Ann Intern Med. 1994;121(6):442–51.CrossRefPubMed Rubenstein LZ, Josephson KR, Robbins AS. Falls in the nursing home. Ann Intern Med. 1994;121(6):442–51.CrossRefPubMed
10.
go back to reference Durbin L, Kharrazi RJ, Graber R, Mielenz TJ. Social support and older adult falls. Inj Epidemiol. 2016;3(1):4. Durbin L, Kharrazi RJ, Graber R, Mielenz TJ. Social support and older adult falls. Inj Epidemiol. 2016;3(1):4.
11.
go back to reference Faulkner KA, Cauley JA, Zmuda JM, Griffin JM, Nevitt MC. Is social integration associated with the risk of falling in older community-dwelling women? J Gerontol A Biol Sci Med. 2003;58(10):M954–9.CrossRef Faulkner KA, Cauley JA, Zmuda JM, Griffin JM, Nevitt MC. Is social integration associated with the risk of falling in older community-dwelling women? J Gerontol A Biol Sci Med. 2003;58(10):M954–9.CrossRef
12.
go back to reference Elliott S, Painter J, Hudson S. Living alone and fall risk factors in community-dwelling middle age and older adults. J Community Health. 2009;34(4):301.CrossRefPubMed Elliott S, Painter J, Hudson S. Living alone and fall risk factors in community-dwelling middle age and older adults. J Community Health. 2009;34(4):301.CrossRefPubMed
13.
go back to reference Leung A, Chi I, Lou VW, Chan KS. Psychosocial risk factors associated with falls among Chinese community-dwelling older adults in Hong Kong. Health Soc Care Community. 2010;18(3):272–81.PubMed Leung A, Chi I, Lou VW, Chan KS. Psychosocial risk factors associated with falls among Chinese community-dwelling older adults in Hong Kong. Health Soc Care Community. 2010;18(3):272–81.PubMed
14.
go back to reference Hacihasanoğlu R, Yildirim A, Karakurt P. Loneliness in elderly individuals, level of dependence in activities of daily living (ADL) and influential factors. Arch Gerontol Geriatr. 2012;54(1):61–6.CrossRefPubMed Hacihasanoğlu R, Yildirim A, Karakurt P. Loneliness in elderly individuals, level of dependence in activities of daily living (ADL) and influential factors. Arch Gerontol Geriatr. 2012;54(1):61–6.CrossRefPubMed
15.
go back to reference Perissinotto CM, Cenzer IS, Covinsky KE. Loneliness in older persons: a predictor of functional decline and death. Arch Intern Med. 2012;172(14):1078–84.CrossRefPubMedPubMedCentral Perissinotto CM, Cenzer IS, Covinsky KE. Loneliness in older persons: a predictor of functional decline and death. Arch Intern Med. 2012;172(14):1078–84.CrossRefPubMedPubMedCentral
16.
go back to reference Burholt V, Windle G, Morgan DJ: A Social Model of Loneliness: The Roles of Disability, Social Resources, and Cognitive Impairment. Gerontologist. 2016;gnw125:1-12. Burholt V, Windle G, Morgan DJ: A Social Model of Loneliness: The Roles of Disability, Social Resources, and Cognitive Impairment. Gerontologist. 2016;gnw125:1-12.
17.
go back to reference Hajek A, Brettschneider C, Posselt T, Lange C, Mamone S, Wiese B, Weyerer S, Werle J, Fuchs A, Pentzek M, et al. How does social support affect functional impairment in late life? Findings of a multicenter prospective cohort study in Germany. Age Ageing. 2017:1–8. Hajek A, Brettschneider C, Posselt T, Lange C, Mamone S, Wiese B, Weyerer S, Werle J, Fuchs A, Pentzek M, et al. How does social support affect functional impairment in late life? Findings of a multicenter prospective cohort study in Germany. Age Ageing. 2017:1–8.
18.
go back to reference Warner DF, Kelley-Moore J. The social context of disablement among older adults: does marital quality matter for loneliness? J Health Soc Behav. 2012;53(1):50–66.CrossRefPubMed Warner DF, Kelley-Moore J. The social context of disablement among older adults: does marital quality matter for loneliness? J Health Soc Behav. 2012;53(1):50–66.CrossRefPubMed
19.
go back to reference Chu L-W, Chiu AY, Chi I. Impact of falls on the balance, gait, and activities of daily living functioning in community-dwelling Chinese older adults. J Gerontol A Biol Sci Med. 2006;61(4):399–404.CrossRef Chu L-W, Chiu AY, Chi I. Impact of falls on the balance, gait, and activities of daily living functioning in community-dwelling Chinese older adults. J Gerontol A Biol Sci Med. 2006;61(4):399–404.CrossRef
20.
go back to reference Pieterse A, Luttikhold T, de Laat K, Bloem B, Van Engelen B, Munneke M. Falls in patients with neuromuscular disorders. J Neurol Sci. 2006;251(1):87–90.CrossRefPubMed Pieterse A, Luttikhold T, de Laat K, Bloem B, Van Engelen B, Munneke M. Falls in patients with neuromuscular disorders. J Neurol Sci. 2006;251(1):87–90.CrossRefPubMed
21.
go back to reference Friedman SM, Munoz B, West SK, Rubin GS, Fried LP. Falls and fear of falling: which comes first? A longitudinal prediction model suggests strategies for primary and secondary prevention. J Am Geriatr Soc. 2002;50(8):1329–35.CrossRefPubMed Friedman SM, Munoz B, West SK, Rubin GS, Fried LP. Falls and fear of falling: which comes first? A longitudinal prediction model suggests strategies for primary and secondary prevention. J Am Geriatr Soc. 2002;50(8):1329–35.CrossRefPubMed
22.
go back to reference Delbaere K, Crombez G, Vanderstraeten G, Willems T, Cambier D. Fear-related avoidance of activities, falls and physical frailty. A prospective community-based cohort study. Age Ageing. 2004;33(4):368–73.CrossRefPubMed Delbaere K, Crombez G, Vanderstraeten G, Willems T, Cambier D. Fear-related avoidance of activities, falls and physical frailty. A prospective community-based cohort study. Age Ageing. 2004;33(4):368–73.CrossRefPubMed
23.
go back to reference Zijlstra G, Van Haastregt J, Van Eijk JTM, van Rossum E, Stalenhoef PA, Kempen GI. Prevalence and correlates of fear of falling, and associated avoidance of activity in the general population of community-living older people. Age Ageing. 2007;36(3):304–9.CrossRefPubMed Zijlstra G, Van Haastregt J, Van Eijk JTM, van Rossum E, Stalenhoef PA, Kempen GI. Prevalence and correlates of fear of falling, and associated avoidance of activity in the general population of community-living older people. Age Ageing. 2007;36(3):304–9.CrossRefPubMed
24.
go back to reference Wenger GC, Davies R, Shahtahmasebi S, Scott A. Social isolation and loneliness in old age: review and model refinement. Ageing Soc. 1996;16(03):333–58.CrossRef Wenger GC, Davies R, Shahtahmasebi S, Scott A. Social isolation and loneliness in old age: review and model refinement. Ageing Soc. 1996;16(03):333–58.CrossRef
25.
go back to reference Victor C, Scambler S, Bond J, Bowling A. Being alone in later life: loneliness, social isolation and living alone. Rev Clin Gerontol. 2000;10(04):407–17.CrossRef Victor C, Scambler S, Bond J, Bowling A. Being alone in later life: loneliness, social isolation and living alone. Rev Clin Gerontol. 2000;10(04):407–17.CrossRef
26.
go back to reference Victor CR, Scambler SJ, Bowling A, Bond J. The prevalence of, and risk factors for, loneliness in later life: a survey of older people in great Britain. Ageing Soc. 2005;25(06):357–75.CrossRef Victor CR, Scambler SJ, Bowling A, Bond J. The prevalence of, and risk factors for, loneliness in later life: a survey of older people in great Britain. Ageing Soc. 2005;25(06):357–75.CrossRef
27.
go back to reference Farid S, Luqman M, Saleem MZ, Saad A, Khan WA, Arshad S, Warraich IA. Social isolation within family: an analysis of old age citizens. British J Educ Soc Behav Sci. 2014;4(9):1300–11.CrossRef Farid S, Luqman M, Saleem MZ, Saad A, Khan WA, Arshad S, Warraich IA. Social isolation within family: an analysis of old age citizens. British J Educ Soc Behav Sci. 2014;4(9):1300–11.CrossRef
29.
go back to reference Dennis C, Alamanos E, Papagiannidis S, Bourlakis M. Does social exclusion influence multiple channel use? The interconnections with community, happiness, and well-being. J Bus Res. 2016;69(3):1061–70.CrossRef Dennis C, Alamanos E, Papagiannidis S, Bourlakis M. Does social exclusion influence multiple channel use? The interconnections with community, happiness, and well-being. J Bus Res. 2016;69(3):1061–70.CrossRef
30.
go back to reference Klaus D, Engstler H, Mahne K, Wolff JK, Simonson J, Wurm S, Tesch-Römer C. Cohort profile: the German Ageing Survey (DEAS). Int J Epidemiol. 2017:1–8. Klaus D, Engstler H, Mahne K, Wolff JK, Simonson J, Wurm S, Tesch-Römer C. Cohort profile: the German Ageing Survey (DEAS). Int J Epidemiol. 2017:1–8.
31.
go back to reference Neller K. Kooperation und Verweigerung. Eine Non-Response-Studie [co-operation and refusal: a non-response study]. ZUMA Nachrichten. 2005;29(57):9–36. Neller K. Kooperation und Verweigerung. Eine Non-Response-Studie [co-operation and refusal: a non-response study]. ZUMA Nachrichten. 2005;29(57):9–36.
32.
go back to reference de Jong GJ, van Tilburg T, Dykstra P, Vangelisti A, Perlman D. Loneliness and social isolation. In: Perlman D, Vangelisti A, editors. The Cambridge handbook of personal relationships. Cambridge, UK: Cambridge University Press; 2006. p. 485–500. de Jong GJ, van Tilburg T, Dykstra P, Vangelisti A, Perlman D. Loneliness and social isolation. In: Perlman D, Vangelisti A, editors. The Cambridge handbook of personal relationships. Cambridge, UK: Cambridge University Press; 2006. p. 485–500.
33.
go back to reference de Jong-Gierveld J, Kamphuls F. The development of a Rasch-type loneliness scale. Appl Psychol Meas. 1985;9(3):289–99.CrossRef de Jong-Gierveld J, Kamphuls F. The development of a Rasch-type loneliness scale. Appl Psychol Meas. 1985;9(3):289–99.CrossRef
34.
go back to reference Gierveld JDJ, Van Tilburg T. The de Jong Gierveld short scales for emotional and social loneliness: tested on data from 7 countries in the UN generations and gender surveys. Eur J Ageing. 2010;7(2):121–30.CrossRef Gierveld JDJ, Van Tilburg T. The de Jong Gierveld short scales for emotional and social loneliness: tested on data from 7 countries in the UN generations and gender surveys. Eur J Ageing. 2010;7(2):121–30.CrossRef
35.
go back to reference Bude H, Lantermann E-D. Soziale Exklusion und Exklusionsempfinden. KZfSS. 2006;58(2):233–52. Bude H, Lantermann E-D. Soziale Exklusion und Exklusionsempfinden. KZfSS. 2006;58(2):233–52.
36.
go back to reference Duncan R, Francis RM, Jagger C, Kingston A, McCloskey E, Collerton J, Robinson L, Kirkwood TBL, Birrell F. Magnitude of fragility fracture risk in the very old—are we meeting their needs? The Newcastle 85+ study. Osteoporos Int. 2015;26(1):123–30.CrossRefPubMed Duncan R, Francis RM, Jagger C, Kingston A, McCloskey E, Collerton J, Robinson L, Kirkwood TBL, Birrell F. Magnitude of fragility fracture risk in the very old—are we meeting their needs? The Newcastle 85+ study. Osteoporos Int. 2015;26(1):123–30.CrossRefPubMed
37.
go back to reference Teno J, Kiel DP, Mor V. Multiple stumbles: a risk factor for falls in community-dwelling elderly; a prospective study. J Am Geriatr Soc. 1990;38(12):1321–5.CrossRefPubMed Teno J, Kiel DP, Mor V. Multiple stumbles: a risk factor for falls in community-dwelling elderly; a prospective study. J Am Geriatr Soc. 1990;38(12):1321–5.CrossRefPubMed
38.
go back to reference Cattan M, White M, Bond J, Learmouth A. Preventing social isolation and loneliness among older people: a systematic review of health promotion interventions. Ageing Soc. 2005;25(01):41–67.CrossRef Cattan M, White M, Bond J, Learmouth A. Preventing social isolation and loneliness among older people: a systematic review of health promotion interventions. Ageing Soc. 2005;25(01):41–67.CrossRef
39.
go back to reference Gracia E, Herrero J. Determinants of social integration in the community: an exploratory analysis of personal, interpersonal and situational variables. J Community Appl Soc Psychol. 2004;14(1):1–15.CrossRef Gracia E, Herrero J. Determinants of social integration in the community: an exploratory analysis of personal, interpersonal and situational variables. J Community Appl Soc Psychol. 2004;14(1):1–15.CrossRef
40.
go back to reference Hajek A, Brettschneider C, Lühmann D, Eisele M, Mamone S, Wiese B, Weyerer S, Werle J, Pentzek M, Fuchs A, et al. Does visual impairment affect social ties in late life? Findings of a multicenter prospective cohort study in Germany. J Nutr Health Aging. 2016:1–7. Hajek A, Brettschneider C, Lühmann D, Eisele M, Mamone S, Wiese B, Weyerer S, Werle J, Pentzek M, Fuchs A, et al. Does visual impairment affect social ties in late life? Findings of a multicenter prospective cohort study in Germany. J Nutr Health Aging. 2016:1–7.
41.
42.
go back to reference Van Regenmortel S, De Donder L, Dury S, Smetcoren A-S, De Witte N, Verté D. Social exclusion in later life: a systematic review of the literature. J Popul Ageing. 2016;9(4):315–44.CrossRef Van Regenmortel S, De Donder L, Dury S, Smetcoren A-S, De Witte N, Verté D. Social exclusion in later life: a systematic review of the literature. J Popul Ageing. 2016;9(4):315–44.CrossRef
43.
go back to reference Vellas BJ, Wayne SJ, Garry PJ, Baumgartner RN. A two-year longitudinal study of falls in 482 community-dwelling elderly adults. J Gerontol A Biol Sci Med. 1998;53(4):M264–74.CrossRef Vellas BJ, Wayne SJ, Garry PJ, Baumgartner RN. A two-year longitudinal study of falls in 482 community-dwelling elderly adults. J Gerontol A Biol Sci Med. 1998;53(4):M264–74.CrossRef
44.
go back to reference Faulkner KA, Cauley JA, Studenski SA, Landsittel DP, Cummings SR, Ensrud KE, Donaldson M, Nevitt M. Group SoOFR: lifestyle predicts falls independent of physical risk factors. Osteoporos Int. 2009;20(12):2025–34.CrossRefPubMedPubMedCentral Faulkner KA, Cauley JA, Studenski SA, Landsittel DP, Cummings SR, Ensrud KE, Donaldson M, Nevitt M. Group SoOFR: lifestyle predicts falls independent of physical risk factors. Osteoporos Int. 2009;20(12):2025–34.CrossRefPubMedPubMedCentral
45.
go back to reference Lawlor DA, Patel R, Ebrahim S. Association between falls in elderly women and chronic diseases and drug use: cross sectional study. BMJ. 2003;327(7417):712–7.CrossRefPubMedPubMedCentral Lawlor DA, Patel R, Ebrahim S. Association between falls in elderly women and chronic diseases and drug use: cross sectional study. BMJ. 2003;327(7417):712–7.CrossRefPubMedPubMedCentral
46.
go back to reference Radloff LS. The CES-D scale a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1(3):385–401.CrossRef Radloff LS. The CES-D scale a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1(3):385–401.CrossRef
47.
go back to reference Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36): I. Conceptual framework and item selection. Med Care. 1992;30(6):473–83.CrossRefPubMed Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36): I. Conceptual framework and item selection. Med Care. 1992;30(6):473–83.CrossRefPubMed
48.
go back to reference Diener E, Diener M. Cross-cultural correlates of life satisfaction and self-esteem. In: Diener E, editor. Culture and well-being. Dordrecht: Springer; 2009. p. 71–91.CrossRef Diener E, Diener M. Cross-cultural correlates of life satisfaction and self-esteem. In: Diener E, editor. Culture and well-being. Dordrecht: Springer; 2009. p. 71–91.CrossRef
49.
go back to reference Hajek A, Brettschneider C, Lange C, Posselt T, Wiese B, Steinmann S, Weyerer S, Werle J, Pentzek M, Fuchs A, et al. Gender differences in the effect of social support on health-related quality of life: results of a population-based prospective cohort study in old age in Germany. Qual Life Res. 2016;25(5):1159–68.CrossRefPubMed Hajek A, Brettschneider C, Lange C, Posselt T, Wiese B, Steinmann S, Weyerer S, Werle J, Pentzek M, Fuchs A, et al. Gender differences in the effect of social support on health-related quality of life: results of a population-based prospective cohort study in old age in Germany. Qual Life Res. 2016;25(5):1159–68.CrossRefPubMed
50.
go back to reference Leary MR. Responses to social exclusion: social anxiety, jealousy, loneliness, depression, and low self-esteem. J Soc Clin Psychol. 1990;9(2):221–9.CrossRef Leary MR. Responses to social exclusion: social anxiety, jealousy, loneliness, depression, and low self-esteem. J Soc Clin Psychol. 1990;9(2):221–9.CrossRef
51.
go back to reference Klaus D, Engstler H: Daten und Methoden des Deutschen Alterssurveys. In: Altern im Wandel: Zwei Jahrzehnte Deutscher Alterssurvey (DEAS). Edited by Mahne K, Wolff JK, Simonson J, Tesch-Römer C. Berlin: Springer 2017: 29–45. Klaus D, Engstler H: Daten und Methoden des Deutschen Alterssurveys. In: Altern im Wandel: Zwei Jahrzehnte Deutscher Alterssurvey (DEAS). Edited by Mahne K, Wolff JK, Simonson J, Tesch-Römer C. Berlin: Springer 2017: 29–45.
Metadata
Title
The association of falls with loneliness and social exclusion: evidence from the DEAS German Ageing Survey
Authors
André Hajek
Hans-Helmut König
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Geriatrics / Issue 1/2017
Electronic ISSN: 1471-2318
DOI
https://doi.org/10.1186/s12877-017-0602-5

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