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BMC Geriatrics

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Open Access 01-12-2021 | Research

Development of a multivariable prognostic PREdiction model for 1-year risk of FALLing in a cohort of community-dwelling older adults aged 75 years and above (PREFALL)

Authors: Gustav Valentin Gade, Martin G. Jørgensen, Jesper Ryg, Tahir Masud, Lasse Hjort Jakobsen, Stig Andersen

Published in: BMC Geriatrics | Issue 1/2021

Abstract

Background

Falls are the leading cause of fatal and non-fatal injuries in older adults, and attention to falls prevention is imperative. Prognostic models identifying high-risk individuals could guide fall-preventive interventions in the rapidly growing older population. We aimed to develop a prognostic prediction model on falls rate in community-dwelling older adults.

Methods

Design: prospective cohort study with 12 months follow-up and participants recruited from June 14, 2018, to July 18, 2019.

Setting: general population.

Subjects: community-dwelling older adults aged 75+ years, without dementia or acute illness, and able to stand unsupported for one minute.

Outcome: fall rate for 12 months.

Statistical methods: candidate predictors were physical and cognitive tests along with self-report questionnaires. We developed a Poisson model using least absolute shrinkage and selection operator penalization, leave-one-out cross-validation, and bootstrap resampling with 1000 iterations.

Results

Sample size at study start and end was 241 and 198 (82%), respectively. The number of fallers was 87 (36%), and the fall rate was 0.94 falls per person-year. Predictors included in the final model were educational level, dizziness, alcohol consumption, prior falls, self-perceived falls risk, disability, and depressive symptoms. Mean absolute error (95% CI) was 0.88 falls (0.71–1.16).

Conclusion

We developed a falls prediction model for community-dwelling older adults in a general population setting. The model was developed by selecting predictors from among physical and cognitive tests along with self-report questionnaires. The final model included only the questionnaire-based predictors, and its predictions had an average imprecision of less than one fall, thereby making it appropriate for clinical practice. Future external validation is needed.

Trial registration

Clinicaltrials.gov (NCT03608709).

Available only for authorised users

United Nations, Department of Economic and Social Affairs PD. World population prospects 2019: Highlights (ST/ESA/SER.A/423). 2019.

Rubenstein LZ. Falls in older people: Epidemiology, risk factors and strategies for prevention. Age Ageing. 2006;35(Suppl 2):ii35–41.

Cummings-Vaughn LA, Gammack JK. Falls, Osteoporosis, and Hip Fractures. Med Clin North Am. 2011;95:495–506.CrossRefPubMed

Deandrea S, Lucenteforte E, Bravi F, Foschi R, La Vecchia C, Negri E. Risk factors for falls in community-dwelling older people: a systematic review and meta-analysis. Epidemiology. 2010;21(5):658–68. https://doi.org/10.1097/EDE.0b013e3181e89905.CrossRefPubMed

Scuffham P, Chaplin S, Legood R. Incidence and costs of unintentional falls in older people in the United Kingdom. J Epidemiol Community Health. 2003;57(9):740–4. https://doi.org/10.1136/jech.57.9.740.CrossRefPubMedPubMedCentral

Panel on Prevention of Falls in Older People American Geriatrics Society and British Geriatrics Society. Summary of the updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons. J Am Geriatr Soc. 2011;59(1):148–57.CrossRef

Inouye SK, Studenski S, Tinetti M, Kuchel G. Geriatric syndromes: clinical, research and policy implications of a Core geriatric concept in older adults related to primary and secondary prevention. J Am Geriatr Soc. 2007;55(5):780–91. https://doi.org/10.1111/j.1532-5415.2007.01156.x.CrossRefPubMedPubMedCentral

Moons KGM, Royston P, Vergouwe Y, Grobbee DE, Altman DG. Prognosis and prognostic research: What, why, and how? BMJ. 2009;338:1317–20.CrossRef

Steyerberg EW, Moons KG, van der Windt DA, Hayden JA, Perel P, Schroter S, Riley RD, Hemingway H, Altman DG, PROGRESS Group. Prognosis research strategy (PROGRESS) 3: prognostic model research. PLoS Med. 2013;10(2):e1001381. https://doi.org/10.1371/journal.pmed.1001381. PMID: 23393430; PMCID: PMC3564751.

10.

Gade GV, Jørgensen MG, Ryg J, Riis J, Thomsen K, Masud T, et al. Predicting falls in community-dwelling older adults: a systematic review of prognostic models. BMJ Open. 2021;11:e044170.CrossRefPubMedPubMedCentral

11.

De Vries OJ, Peeters GMEE, Lips P, Deeg DJH. Does frailty predict increased risk of falls and fractures? A prospective population-based study. Osteoporos Int. 2013;24(9):2397–403. https://doi.org/10.1007/s00198-013-2303-z.CrossRefPubMed

12.

Pluijm SMF, Smit JH, Tromp EAM, Stel VS, Deeg DJH, Bouter LM, et al. A risk profile for identifying community-dwelling elderly with a high risk of recurrent falling: results of a 3-year prospective study. Osteoporos Int. 2006;17(3):417–25. https://doi.org/10.1007/s00198-005-0002-0.CrossRefPubMed

13.

Tromp AM, Pluijm SMF, Smit JH, Deeg DJ. JH, Bouter LM, Lips P, et al. Fall-risk screening test: a prospective study on predictors for falls in community-dwelling elderly. J Clin Epidemiol 2001;54(8):837–844, DOI: https://doi.org/10.1016/S0895-4356(01)00349-3.

14.

Maki BE, Holliday PJ, Topper AK. A prospective study of postural balance and risk of falling in an ambulatory and independent elderly population. J Gerontol. 1994;49(2):M72–84. https://doi.org/10.1093/geronj/49.2.M72.CrossRefPubMed

15.

Gadkaree SK, Sun DQ, Huang J, Varadhan R, Agrawal Y. Comparison of simple vs. performance-based fall prediction models: data from the National Health and Aging Trends Study. Gerontol Geriatr Med. 2015;1:2333721415584850. https://doi.org/10.1177/2333721415584850. PMID: 26702410; PMCID: PMC4686273.

16.

Stel VS, Pluijm SMF, Deeg DJH, Smit JH, Bouter LM, Lips P. A classification tree for predicting recurrent falling in community-dwelling older persons. J Am Geriatr Soc. 2003;51(10):1356–64. https://doi.org/10.1046/j.1532-5415.2003.51452.x.CrossRefPubMed

17.

Mi A, Ruiz J, Valldosera E, Gonzalo N, Ng T, Yuste A, et al. A two-question tool to assess the risk of repeated falls in the elderly. PLoS One. 2017;12(5):e0176703.CrossRef

18.

Royston P, Moons KGM, Altman DG, Vergouwe Y. Prognosis and prognostic research: developing a prognostic model. BMJ. 2009;338(7707):1373–7.

19.

Sørensen G, Jorgensen M, Ryg J, Masud T, Andersen S. Development of a Multivariable Prognostic PREdiction Model for 1-year Risk of FALLing in Community-dwelling Older Adults in a Non-clinical Setting (PROTOCOL) [Internet]. [cited 2020 Jul 7]. Available from: https://clinicaltrials.gov/ct2/show/NCT03608709.

20.

Collins GS, Reitsma JB, Altman DG, Moons K. Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): the TRIPOD statement. BMC Med. 2015;13(1):1. https://doi.org/10.1186/s12916-014-0241-z.CrossRefPubMedPubMedCentral

21.

von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, et al. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370(9596):1453–7. https://doi.org/10.1016/S0140-6736(07)61602-X.CrossRef

22.

Lamb SE, Jørstad-Stein EC, Hauer K, Becker C. 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(9):1618–22. https://doi.org/10.1111/j.1532-5415.2005.53455.x.CrossRefPubMed

23.

Sørensen GV, Jørgensen MG, Ryg J, Masud T, Andersen S. Development, feasibility, acceptability, and adjustment of a portable, multifactorial falls risk test battery for community-dwelling older adults. Cogent Med. 2019;6(1):1674099. https://doi.org/10.1080/2331205X.2019.1674099.

24.

Blomkvist AW, Andersen S, de Bruin E, Jorgensen MG. Unilateral lower limb strength assessed using the Nintendo Wii balance board: a simple and reliable method. Aging Clin Exp Res. 2017;29(5):1013–20. https://doi.org/10.1007/s40520-016-0692-5.CrossRefPubMed

25.

Jorgensen MG, Paramanathan S, Ryg J, Masud T, Andersen S, Rubenstein L, et al. Novel use of the Nintendo Wii board as a measure of reaction time: a study of reproducibility in older and younger adults. BMC Geriatr. 2015;15(1):80. https://doi.org/10.1186/s12877-015-0080-6.CrossRefPubMedPubMedCentral

26.

Blomkvist AW, Andersen S, De Bruin ED, Jorgensen MG. Isometric hand grip strength measured by the Nintendo Wii balance board - a reliable new method rehabilitation, physical therapy and occupational health. BMC Musculoskelet Disord. 2016;17(1):1–7.CrossRef

27.

Jørgensen MG, Laessoe U, Hendriksen C, Nielsen OBF, Aagaard P, Jorgensen MG, et al. Intrarater reproducibility and validity of Nintendo Wii balance testing in community-dwelling older adults. J Aging Phys Act. 2014;22(2):269–75. https://doi.org/10.1123/japa.2012-0310.CrossRefPubMed

28.

Quach L, Galica AM, Jones RN, Procter-Gray E. The non-linear relationship between gait speed and falls:the mobilize Boston study. J Am Geriatr Soc. 2012;59(6):1069–73.CrossRef

29.

Andreasen J, Sørensen EE, Gobbens RJJ, Lund H, Aadahl M. Danish version of the Tilburg frailty Indicator - translation, cross-cultural adaption and validity pretest by cognitive interviewing. Arch Gerontol Geriatr. 2014;59(1):32–8. https://doi.org/10.1016/j.archger.2014.02.007.CrossRefPubMed

30.

Rubenstein LZ, Harker JO, Salvà A, Guigoz Y, Vellas B. Screening for undernutrition in geriatric practice : developing the short form mini nutritional assessment (MNA-SF). J Gerontol. 2001;56(6):366–72.CrossRef

31.

Saliba D, Elliott M, Rubenstein LZ, Solomon DH, Young RT, Kamberg CJ, et al. The vulnerable Elders survey: a tool for identifying vulnerable older people in the community. J Am Geriatr Soc. 2001;49(12):1691–9. https://doi.org/10.1046/j.1532-5415.2001.49281.x.CrossRefPubMed

32.

Kempen GIJM, Yardley L, Van Haastregt JCM, Zijlstra GAR, Beyer N, Hauer K, et al. The short FES-I: a shortened version of the falls efficacy scale-international to assess fear of falling. Age Ageing. 2008;37(1):45–50. https://doi.org/10.1093/ageing/afm157.CrossRefPubMed

33.

D’Ath P, Katona P, Mullan E, Evans S, Katona C. Screening, detection and Management of Depression in elderly primary care attenders. I: the acceptability and performance of the 15 item geriatric depression scale (GDS15) and the development of short versions. Fam Pr. 1994;11(3):260–6. https://doi.org/10.1093/fampra/11.3.260.CrossRef

34.

Wade DT, Vergis E. The short orientation-memory-concentration test: a study of its reliability and validity. Clin Rehabil. 1999;13(2):164–70. https://doi.org/10.1191/026921599673848768.CrossRefPubMed

35.

Ambler G, Omar RZ, Royston P. A comparison of imputation techniques for handling missing predictor values in a risk model with a binary outcome. Stat Methods Med Res. 2007;16(3):277–98. https://doi.org/10.1177/0962280206074466.CrossRefPubMed

36.

Altman DG, Royston P. The cost of dichotomising continuous variables. BMJ. 2006;332(7549):1080. https://doi.org/10.1136/bmj.332.7549.1080. PMID: 16675816; PMCID: PMC1458573.

37.

Friedman J, Hastie T, Tibshirani R. Regularization paths for generalized linear models via coordinate descent. J Stat Softw. 2010;33(1):1–22.CrossRefPubMedPubMedCentral

38.

Moreland JD, Richardson JA, Goldsmith CH, Clase CM. Muscle weakness and falls in older adults: A systematic review and meta-analysis. J Am Geriatr Soc. 2004;52:1121–9.CrossRefPubMed

39.

Eika F, Blomkvist AW, Rahbek MT, Eikhof KD, Hansen MD, Søndergaard M, et al. Reference data on hand grip and lower limb strength using the Nintendo Wii balance board: a cross-sectional study of 354 subjects from 20 to 99 years of age. BMC Musculoskelet Disord. 2019;20(1):21. https://doi.org/10.1186/s12891-019-2405-7.CrossRefPubMedPubMedCentral

40.

Decoster L, Van Puyvelde K, Mohile S, Wedding U, Basso U, Colloca G, et al. Screening tools for multidimensional health problems warranting a geriatric assessment in older cancer patients: An update on SIOG recommendations. Ann Oncol. 2015;26:288–300.CrossRefPubMed

41.

Muir-Hunter SW, Wittwer JE. Dual-task testing to predict falls in community-dwelling older adults: a systematic review. Physiotherapy. 2016;102(1):29–40. https://doi.org/10.1016/j.physio.2015.04.011.CrossRefPubMed

42.

Muir SW, Gopaul K, Montero Odasso MM. The role of cognitive impairment in fall risk among older adults: a systematic review and meta-analysis. Age Ageing. 2012;41(3):299–308. https://doi.org/10.1093/ageing/afs012.CrossRefPubMed

43.

Montero-Odasso M, Almeida QJ, Bherer L, Burhan AM, Camicioli R, Doyon J, et al. Consensus on Shared Measures of Mobility and Cognition: From the Canadian Consortium on Neurodegeneration in Aging (CCNA). J Gerontol Ser A. 2018;XX((Xx):1–13.

44.

Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I, et al. The Montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53(4):695–9. https://doi.org/10.1111/j.1532-5415.2005.53221.x.CrossRefPubMed

45.

Vazzana R, Bandinelli S, Lauretani F, Volpato S, Lauretani F, Di Iorio A, et al. Trail making test predicts physical impairment and mortality in older persons. J Am Geriatr Soc. 2010;58(4):719–23. https://doi.org/10.1111/j.1532-5415.2010.02780.x.CrossRefPubMedPubMedCentral

46.

Van Schooten KS, Pijnappels M, Rispens SM, Elders PJM, Lips P, Daffertshofer A, et al. Daily-life gait quality as predictor of falls in older people: a 1-year prospective cohort study. PLoS One. 2016;11(7):1–13.

47.

Davis JC, Best JR, Dian L, Khan KM, Hsu CL, Chan W, et al. Are the EQ-5D-3L and the ICECAP-O responsive among older adults with impaired mobility? Evidence from the Vancouver falls prevention cohort study. Qual Life Res. 2017;26(3):737–47. https://doi.org/10.1007/s11136-016-1487-z.CrossRefPubMed

48.

Yardley L, Beyer N, Hauer K, Kempen G, Piot-Ziegler C, Todd C. Development and initial validation of the falls efficacy scale-international (FES-I). Age Ageing. 2005;34(6):614–9. https://doi.org/10.1093/ageing/afi196.CrossRefPubMed

49.

Keller HH, McKenzie JD, Goy RE. Construct validation and test-retest reliability of the seniors in the community: risk evaluation for eating and nutrition questionnaire. J Gerontol Ser A Biol Sci Med Sci. 2001;56(9):552–8.CrossRef

50.

Sutton JL, Gould RL, Daley S, Coulson MC, Ward EV, Butler AM, Nunn SP, Howard RJ. Psychometric properties of multicomponent tools designed to assess frailty in older adults: a systematic review. BMC Geriatr. 2016;16:55. https://doi.org/10.1186/s12877-016-0225-2. PMID: 26927924; PMCID: PMC4772336.

Title: Development of a multivariable prognostic PREdiction model for 1-year risk of FALLing in a cohort of community-dwelling older adults aged 75 years and above (PREFALL)
Authors: Gustav Valentin Gade
Martin G. Jørgensen
Jesper Ryg
Tahir Masud
Lasse Hjort Jakobsen
Stig Andersen
Publication date: 01-12-2021
Publisher: BioMed Central
Published in: BMC Geriatrics / Issue 1/2021
Electronic ISSN: 1471-2318
DOI: https://doi.org/10.1186/s12877-021-02346-z

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Development of a multivariable prognostic PREdiction model for 1-year risk of FALLing in a cohort of community-dwelling older adults aged 75 years and above (PREFALL)

Abstract

Background

Methods

Results

Conclusion

Trial registration

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At a glance: The ONWARDS insulin icodec trials

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Abstract

Background

Methods

Results

Conclusion

Trial registration

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