Neurological diseases and accidental falls of the aged.

OBJECTIVE

To assess the influence of central and peripheral neurological diseases on the incidence of accidental falls of the aged.

DESIGN

1. Case-control study with cross-section at two years and 2. prospective study in a follow-up up to seven years thereafter.

SETTING

Sample of a population study including all 589 inhabitants older than 70 years in three rural communities.

PARTICIPANTS

44 subjects with recurrent falls during two years' follow-up and 41 age and sex matched controls.

MEASURES

Neurological diseases and evaluation, other diseases, and incidence of falls during the seven years' follow-up after the cross-section.

RESULTS

Compared with the controls the fallers had more often multiple vascular lesions of the brain, extrapyramidal symptoms and signs as well as lumbar nerve root lesions. In the follow-up, cerebrovascular disease, especially with multiple lesions and residual signs of pyramidal tract lesion, Parkinson's disease, rigidity and hypokinesia were associated with increases risk of falling. In multivariate analysis signs of pyramidal tract lesion, rigidity and prior falls were predictors of falls. An increase in the incidence of falls was also associated with vascular lesion of the cerebellum, cerebral white matter hypodensity and cortical atrophy visible on CT.

CONCLUSIONS

High incidence of falls was associated with chronic central nervous system diseases. Lumbar root lesions were more common among the fallers but did not increase the incidence of falls in the follow-up. Neurological diseases and evaluation, other diseases, and incidence of falls during the seven years' follow-up after the cross-section. Compared with the controls the fallers had more often multiple vascular lesions of the brain, extrapyramidal symptoms and signs as well as lumbar nerve root lesions. In the follow-up, cerebrovascular disease, especially with multiple lesions and residual signs of pyramidal tract lesion, Parkinson's disease, rigidity and hypokinesia were associated with increased risk of falling. In multivariate analysis signs of pyramidal tract lesion, rigidity, and prior falls were predictors of falls. An increase in the incidence of falls was also associated with vascular lesion of the cerebellum, cerebral white matter hypodensity and cortical atrophy visible on CT.