[Epidemiology of falls among the elderly].

INTRODUCTION

Falls among the elderly have important physical and psychological consequences. Interventions of proven effectiveness exist at individual and population level for their prevention. Studies conducted in other countries have estimated the prevalence and identified the health and environmental risk factors associated with falls, while in Italy, the information available is limited to elderly living in protected residences. To estimate therefore the prevalence of falls and to estimate the association between these events and different risk factors, a series of questions on falls and their possible determinants were included in Studio Argento, a cross-sectional survey of the state of health of the non-institutionalized population > or = 65 years of age that was conducted in 2002 in 11 Italian Regions.

METHODS

In each region, two-stage cluster sampling was used to sample 210 individuals. In the first phase, 30 communes were selected, with the probability of selection proportionate to their population; in the second phase, simple random sampling using the communal population register to select the persons to be interviewed. Interviews were conducted in the homes of the study subjects using a standardized questionnaire. Data from the 11 regions were merged for purposes of the analysis, and the C-sample routine of Epi-Info version 2002 was used to conduct the analysis, taking into account of the survey design and the size of the total population > or = 65 years in the various Regions. SUDAAN, an application of SAS was used for the calculation of the rate ratios (R.R.) and 95% confidence intervals (95% CI) and the population-attributable fractions, taking into account potentially confounding variables.

RESULTS

A total of 2,273 persons were included in the study. During the previous 12 months, 651 (28.6%; 95% CI = 26.4%-30.7%) had fallen; of these 43.1% (95% IC = 38.6%-47.7%) had fallen 2 or more times. Sixty percent (95% CI = 55,6%-64,2%) of those who had fallen reported having fallen at home. Risk factors for falls included stroke (adjusted RR = 1.4 (95% CI = 1.03-1.8)). diabetes (adjusted RR = 1.7 (95% CI = 1.2-2.1)). visual difficulties (adjusted RR = 1.3 (95% CI = 1.02-1.6)). urinary incontinence (adjusted RR = 1.3 (95%CI= 1.1-1.5) and physical inactivity (adjusted RR = 1.3 (95% CI = 1.03-1.5)). In addition, the consumption of anti-anxiety drugs was also associated with a greater risk of falls. The highest population-attributable fractions were seen for urinary incontinence (9.4%) and lack of physical activity (10.0%).

CONCLUSIONS

Falls are common in Italian elderly and are linked with the fragility of aging. To prevent falls, it is necessary to intervene on factors associated with fragility. Methods include encouraging regular physical activity to improve equilibrium and muscle strength and the continuous monitoring of health status to prevent further deterioration. Moreover studies carried out in other countries have demonstrated that the multidisciplinary interventions targeted at persons who have already experienced a fall reduces their risk of further falls. These interventions consist of evaluations of visual acuity, balance, and gait and a review of clinical history with eventual modifications of drug therapy and the environmental risks in the home.