The Epidemiology of Aging
In the single prospective cohort study of community-dwelling older adults addressing the Brazilian population and selected for review, the incidence of falls was Recurrence was In the studies of older patients living in LTCFs, all cross-sectional, the occurrence of falls ranged from Two studies showed that the bedroom is where community-dwelling older adults most often fall.
Four studies that evaluated time of falls in community-dwelling older adults showed that they most often occur during daytime morning and afternoon. The bedroom was also the most commonly reported place for falls in institutionalized older adults, followed by yard external area and living room. The same study was also the only one that investigated the circumstances of falls in this specific population, which were associated with slipping and dizziness.
None of the selected articles showed that being male is a risk factor for falling. Nonetheless, 15 studies demonstrated that female sex is associated with falls in community-dwelling older adults. The following characteristics were identified as risk factors for falls in only two of the 25 studies of community-dwelling older adults: not having a partner, 7,28 living alone, 4,28 osteoporosis, 3,15 low educational level, 5,7 frailty syndrome, 12,31 sedentary lifestyle, 4,30 use of mobility aids, 5,15 poor self-perceived health, 20,30 and being dependent for basic activities of daily living BADLs.
The following clinical conditions were associated with falls in community-dwelling older adults in one study each: chronic pain for more than two years, 3 osteoarthritis, 3 osteo-articular diseases, 25 urinary incontinence, 3 cataract, 3 visual impairment, 7 hearing impairment, 6 daytime napping, 26 alcohol consumption greater than four drinks per day, 33 previous fracture, 7 previous hospitalization, 6 obesity, 4 having more than eight associated diseases, 6 being black, 16 polypharmacy, 30 presence of caregiver, 27 winter season, 29 poor sleep quality, 34 low muscle strength, 34 and use of benzodiazepines and antidepressants.
In the studies of institutionalized older adults, the factors associated with falls differed considerably from those of the studies of older people living in the community. For instance, white skin color was associated with falls in two of the studies of patients living in LTCF.
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Falls are the main external cause of morbidity and mortality in older adults, while in younger people this is attributed to traffic accidents. Older adults who are younger and more active are more often involved in traffic accidents than in falls.
In one study of community-dwelling older adults, fear of falling was reported by A single selected study including a group of institutionalized older patients who fell evaluated bone fractures because of falls. Antes et al. Falling depends on a number of factors, and since many of them are preventable or modifiable, relatively simple changes may reduce the risk of falls as well as morbidity and mortality in the older population.
Falling in older age is a public health issue that may lead to increased health expenses and reduced quality of life. To prevent it, a comprehensive epidemiological knowledge of the current context is important. In the selected studies, the prevalence of falls was higher among women and those aged over 80 years. Faller older adults had a lower mean score in the emotional domain of the Item Short Form Health Survey SF quality of life measure, with development of negative feelings and fear of falling again.
Fear of falling may significantly reduce the functionality of older adults, who may remain bedbound and subjected to the onset of immobility syndrome. Such fear must be addressed by health professionals as part of the approach to fall prevention, with special attention to immobility and functional loss. Investigating the history of falls as well as their risk factors and consequences must be included, therefore, in the anamnesis performed by Brazilian Family Health Program professionals and in the health care of older patients in any context because of the importance and prevalence of falls.
When the present results are compared with those of the international literature, heterogeneous data emerge from different countries. Sandoval et al. The occurrence rate ranged from A systematic review of studies investigating falls in older adults in Southeast Asian countries found prevalence rates ranging from Most risk factors identified in this review were similar to those of the Brazilian studies. However, unlike studies conducted in Brazil and other countries, this review identified as fall-related risk factors sedentary lifestyle and being dependent on family members in multigenerational environments.
A meta-analysis examined the incidence of fall-related injuries in older people in mainland China. A moderate incidence was found; overall incidence in those older than 60 years was In addition, the number of injuries increased proportionally to age.ras.boxed-rocket.com/the-dyatlov-pass-incident-the-world.php
Introduction to Epidemiology of Aging
Silva Gama et al. Risk factors included antipsychotic drugs, benzodiazepines, comorbidities, decreased physical strength, female sex, and previous falls. The major fall-related consequences were fractures and fear of falling. These findings were similar to those of Brazilian studies. A limitation of the present study is the relative lack of data on falls in older adults from Brazilian North, Northeast, and Mid-west regions.
Additionally, because of the predominance of cross-sectional studies, the heterogeneity of data collection methods, and the identification of a single prospective cohort study on the topic, determining the true risk factors for falls is a difficult task. Nonetheless, a comprehensive review of studies on falls in older adults in Brazil was conducted and allowed the identification of potentially modifiable risk factors in this population.
The occurrence of falls in older adults varied widely, being more common in institutionalized persons. Few studies have described the risk factors associated with this phenomenon in older adults living in LTCF. For older adults living in the community, the most common setting for falls is the home during daytime. Fractures and fear of falling again were identified as consequences and may lead to immobility syndrome.
The Epidemiology of Aging | SpringerLink
Prevention is a key measure to manage falls in this population. In community-dwelling older people, several fall-associated factors are modifiable or preventable through simple interventions. Prospective studies will be useful to confirm the present results and evaluate potential interventions. Am J Public Health. Rev Bras Enferm. Prevalence of falls in elderly in Brazil: a countrywide analysis. Falls in the elderly of the Family Health Program. Arch Gerontol Geriatr. Fatores associados a quedas em uma coorte de idosos residentes na comunidade. Rev Pesq Cuid Fundam. Rev Bras Epidemiol.
Characteristics and circumstances of falls leading to severe fractures in elderly people in Rio de Janeiro, Brazil.
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Elderly patients attended in emergency health services in Brazil: a study for victims of falls and traffic accidents. Broska Jr. For the first time in history, worldwide there will soon be more adults aged 65 and older than children aged five and younger. As a result, there is an urgent need for public health professionals who specialize in aging to address the needs of this growing segment of the population. In the Epidemiology of Aging track, faculty and students examine the public health impact of aging societies, and the multifactorial changes associated with aging that make health issues for older persons important and unique.
The Epidemiology of Aging track is intended for master's, doctoral and postdoctoral students who wish to learn about the unique health challenges facing older adults. It aims to provide advanced training to epidemiologists interested in the major public health and clinical issues relevant to older adults, and the conceptual and methodological framework that form a basis for studies of older populations.
In the Epidemiology of Aging track, faculty and students examine the public health importance of aging societies through coursework, journal clubs and research projects. Students within the program benefit from coursework in epidemiology, biostatistics, and gerontology offered in departments throughout the school.
Students learn about the challenges posed by changes in physical and cognitive functioning, as well as the impact of multi-comorbid diseases in older adults. This track also focuses on the epidemiology of major geriatric syndromes, including frailty, disability, falls and cognitive decline in older populations. Significant attention is dedicated to the understanding of opportunities for primary, secondary, and tertiary prevention in the context of the marked health status heterogeneity among older adults.
This program focuses on the scientific basis for improved prevention and treatment of adverse functional outcomes in older adults.
The strengths of the program include the existing depth of interest and expertise in gerontology, methodology and geriatric medicine at the Johns Hopkins Medical Institutions. Students are mentored by faculty housed in the Johns Hopkins Center on Aging and Health , who are active in both population-based and clinical research.