Table 1:

Studies evaluating risk factors for falls

Risk factor; study AgeStudy designNo. of studies in reviewTotal no. of participantsSummary of results
Ganz et al.2Systematic review of prospective cohort studies18 (3 studies of age)19 178

  • For first and second studies combined, probability of falls by age category: 65–74 yr, 31%–32%; 70–74 yr, 22%–33%; 75–79 yr, 25%–36%; ≥80 yr, 34%–37%

  • For third study, increased risk of falling at least once in next 11 mo among older patients (OR per age category 1.90; p < 0.001)

  • Probability of falls, by age category: 65–69 yr, 14%; 70–74 yr, 16%; 75–79 yr, 24%; ≥ 80 yr, 34%

Previous falls
Ganz et al.2Systematic review of prospective cohort studies18 (11 studies of history of falls, 4 with extractable data)19 178Occurrence of fall in past year associated with subsequent falls (LR range 2.3–3.8)
Cognitive impairment
Ganz et al.2Systematic review of prospective cohort studies18 (8 studies of cognitive impairment, 2 with extractable data)19 178

  • In first study, presence of ≥ 5 errors on Short Portable Mental Status Questionnaire associated with ≥ 1 falls (LR 4.2, 95% CI 1.9–9.6)

  • In second study, history of dementia associated with ≥ 1 falls (LR 17, 95% CI 1.9–149) and with ≥ 2 falls (LR 13, 95% CI 2.3–79)

Visual impairment
Ganz et al.2Systematic review of prospective cohort studies18 (11 studies of visual impairment, 3 studies showed significant results)19 178

  • For first and second studies, visual impairment increased the likelihood of a fall (OR 1.6 and 2.0, respectively

  • For third study, using Bailey–Lovie charts to measure visual acuity, each additional letter read correctly off the chart at baseline was associated with lower risk of falls (OR 0.96)

Medications
Woolcott et al.10Meta-analysis of cohort, cross-sectional, case–control studies2279 081

  • Antidepressants, OR 1.68 (95% CI 1.47–1.91)

  • Antihypertensive agents, OR 1.24 (95% CI 1.01–1.50)

  • Benzodiazepines, OR 1.57 (95% CI 1.43–1.72)

  • Diuretics, OR 1.07 (95% CI 1.01–1.14)

  • Neuroleptics and antipsychotics, OR 1.59 (95% CI 1.37–1.83)

  • NSAIDs, OR 1.21 (95% CI 1.01–1.44)

  • Sedatives and hypnotics, OR 1.47 (95% CI 1.35–1.62)

Updated Bayesian adjusted estimates:

  • Antidepressants, OR 1.36 (95% CI 1.13–1.76)

  • Benzodiazepines, OR 1.41 (95% CI 1.20–1.71

Hegeman et al.11Systematic review of case–control, prospective and cross-sectional studies13 (12 with extractable OR values)209 015NSAIDs, OR range 1.13 (95% CI 0.93–1.38) to 4.35 (95% CI 1.79–10.91)
Sterke et al.12Systematic review of prospective cohort studies1761 392Large range of OR and RR values for various combinations of psychoactive medications (antidepressants, tranquilizers, antipsychotics, benzodiazepines) used for patients with dementia living in nursing homes:

  • From 17 studies, OR range 1.13–5.67 and RR range 1.32–10.3

  • Multiple drugs (3/3 studies: n = 177–282, RR range 1.30–10.3), antidepressants (10/12 studies: n = 78–2428, range of effect sizes 1.1–7.6) and antianxiety drugs (2/2 studies: n = 2015, RR 1.32 and n = 18 855, OR 1.22) increase fall risk

  • Evidence for other psychoactive drug classes is limited (antipsychotics), inconclusive (sedatives) or no association (hypnotics)

Kim et al.13Meta-analysis of RCTs40 total studies
22 studies of cholinesterase inhibitors in analysis of falls9882 (for cholinesterase inhibitors)Cholinesterase inhibitors: syncope, OR 1.53 (95% CI 1.02–2.30)
14 studies of memantine, with 13 in analysis of falls3583 (for memantine)Memantine: fewer fractures, OR 0.21 (95% CI 0.05–0.85)
Functional limitations, disabilities in ADLs
Bloch et al.14Meta-analysis of RCTs and observational studies (cohort, cross-sectional, case–control)17719 178

  • Any impairment in ADLs, OR 2.26 (95% CI 2.09–2.45)

  • Any impairment in instrumental ADLs, OR 2.10 (95% CI 1.68– 2.64)

Ganz et al.2Systematic review of prospective cohort studies18 (10 studies specifically on impairment of ADLs, 3 studies showed significant results)19 1782 studies reported LR values:

  • In first study, inability to rise from chair of knee height without using chair arms was associated with increased risk of ≥ 1 falls among men (LR 4.3, 95% CI 2.3–7.9); not significant in women

  • In second study, presence of ≥ 5 of 11 physical impairments (mostly ADLs) was associated with increased risk of ≥ 1 falls (LR 1.9, 95% CI 1.4–2.6)

Home hazards
Letts et al.15Meta-analysis of cohort and cross-sectional studies10025 145

  • Various indoor and outdoor home hazards (e.g., bathroom, environmental) were associated with increased risk of falls (OR 1.15, 95% CI 0.97–1.36)

  • Use of mobility aids was associated with significantly increased risk of falls in community (OR 2.07, 95% CI 1.59–2.71) and institutional settings (OR 1.77, 95% CI 1.66–1.89)

Orthostatic hypotension
Ganz et al.2Systematic review of prospective cohort studies18 (4 studies specific to orthostatic hypotension)19 178

  • In 4 studies, no association between orthostatic hypotension and falls when other risk factors were considered

  • In 1 study, increase in pulse (< 6 beats/min) measured 30 s after standing up was weakly associated with falls (LR 1.4, 95% CI 1.0–1.9)

Balance impairment
Muir et al.16Meta-analysis of prospective studies2360 602Overall fall risk, OR 1.98 (95% CI 1.60–2.46)
Impairment of gait or balance
Ganz et al.2Systematic review of prospective cohort studies18 (15 studies on impairment of gait or balance)19 178

  • Of 15 studies found, 4 reported LR for clinically detected abnormality of gait or balance (LR range 1.7–2.4)

  • For presence of lower-extremity disability (i.e., reported problem with strength, sensation or balance), LR 1.8 (95% CI 1.5–2.2)

  • Note: ADLs = activities of daily living, CI = confidence interval, LR = likelihood ratio, NSAID = nonsteroidal anti-inflammatory drug, OR = odds ratio, RCT = randomized controlled trial, RR = relative risk.