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Falls are associated with decreased grip strength, slower wa

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Mette Lindholm Eriksen

on 13 June 2014

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Transcript of Falls are associated with decreased grip strength, slower wa

Background
Study Aim
To investigate the association between falls and three commonly used functional measures in a large European ageing study

Method
Results
Conclusions
Falls are associated with decreased grip strength, slower walking speed and inability to stand from chair without using arms in a large European ageing study

Mette Lindholm Eriksen, MScPH (1), Prof. Tahir Masud, MD (2,3,4), Jesper Ryg, MD, PhD (3,4), Sonja Vestergaard, PhD (1), Karen Andersen-Ranberg, MD, PhD (1,3)

1 - Danish Ageing Research Centre, University of Southern Denmark
2 - Geriatric Medicine, Nottingham University Hospitals NHS Trusts, UK
3 - Geriatric Medicine, Odense University Hospital, Denmark
4 - Institute of Clinical Research, University of Southern Denmark

Impact
of
Falls
Long Lie
Pneumonia
Dehydration
Pressure Sores
Physical
Injuries
Bruises
Head Injury
Fractures
Psychological
Loss of Confidence
Depression
Increased Dependency
Functional
Immobility
Deconditioning
Decreased Righting Reflex
Social
Social Withdraw
Institutionalization
Around 40-60 & of falls lead to injuries
Up to 12 % of falls lead to fractures
About 1 % of falls lead to hip fracture
Fall related accidents are predisposing factors in 40 % of events leading to long-term institutionalization
Significant cost to health and social services
Falls are associated with frailty and co-morbidity
Ryynanen et al, Public Health, 1991
Tinetti et al., N Eng J Med, 1988
Karlson et al., Scand J Public Health, 2013
Kennedy et al., Dan Med Bull, 1987
Rizzo et al., Med Care, 1998
Medical Advisory Secretariat, Ont Health Techol Assess Ser., 2008
Physical Tests
Frailty key markers
Provide objective measurements vs. self-reported health
Handgrip strength, walking speed and chair stand
Clinical markers of poor mobility
Predictive of disability, morbidity, and mortality
Being able to predict who are in risk of falling will therefor be beneficial for both the individual and society
Fried et al., J Gerontology, 2001
Cruz-Jentoft et al., Age and Ageing 2010
Laurentani et al., J Appl Physiol, 2003
Guralnik et al., J Gerontol A Biol Sci Med Sci, 2009
Cesari et al., J Am Geriatr Soc, 2009
Survey of Health, Ageing and Retirement in Europe (SHARE)
Ongoing longitudinal study of individual Europeans aged ≥50 years
First cross-national and cross-disciplinary study
Designed to adjust for national differences in population and non-participation
Börsch-Supan et al., Eur J Ageing 2005
Andersen-Ranberg et al., Eur J Ageing 2009
Baseline Characteristics
SE
DK
NL
DE
BE
FR
ES
IT
GR
CH
AT
PT
SI
HU
EE
IE
PL
CZ
Wave 1 participation (2004)
11 countries: NL, DE, AT, DK, BE, FR, CH, ES, IT, GR, SE (+UK)
Wave 2 & 3 (2006 and 2008)
Plus CZ, PL, IE, IL
Wave 4 (2010)
Plus EE, HU, SI, PT: 20
IL
UK
Physical Measures
SHARE_InterviewerProjectManual_version5.0
Rantanen et al. Age 2012

SHARE_InterviewerProjectManual_version5.0
Guralnik et al. J Gerontol A Biol Sci Med Sci 1994 & 2000
Jones et al., Res Q Exerc Sport, 2013

Handgrip Strength
Measured by handheld dynamometer (Smedley, S Dynamometer) in kg
Two measures per hand per person
Valid if 2 measures in one hand differs <20 kg
SHARE_InterviewerProjectManual_version5.0
Rantanen et al., Age 2012
Walking Speed
Time used for walking 2.5 meters measured by stop watch
Two measurements per person aged >75 years
SHARE_InterviewerProjectManual_version5.0
Guralnik et al., Gerontol A Biol Sci Med 1994 & 2000
Peel et al., J Gerontology: Med Sci, 2012
Chair Stand
Ability to perform one chair stand with or without using arms
Persons <75 years of age
SHARE_InterviewerProjectManual_version5.0
Guralnik et al., J Gerontol A Bio Sci Med 1994 & 2000
Jones et al., Res Q Exerc Sport, 2013
Questionnaire
Falls
Question by interview:
"For the past 6 months at least, have you been bothered by any of the health conditions? (Yes/No):
Falling down"
Depressive symptoms
EURO-D scale (12 items), "No" (items scores 0-3) "Yes" (items scores 4-12)
Prince et al., British Journal of Psychiatry 1999
Poor vision
Question by interview:
"How good is your eyesight for seeing things at a distance?" / "How good is your eyesight for seeing things up close?"
1-5 ranking score where 1 is "Excellent" and 5 is "Poor", "No" (1-3), "Yes" (4-5)
BMI
Self-reported weight and height
Education
The international Standard Classification of Education (ISCED)
www.unesco.org/education/information/nfsunesco/doc/isced_1997.htm
Maximal Gandgrip Strength, kg
Walking Speed, m/sec
Chair Stand, %
a. Walking speed test performed in those age>75
a
b
b. Chair stand test performed in those aged <75 years
Unadjusted analysis
Adjusted
Handgrip strength
Walking speed
a
Chair stand
b
Limitations
Cross sectional data
Retrospective
Recall bias
Not including people living at institutions
Strengths
Ex-ante harmonized questionnaire
One generic questionnaire
Large cross-national dataset
Both men and women
These results supports that:
Falling is associated with age, gender, BMI, poor vision, handgrip, walking speed and chair stand
After multivariae adjustments falling stayed significant associated with all 3 functional tests
Causality cannot be determined from the present results
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