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Multidimensional Geriatric Assessment: Back to the Future Preclinical Disability as a Risk Factor for Falls in Community-Dwelling Older Adults

¹ Department of Geriatrics, Inselspital University of Bern Hospital, Switzerland.
² University Department of Geriatrics, Spital Netz Bern Ziegler, Bern, Switzerland.
³ Institute of Social and Preventive Medicine, University of Bern, Switzerland.
⁴ Albertinen-Haus Geriatrics Centre, University of Hamburg, Germany.
⁵ Department of Primary Care and Population Sciences, University College London, United Kingdom.
⁶ School of Medicine, University of California, Los Angeles.
⁷ Langley Research Institute, Pacific Palisades, California.

Address correspondence to Andreas E. Stuck, MD, University Department of Geriatrics, Spital Netz Bern Ziegler, Morillonstrasse 75-91, CH-3001 Bern, Switzerland. E-mail: andreas.stuck{at}spitalnetzbern.ch

Background. Falls are common and serious problems in older adults. The goal of this study was to examine whether preclinical disability predicts incident falls in a European population of community-dwelling older adults.

Methods. Secondary data analysis was performed on a population-based longitudinal study of 1644 community-dwelling older adults living in London, U.K.; Hamburg, Germany; Solothurn, Switzerland. Data were collected at baseline and 1-year follow-up using a self-administered multidimensional health risk appraisal questionnaire, including validated questions on falls, mobility disability status (high function, preclinical disability, task difficulty), and demographic and health-related characteristics. Associations were evaluated using bivariate and multivariate logistic regression analyses.

Results. Overall incidence of falls was 24%, and increased by worsening mobility disability status: high function (17%), preclinical disability (32%), task difficulty (40%), test-of-trend p <.003. In multivariate analysis adjusting for other fall risk factors, preclinical disability (odds ratio [OR] = 1.7, 95% confidence interval [CI], 1.1–2.5), task difficulty (OR = 1.7, 95% CI, 1.1–2.6) and history of falls (OR = 4.7, 95% CI, 3.5–6.3) were the strongest significant predictors of falls. In stratified multivariate analyses, preclinical disability equally predicted falls in participants with (OR = 1.7, 95% CI, 1.0–3.0) and without history of falls (OR = 1.8, 95% CI, 1.1–3.0).

Conclusions. This study provides longitudinal evidence that self-reported preclinical disability predicts incident falls at 1-year follow-up independent of other self-reported fall risk factors. Multidimensional geriatric assessment that includes preclinical disability may provide a unique early warning system as well as potential targets for intervention.

Key Words: Assessment • Falls • Geriatric assessment • Older adults • Preclinical disability