Falls among Chinese community-dwelling older population in Hong Kong : trend, seasonal pattern and risk factors

Abstract

Given that the ageing of global population has become an inexorable trend, the older population composes a larger and considerably vulnerable community. Falls are a common and serious health threat, which have caused numerous injuries and deaths and have placed a heavy financial burden on older adults. Each year, 28-35% of people aged 65 and over experience at least one fall, which is associated with risk factors from biological, socioeconomic, behavioural, and environmental domains. To prevent falls, sufficient epidemiological evidence concerning the occurrence of falls and their risk factors are of major importance. Meanwhile, recurrent falls are a major cause of fall-related injuries and deaths, which make it a significant type of falls. However, while most studies focused on the annual frequency or the spatial pattern of falls, few studies have investigated the temporal pattern of falls, particularly of single falls and recurrent falls separately. Furthermore, there is a lack of studies taking into account risk factors from four dimensions at the same time. Additionally, little is known about the difference between risk factors for single falls and recurrent falls. This thesis aims to (i) review systematically the existing cohort studies on risk factors for falls within the community-dwelling older population; (ii) examine temporal patterns, including time trends and seasonal patterns, in any, single, and recurrent falls; and (iii) identify the associated factors of any, single, and recurrent falls. First, a systematic review and meta-analysis was performed to investigate the falls risk factors in cohort studies published after 2008. Then, a two-phase study was conducted using a dataset including the 10-year Minimum Data Set-Home Care assessment records of older adults first applying for publicly funded long-term care services in Hong Kong (2005-2014). This dataset was obtained from the InterRAI Corporation to examine the temporal pattern and identify the risk factors of any, single, and recurrent falls among community-dwelling older adults. Pooled odds ratio from the meta-analysis shows that for any falls, falls history and impaired balance were the factors with the highest risk among the 20 studied factors, while for recurrent falls, falls history, advancing age, depression, and dizziness are the prominent factors with high risk among the studied factors. In the two-phase study, the risk of any, single, and recurrent falls decreased over ten years and peaked during the cold months in Hong Kong. The crucial associated factors for any falls were Parkinson’s disease and faecal incontinence, while that for single falls was bladder incontinence, and those for recurrent falls were Parkinson’s disease and locomotion outdoors. Age and gender have significant interaction effects on association of certain associated factors for any, single, and recurrent falls. The findings implied that implementing exercise intervention, enhancing falls health education, and sending a reminder to older adults would be needed to reduce falls, particularly, during the fall season. As the associated factors and their interaction effects with age and gender are different in any, single, and recurrent falls, different subgroups should be targeted to prevent any, single, and recurrent falls effectively. (498 words)