BACKGROUND: Falls guidelines recommendations for individuals classified as 'not-at-risk' range from no further actions to offering education and exercises. However, there is a scarcity of prospective studies analysing the rate of falls and injuries in this not-at-risk group to inform recommendations.
OBJECTIVE: To prospectively estimate the rate of falls and injuries in older adults considered 'not-at-risk' for falls.
DESIGN: Prospective cohort study.
SETTING: Geriatric Medicine Clinics.
SUBJECTS: Community-dwelling older adults aged 65 and older.
METHODS: Falls risk stratification was operationalised by adapting the Centers for Disease Control and Prevention's Stopping Elderly Accidents, Deaths and Injuries algorithm. Associations of risk strata (screened not-at-risk vs. at-risk) with incident falls and injuries were estimated using incidence rate ratios [adjusted incident rate ratio (aIRR), Poisson regression model]. Associations between slow gait speed (<1 m/s) and injurious falls were estimated by risk strata using hazard ratios (adjusted hazard ratio, Cox and Poisson regression model).
RESULTS: Of 403 participants, 64% of at-risk individuals fell during the follow-up compared to 41.3% in the not-at-risk group, whilst injurious falls were reported by 63.2% of the not-at-risk group and by 59.7% of the at-risk group. At-risk individuals had a higher rate of falls (aIRR = 3.91, 95% CI: 3.30-4.64, P < .001) but a similar rate of injurious falls as the not-at-risk individuals (aIRR = 1.26, 95% CI: 0.93-1.71; P = .11). Not-at-risk individuals with slow gait speed sustained injurious falls at twice the rate (aIRR = 1.83, 95% CI: 1.12-3.91, P = .008) than those without slow gait speed.
CONCLUSIONS: Being screened as not-at-risk for falls does not mean no risk at all. Routinely and universally assessing gait speed could identify not-at-risk individuals who are likely to sustain injuries after a fall and could benefit from primary prevention.
| Discipline Area | Score |
|---|---|
| Family Medicine (FM)/General Practice (GP) |  |
| General Internal Medicine-Primary Care(US) | |
| Geriatrics | |
Very interesting result that poses a question on whether the current fall risk assessment process is enough. Should mobility speed assessment be included (e.g.,"timed up and go" test) in those identified as "low risk" for falls?
Falls are a big problem in the geriatric population, often with dire consequences if injury occurs secondary to the fall. Spotting those at fall risk is very important for implementing preventive measures. I am not surprised that gait speed was found to be a better indicator of fall risk because it does help geriatricians get an idea of a person's functionality and overall health.
