Falls in older people with diabetes: Identification of simple screening measures and explanatory risk factors (original) (raw)
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Falls as a complication of diabetes mellitus in older people
Journal of Diabetes and its Complications, 2006
Objectives: The aims of this study were to determine the incidence of falls in a group of elderly patients with diabetes and to assess for the prevalence of risk factors for falls in this population. Design: This is a population-based study with questionnaire-based interviews. Setting: The setting for this study was the London District General Hospital outpatient department. Participants: Seventy-seven patients with diabetes, aged over 65 years, randomly selected whilst attending for general diabetic annual review. Patients with dementia, blindness, and immobility and those who were unable to give informed consent were excluded from this study. Measurements: The incidence of falls in the last 12 months was used. Information was collected on the incidence of hypoglycaemic episodes, the presence of other medical conditions, visual impairment, and peripheral neuropathy, the use of medications and walking aids, and HbA1C and blood pressure control. Results: The incidence of falls was 39%. Falls occurred more frequently in female patients and patients of increasing age. Falls occurred more frequently in patients with poor diabetic control [risk ratio (RR)=7.83 (2.948-20.799), v 2 value = 6.422]; patients requiring assistance with mobility: for those mobile with a stick [RR=1.839 (1.048-3.227), v 2 = 4.619]; and those who had previously suffered a stroke [RR=1.929 (1.143-3.257), v 2 = 4.615]. Conclusion: We provide evidence that poorly controlled diabetes and conditions associated with complications of diabetes are associated with an increased risk of falling in older people. We recommend early recognition of the multiple causes of falls in the older diabetic patient and prompt referral of this group of patients to a specialist falls clinic.
Risk factors for falls in older disabled women with diabetes: the women's health and aging study
The Journals …, 2005
Background. The aim of this study was to determine whether older disabled women with diabetes have an increased risk of falls compared to women without diabetes and to identify fall risk factors among this high-risk subgroup of patients. Methods. Data are from the Women's Health and Aging Study I (n ¼ 1002, age 65 years), a prospective, populationbased cohort study of the one third most disabled women in the Baltimore (MD) urban community-dwelling population. Participants were followed semiannually for 3 years. Falls were ascertained at each interview. Diabetes was ascertained by means of a standardized algorithm using multiple sources of information. Results. Baseline prevalence of diabetes was 15.5%. Of the 878 women who participated in at least one follow-up visit and were able to walk at baseline, 64.9% fell at least once during the study and 29.6% experienced two or more falls during a follow-up interval. After adjustment for traditional risk factors, women with diabetes had a higher probability of any fall (odds ratio [OR] 1.38; 95% confidence interval [CI], 1.04-1.81) and of falling two or more times during a follow
Age and Ageing, 2011
Objectives: to compare the incidence of recurrent falls in older people with and without diabetes, and to examine diabetesand fall-related risk factors explaining the increased risk of recurrent falls associated with diabetes. Methods: population-based cohort study of 1,145 (85 with diabetes) community-dwelling participants, aged ≥65 years, from The Longitudinal Aging Study Amsterdam (LASA). Falls were assessed prospectively (every 3 months) during a 3-year follow-up period. Incidence of recurrent falls was estimated with Poisson regression analyses. The associations between diabetes and time to recurrent falls, defined as at least two falls occurring within a 6-month period, and the potential explanatory role of several risk factors herein, were analysed with the use of Cox-regression models. Results: during a mean follow-up of 139 weeks, 30.6% of the individuals with and 19.4% of the individuals without diabetes fell recurrently [incidence rate of 129.7 versus 77.4 per 1,000 persons-years, respectively, HR = 1.67 (95% CI: 1.11-2.51)]. Adjustments for potential confounders did not change the increased risk associated with diabetes [HR = 1.63 (1.06-2.52)]. Factors that partly explained this increased risk were: greater number of medication, higher levels of pain, poorer self-perceived health, lower physical activity and grip strength, more limitations in ADLs, lower-extremity physical performance and cognitive impairment. Altogether, these variables accounted for 47% of the increased risk of recurrent falls associated with diabetes [adjusted HR = 1.30 (0.79-2.11)]. Conclusion: fall prevention efforts targeting the factors identified above may need to be incorporated into the care and treatment of older individuals with diabetes.
Comparative analysis of risk for falls in patients with and without type 2 diabetes mellitus
Revista da Associação Médica Brasileira (English Edition), 2012
Objective: To compare frequency and risk of falls based on a functional mobility test in diabetic and non-diabetic individuals. Methods: Cross-sectional study involving patients with and without type 2 diabetes mellitus (DM2) selected by convenience sampling. Men and women between the ages of 50 and 65 were included and divided as group 1 (G1) -with DM2 diagnosis for < 10 years fasting blood glucose at interview/test time, as well as prior > 200 mg/dL; and group 2 (G2) -no diabetes, same age group, and fasting blood glucose < 100 mg/dL. Both groups responded to a structured questionnaire about their health, fall risk, and underwent a physical exam and a mobility assessment test (Timed Up and Go -TUG). The results were analyzed by the software SPSS, with TUG being categorized in ranges of risk for fall. We considered that the risk was positive for all those who fit into medium-and high-risk range. Results: Fifty patients with DM2 and 68 patients without DM2 were assessed. There were no statistical differences in the number of falls between the groups, however non-diabetic subjects obtained a higher performance in TUG test (p = 0.003) as the risk categories were observed. Reduced visual acuity and difficulty in getting up were more frequently reported in G1 (p < 0.05). Conclusion: There appears to be an association between hyperglycemic status and poorer mobility, with an increased fall risk even in younger patients and in those with shorter disease duration.
Pakistan Journal of Medical and Health Sciences, 2022
Background: Diabetes Mellitus type 2 causes multiple complications like peripheral neuropathy, retinopathy and vestibulopathy. Diabetic neuropathy was one of the very common and long-term complications of DM which worsen throughout time. Postural variability and balance illness were mutual findings in DN due to lessened proprioception. Objective: The objective was to determine the frequency of elderly patients with diabetes type II having risk of Fall and impaired Balance. Methods: It was a cross sectional study. The Sample size was 133 participants surveyed through convenient sampling technique. Total time from May to October 2021 was utilized for study. Berg Balance Scale was used to determine the risk of fall in older adults having diabetes mellitus type 2. Participants were appearing for assessment for once. Data was analyzed on SPS S version 25. Results: The result showed that 76.7% patients were independent in their daily life activities. The results of our study were that total 23.3% patients were at the risk of fall. The means and standard deviation of total score of Berg Balance Scale was found to be 44.49±10.48. Conclusion: Based on findings of study it was concluded about one fourth of patients were at risk of fall and impaired balance. The adverse effects associated with diabetes mellitus like retinopathy, vestibulopathy and diabetic neuropathy may contribute to worsening balance and fall risk.
Endocrine Practice, 2017
Falls are a major health issue for older adults, leading to adverse events and even death. 2. Older persons with type 2 diabetes are at increased risk of falling compared to healthy adults of a similar age. 3. Over 400 factors are associated with falls risk, making identification and targeting of key factors to prevent falls problematic. However, the major risk factors include hypertension, diabetes, pain, and polypharmacy. 4. In addition to age and polypharmacy, diabetes-related loss of strength, sensory perception, and balance secondary to peripheral neuropathy along with decline in cognitive function lead to increased risk of falling. 5. Designing specific interventions to target strength and balance training, reducing polypharmacy to improve cognitive function, relaxation of diabetes management to avoid hypoglycemia and hypotension, and relief of pain will produce the greatest benefit for reducing falls in older persons with diabetes.
Analysis of risk factors for falls in geriatric patients: a single institutional experience
International Journal of Advances in Medicine, 2019
A fall is defined as "unintentionally coming to the ground or some lower level and other than as a consequence of sustaining a violent blow, loss of consciousness, sudden onset of paralysis as in stroke or an epileptic seizure. 1 Although falls can occur at all ages, the frequency and severity of fall-related injuries increase with age; the term "older person" or elderly has been used to refer to people aged 65 years and older. 2 Individuals over 65 years of age fall each year; the incidence of falls in those over 75 years of age is 32-42%. 3 The annual incidence of falls in elderly diabetic individuals is 39%. 4 Diabetic complications lead to a multitude of impairments, which would constitute many recognized risk factors for falls. 5 There are several independent risk factors for falling and ABSTRACT Background: In elderly people, falls have been recognized as one of the major causes of disability and potentially preventable mortality. Authors analyzed the incidence of falls in elderly diabetic people who have been receiving insulin therapy versus those on oral hypoglycaemic agents (OHGAs). Methods: This observational study was conducted at the department of neurology of Shorsh military general teaching hospital and its outpatients' department, Iraq, from April 1 st to September 30 st , 2016. A total of 100 diabetic patients older than 65 years of age, who had a history of one or more falls, were included in the study. The duration of diabetes, mode of its treatment, and its complications all were analyzed in addition to the risk factors for falls. Results: Females (n=57) outnumbered males (n=43) and the mean age of the patients was (71.2±3.6) years. Increasing patient's age, long-standing diabetes, poor glycaemic control, insulin therapy, and polypharmacy (of 3 and more antidiabetic agents) were significantly and statistically encountered and associated parameters for the risk of falls. The presence of additional risk factors for falls (e.g., previous stroke, alcoholism, cardiac dysrhythmia, and osteoarthrosis) augmented this risk. Conclusions: Diabetes and its treatment render older people more liable for falls. The longer duration of the disease and the higher patients' age (which were the commonest risks) are irreversible and non-correctable parameters for falls. Further analytic studies are required to unveil the role of each risk factor authors have detected.