title: Frailty and risk of falls, fracture, and mortality in older women: the study of osteoporotic fractures. Effects of Thiazide Diuretic Therapy on Bone Mass, Fractures, and Falls Cerebral White Matter Lesions, Gait, and the Risk of Incident Falls: A Prospective Population-Based Study An age-related decrease in creatinine clearance is associated with an increase in number of falls in untreated women but not in women receiving calcitriol treatment. Different cognitive functions in relation to falls among older persons. Immediate memory as an independent risk factor for falls. Incidence and consequences of falls among elderly people living in the community. A risk profile for identifying community-dwelling elderly with a high risk of recurrent falling: results of a 3-year prospective study Non-syncopal falls in the elderly in relation to home environments Poor vision accompanied with other sensory impairments as a predictor of falls in older women. Endogenous testosterone levels, physical performance, and fall risk in older men. Higher risk of multiple falls among elderly women who lose visual acuity. Physiological factors associated with falls in older community-dwelling women. Older women with diabetes have a higher risk of falls: a prospective study. Predictors for occasional and recurrent falls in community-dwelling older people A classification tree for predicting recurrent falling in community-dwelling older persons. Can Echocardiographic Findings Predict Falls in Older Persons? Late-life anemia is associated with increased risk of recurrent falls. Predictors for falls and fractures in the Longitudinal Aging Study Amsterdam. Environmental Hazards and the Risk of Nonsyncopal Falls in the Homes of Community-Living Older Persons Incidence and predictors of falls in the chinese elderly. Falls in the elderly: a prospective study of risk factors and risk profiles. History and mobility exam index to identify community-dwelling elderly persons at risk of falling. Binocular visual-field loss increases the risk of future falls in older white women. Self-reported sleep and nap habits and risk of falls and fractures in older women: the study of osteoporotic fractures. Self-reported alcohol consumption and falls in older adults: cross-sectional and longitudinal analyses of the cardiovascular health study. Musculoskeletal pain and risk for falls in older disabled women living in the community. Falls and fear of falling: which comes first? A longitudinal prediction model suggests strategies for primary and secondary prevention. Fall-risk screening test: a prospective study on predictors for falls in community-dwelling elderly. The Physical Performance Test as a predictor of frequent fallers: a prospective community-based cohort study Alcohol intake and its relationship with bone mineral density, falls, and fracture risk in older men. A two-year longitudinal study of falls in 482 community-dwelling elderly adults. Prospective association between physical activity and falls in community-dwelling older women Central nervous system-active medications and risk for falls in older women. Falls risk among a very old home-dwelling population Social status, life changes, housing conditions, health, functional abilities and life-style as risk factors for recurrent falls among the home-dwelling elderly. Association between Parkinson's disease and low bone density and falls in older men: the osteoporotic fractures in men study. Predictors of falls in the elderly by location Risk factors for falls among elderly persons living in the community. Higher 1,25-dihydroxyvitamin D3 concentrations associated with lower fall rates in older community-dwelling women A risk model for the prediction of recurrent falls in community-dwelling elderly: a prospective cohort study. Genetic factors and susceptibility to falls in older women. Forgetting falls. The limited accuracy of recall of falls in the elderly. Home hazards and falls in the elderly: the role of health and functional status. Walking and talking as predictors of falls in the general population: the Leiden 85-Plus Study. Clinical history and biologic age predicted falls better than objective functional tests. Predictors for recurrent falls among the home-dwelling elderly. Vitamin D status in relation to one-year risk of recurrent falling in older men and women. Effects of Central Nervous System Polypharmacy on Falls Liability in Community-Dwelling Elderly
abstract: BACKGROUND A st and ard phenotype of frailty was associated with an increased risk of adverse outcomes including mortality in a recent study of older adults . However , the predictive validity of this phenotype for fracture outcomes and across risk subgroups is uncertain . METHODS To determine whether a st and ard frailty phenotype was independently associated with risk of adverse health outcomes in older women and to evaluate the consistency of associations across risk subgroups defined by age and body mass index ( BMI ) , we ascertained frailty status in a cohort of 6724 women > or=69 years and followed them prospect ively for incident falls , fractures , and mortality . Frailty was defined by the presence of three or more of the following criteria : unintentional weight loss , weakness , self-reported poor energy , slow walking speed , and low physical activity . Incident recurrent falls were defined as at least two falls during the subsequent year . Incident fractures ( confirmed with x-ray reports ) , including hip fractures , and deaths were ascertained during an average of 9 years of follow-up . RESULTS After controlling for multiple confounders such as age , health status , medical conditions , functional status , depressive symptoms , cognitive function , and bone mineral density , frail women were subsequently at increased risk of recurrent falls ( multivariate odds ratio=1.38 , 95 % confidence interval [ CI ] , 1.02 - 1.88 ) , hip fracture ( multivariate hazards ratio [MHR]=1.40 , 95 % CI , 1.03 - 1.90 ) , any nonspine fracture ( MHR=1.25 , 95 % CI , 1.05 - 1.49 ) , and death ( MHR=1.82 , 95 % CI , 1.56 - 2.13 ) . The associations between frailty and these outcomes persisted among women > or=80 years . In addition , associations between frailty and an increased risk of falls , fracture , and mortality were consistently observed across categories of BMI , including BMI > or=30 kg/m2 . CONCLUSION Frailty is an independent predictor of adverse health outcomes in older women , including very elderly women and older obese women Osteoporosis is responsible for about 1.3 million fractures in the United States each year [ 1 ] . Further , recent research has shown that the risk for most types of fracture in elderly women is related to low bone mass ; thus , the public health impact of osteoporosis may , in fact , be much greater [ 2 ] and is projected to increase over the next several decades [ 3 ] . Postmenopausal estrogen replacement is the current recommended therapy for the prevention of osteoporosis [ 4 ] . However , the use of estrogen is not widespread among elderly women [ 5 ] . Clearly , more options for the prevention of osteoporosis and fracture need to be developed and explored . One option is the use of thiazide diuretics . Thiazide diuretics are known to reduce urinary excretion of calcium [ 6 , 7 ] and may also decrease bone resorption [ 6 ] and bone turnover [ 8 ] . The use of thiazide diuretics has been associated with a reduced risk for fracture , with risk ratios ranging from 0.3 to 0.8 [ 9 - 18 ] . For example , in a casecontrol study that excluded patients taking other drugs thought to affect bone mass , Ray and colleagues [ 15 ] found a 50 % reduction in the risk for hip fracture among patients who had used thiazide diuretics  for 6 years . In addition , LaCroix and colleagues [ 16 ] reported a 30 % lower risk for hip fracture in current users compared with nonusers . The Framingham Study also showed a lower risk for hip fracture among users of pure thiazide drugs when compared with those using agents that combined thiazide diuretics with other antihypertensive drugs [ 17 ] . However , all of these studies have been observational , which allows the possibility that users of thiazide diuretics have a lower risk for hip fracture because of other confounding factors . In addition , the more recent data of Heidrich and colleagues [ 19 ] conflict with these results . These investigators found a crude odds ratio for thiazide use and hip fracture of 1.1 , which is not statistically significant . However , when they adjusted for the potentially confounding effects of nursing-home residence ; previous hospitalizations ; history of stroke , alcoholism or organic brain syndrome ; body weight ; leg paralysis ; and use of phenobarbital , corticosteroids , or other diuretics , a significantly increased risk for hip fracture was found among women who reported current use of thiazide diuretics  [ 19 ] . No study has prospect ively evaluated the relation between thiazide diuretics and other types of fracture . The mechanism by which thiazide diuretics might protect against hip fracture is not known . Thiazide diuretics may decrease fracture risk by preserving bone mass [ 10 , 11 , 20 - 23 ] . Cross-sectional studies have shown that users of thiazide diuretics have slightly higher cortical and trabecular bone mass than nonusers . Two r and omized clinical studies of the effect of thiazide diuretics on bone loss had conflicting results [ 24 , 25 ] . If thiazide diuretics reduce the risk for hip fracture by slowing bone loss , then these agents should also protect against other types of fracture that are associated with reduced bone mass [ 2 ] . On the other h and , thiazide diuretics could increase the risk for fractures by increasing the risk for falls [ 26 ] . Thiazide diuretics might do this by causing dizziness or postural hypotension [ 27 ] , although the association of diuretic use with falling is not consistent [ 28 ] . More than 90 % of hip fractures are related to falls [ 29 ] . No previous study has included a comprehensive analysis of the effects of thiazide diuretics on bone mass , the risk for falls , and the risk for all fractures in a single population . In our prospect i ve study of 9704 women who were 65 years or older ( the Study of Osteoporotic Fractures ) , we assessed thiazide diuretic use and bone mass at baseline and conducted follow-up examinations every 4 months for the occurrence of fractures and falls . Methods Study Sample From September 1986 through October 1988 , women who were at least 65 years old were recruited for the Study of Osteoporotic Fractures in four areas of the United States : Portl and , Oregon ; Minneapolis , Minnesota ; Baltimore County , Maryl and ; and the Monongahela Valley region near Pittsburgh , Pennsylvania . Age-eligible women were recruited through several sources : health maintenance organizations ; lists of residents that had been compiled for other epidemiologic studies ; jury- selection lists ; voter- registration lists ; and lists of driver 's license holders [ 30 ] . We excluded black women because of their lower incidence of fractures , women who were unable to walk without the assistance of another person , and women who had bilateral hip replacements . Measurement of Bone Mass Bone mineral content ( g/cm ) and density ( g/cm2 ) were measured using single-photon absorptiometry ( OsteoAnalyzer , Siemens-Osteon , Wahiawa , Hawaii ) . Details of these methods have been reported elsewhere [ 30 ] . We scanned three sites : the distal radius , the proximal radius , and the calcaneus . The distal radius is composed of about 60 % cortical bone and 40 % trabecular bone , the proximal radius is about 99 % cortical bone [ 31 ] , and the calcaneus is about 97 % trabecular bone [ 32 ] . The reproducibility of the bone mass measurements , expressed as coefficients of variation , ranged from 1.3 % to 2.0 % among individuals and from 0.4 % to 1.2 % among scanners [ 30 ] . Diuretic Use Information on diuretic use was obtained at the baseline clinic interview . Participants were asked to bring all current medications to the clinic for verification . In addition , pictures of tablets were presented to participants to assist them in the re collection of previously prescribed diuretics . Diuretics , including combination drugs , were classified as thiazide diuretics according to the American Medical Association drug evaluations [ 33 ] . Separate histories were obtained from participants for use of thiazide and nonthiazide diuretics . Chlorthalidone was classified as a thiazide diuretic because its effects on calcium excretion are similar to those of thiazide diuretics . Analyses in which chlorthalidone was not considered as a thiazide diuretic yielded similar results . Women were asked whether they had ever taken diuretics ; at what age they had started taking diuretics ; whether they were currently using diuretics and , if not , when they had stopped ; whether they took diuretics the entire time or stopped for a few years ; and the name of the medication they were currently using . Duration of diuretic use was calculated as the total number of years that they reported using diuretics . No information was collected on dose at the baseline visit , but dose-related data were recorded at the first annual telephone interview . Information on duration of thiazide diuretic use was missing in 15 women . These women were excluded from all analyses . Other Measurements Reported health status , type of menopause , alcohol consumption , and cigarette smoking were assessed using a question naire that was review ed with the participant by a trained interviewer . Women were considered to have had a surgical menopause if they reported having had a bilateral oophorectomy at the age at which they stopped menstruating . Regarding alcohol consumption , participants were asked how much they had consumed during the past 30 days and how many times they had consumed three or more drinks per day and five or more drinks per day during the past 30 days . The measure of alcohol consumption used in our study was drinks per week , which was adjusted for atypical drinking , particularly heavy drinking over the last 30 days .  Dietary calcium  was assessed by a food frequency question naire and an interview using st and ardized food models to estimate portion sizes [ 34 ] . In our study , total calcium intake included dietary and supplemental calcium . Women were also asked if they had ever taken the following medications : thyroid hormones , medicine for seizures , vitamin D or multivitamins containing vitamin D , TUMS , calcium supplements , antacids , prednisone , cortisone , other steroid pills , birth control pills , estrogen pills , estrogen skin patches , estrogen vaginal cream or suppositories , estrogen injections , and progestins . Information was obtained on current use , duration of use , and specific drug and dosage used for the longest period . Functional status was measured by a respondent 's answers to questions about her ability to perform six instrumental activities of daily living by herself and without using special aids or equipment . These activities were as follows : walking two or three blocks outside on level ground ; climbing up 10 steps without stopping ; walking down 10 steps ; preparing one 's own meals ; doing heavy housework ; and doing one 's own shopping for groceries or clothes . The measure used in these analyses is the total number of activities ( ranging from 0 to 6 ) that a woman reported she was unable to do or had difficulty doing . Additionally , women were asked to rate their health status as very good , good , fair , poor , or very poor . During the clinic examination , body weight was measured ( after removal of shoes and heavy outer clothing ) using a balance beam scale . Height was measured ( after removal of shoes ) using a Harpenden stadiometer ( Holtain , Ltd. , Dyved , United Kingdom ) . Height and weight were used to calculate the body mass index ( kg/m2 ) . Ascertainment of Prevalent Vertebral Deformities The prevalence of vertebral deformities as shown by lateral thoracic and lumbar spine films was obtained on 2992 women ( 31 % of the cohort ) who were between 65 and 70 years old . The methods used to identify vertebral deformities have been described previously [ 35 ] . In summary , six points for each vertebral body , T4 through L4 , were marked with a translucent digitizer . We calculated three heights ( anterior , posterior , and middle ) and three ratios : anterior-to-posterior height ( wedge ) ; mid-to-posterior height ( endplate ) ; and the posterior height of each vertebra to the posterior height of the adjacent vertebrae ( crush ) . We classified a vertebral body Background and Purpose — The association between cerebral white matter lesions ( WMLs ) and the risk of falls in older people is uncertain , with no supporting prospect i ve evidence . We aim ed to determine the risk of incident falls associated with WML volume , and the interactions between WML volume , gait , and other sensorimotor factors leading to falls . Methods — We conducted a prospect i ve , population -based study ( n=294 , mean age 72.3 years , independently mobile ) .  Volumetric MRI , computerized gait measures , and sensorimotor measures of falls risk  were obtained at baseline . Incident falls were recorded prospect ively over a 12-month period . Using regression modeling , we estimated the risk of incident falls associated with baseline WML volume . Results — Increasing baseline WML volume was independently associated with any incident fall ( P=0.01 ) and multiple incident falls ( P=0.02 ) . The risk of incident falls was doubled in people with lesion volumes in the highest quintile of its distribution compared with the lowest ( adjusted relative risk , 2.32 ; 95 % CI , 1.28–4.14 ) . Greater lesion volume was also associated with poorer gait and greater gait variability ( both P<0.001 ) . The effect of WML volume on the risk of falls was magnified in people with poorer quadriceps muscle strength ( P=0.03 ) and greater gait variability ( P=0.001 ) . Conclusions — These data provide the first prospect i ve evidence to our knowledge demonstrating that WMLs are strong risk factors for falls in the general older population . WMLs present potential therapeutic targets for interventional trials in falls prevention CONTEXT Decreased calcitriol production due to impaired renal function may be a significant risk factor for falls in normal aging population . OBJECTIVE The objective of the study was to examine the association between creatinine clearance ( CrCl ) and the incidence of falls and fallers in groups treated with placebo , calcitriol , estrogen therapy (ET)/estrogen + progestin therapy ( HT ) , and calcitriol + ET/HT . DESIGN This was a 3-yr , double-blind , placebo-controlled study design ed to test the efficacy of calcitriol and ET/HT on bone loss and falls with analysis by intention to treat and post hoc . SETTING The study was conducted at an academic outpatient center . PARTICIPANTS Four hundred eighty-nine normal elderly women aged 65 - 77 yr ; 415 women completed the study . INTERVENTION Subjects were r and omized to placebo , calcitriol 0.25 mug twice a day , ET daily ( conjugated equine estrogens 0.625 mg ) , HT ( conjugated equine estrogen 0.625 mg + medroxyprogesterone acetate 2.5 mg ) and calcitriol + ET/HT . MAIN OUTCOME MEASURES Cumulative number of falls and fallers were compared between groups with 24-h urine CrCl less than 60 and 60 ml/min or greater . RESULTS Calcitriol treatment decreased the number of fallers and falls . Low CrCl less than 60 ml/min was a predictor of the number of falls per person but not fallers in the placebo group ( P = 0.007 ) . In the low CrCl group ( < 60 ml/min ) , the rate of falls decreased on calcitriol by 53 % [ 95 % confidence interval ( CI ) -71 % to -22 % ; P = 0.003 ] , calcitriol + ET/HT by 61 % ( 95 % CI -76 % to -37 % ; P = 0.001 ) , and ET/HT by 25 % ( 95 % CI : -55 % to + 24 % ; not significant ) . Calcitriol reduced the rate of falls by 30 % ( 95 % CI -49 % to -4 % ; P = 0.027 ) in the CrCl 60 ml/min or greater group . CONCLUSION Calcitriol treatment decreases falls in all subjects but especially in elderly women with decreased renal function ( < 60 ml/min ) and frequent fallers It is not clear which specific cognitive function is strongest related to falls . To investigate this , not only " general cognitive functioning , " but also " nonverbal and abstract reasoning , " " information processing speed , " and " immediate memory " were related to falls . Furthermore , relevant effect modifiers , confounders , and mediators were identified . This study was performed within the Longitudinal Aging Study Amsterdam ( LASA ) , a multidisciplinary , prospect i ve cohort study . In this study ( n = 1437 ) , an interaction between " immediate memory " and age was found . In persons aged 75 years and over , " immediate memory , " as measured by the  15 Words Test  , showed to be an independent risk factor for falls . Part of this relationship was explained by the mediating effects of activity , mobility , and grip strength . The association between the other cognitive functions and falls was only statistically significant in univariate analysis . We conclude that " immediate memory " is an independent risk factor for recurrent falls in persons aged 75 years and older BACKGROUND AND OBJECTIVES To evaluate the incidence of falls according to socio-demographic and health factors , and to determine their physical , psychological and social consequences . SUBJETS AND METHOD : Population -based prospect i ve study , which included a representative cohort of 448 elderly community-dwellers , aged 65 or more living in the city of Mataró ( Spain ) . We made a baseline evaluation , which was repeated after a one-year follow up , consisting of a st and ardized question naire on socio-demographic characteristics , physical activity , tests of physical and cognitive function , history of falls during the previous year , the Falls Efficacy Scale , and associated chronic conditions .  Follow-up interviews at intervals of one month over 12 months , consisting of a st and ardized question naire aim ed at detecting and describing any fall occurred during the previous month . RESULTS 25.1 % ( 95 % CI , 18.8 - 31.4 ) of males and 37.0 % ( 95 % CI , 31.2 - 42.8 ) of females fell . Multiple falls were observed in 3.8 % of men and 10.9 % of women . 203  falls  were reported , providing a crude incidence rate of 30.9 falls per 100 men-years ( 95 % CI , 23.3 - 41.0 ) and 56.5 falls per 100 women-years ( 95 % CI , 46.5 - 68.8 ) . A positive association with falls was found with age , reduced physical and cognitive function , associated chronic conditions and previous falls . 71.1 % of falls had physical consequences , with 7.7 % of fractures , and 21.7 % needed medical aid . 64.4 % of fallers feared of falling again . CONCLUSIONS Our study shows a pattern of high incidence of falls among the elderly living in the Spanish non-institutionalized community . Our data confirm that adverse consequences derived from the falls are frequent and often severe , which makes falls one of the major problems of elderly people Introduction The aim of the prospect i ve study reported here was to develop a risk profile that can be used to identify community-dwelling elderly at a high risk of recurrent falling .  Material s and methods The study was design ed as a 3-year prospect i ve cohort study . A total of 1365 community-dwelling persons , aged 65 years and older , of the population -based Longitudinal Aging Study Amsterdam participated in the study . During an interview in 1995/1996 , physical , cognitive , emotional and social aspects of functioning were assessed . A follow-up on the number of falls and fractures was conducted during a 3-year period using fall calendars that participants filled out weekly . Recurrent fallers were identified as those who fell at least twice within a 6-month period during the 3-year follow-up . Results The incidence of recurrent falls at the 3-year follow-up point was 24.9 % in women and 24.4 % in men . Of the respondents , 5.5 % reported a total of 87 fractures that result ed from a fall , including 20 hip fractures , 21 wrist fractures and seven humerus fractures . Recurrent fallers were more prone to have a fall-related fracture than those who were not defined as recurrent fallers ( 11.9 % vs. 3.4 % ; OR : 3.8 ; 95 % CI : 2.3–6.1 ) . Backward logistic regression analysis identified the following predictors in the risk profile for recurrent falling : two or more previous falls , dizziness , functional limitations , weak grip strength , low body weight , fear of falling , the presence of dogs/cats in the household , a high educational level , drinking 18 or more alcoholic consumptions per week and two interaction terms ( high education × 18 or more alcohol consumptions per week and two or more previous falls × fear of falling ) ( AUC=0.71 ) . Discussion At a cut-off point of 5 on the total risk score ( range 0–30 ) , the model predicted recurrent falling with a sensitivity of 59 % and a specificity of 71 % . At a cut-off point of 10 , the sensitivity and specificity were 31 % and 92 % , respectively . A risk profile including nine predictors that can easily be assessed seems to be a useful tool for the identification of community-dwelling elderly with a high risk of recurrent falling Methods of prevention of falls in the home may differ for healthy and frail individuals . We therefore sought to determine whether measures of health and functioning in older persons are more useful in predicting  falls at home not involving home hazards ( non-environmental falls ) than falls at home related to home hazards ( environmental falls ) , and whether these relationships differ among those who fell once and those who fell multiple times during follow-up . Data for this analysis are from a 1-year prospect i ve cohort study of 325 community-dwelling volunteers aged 60–93 years who had fallen during the year before baseline . In general , associations were stronger between poor functional ability and non-environmental falls than between poor functional ability and environmental falls . Independent predictors of  non-environmental first falls during follow-up included Parkinson 's disease ( adjusted odds ratio ( AOR ) 7.66 , 95 % confidence interval ( 95 % CI ) 1.15–51.1 ) and being home alone 10 or more hours per day ( AOR 2.36 , 95 % CI 1.20–4.61 ) ; independent predictors of environmental first falls during follow-up included arthritis ( AOR 2.60 , 95 % CI 1.32–5.09 ) and poor depth perception ( AOR 0.73 , 95 % CI 0.59–0.89 , for each unit increase in depth perception score ) . Also , associations between poor function and falls were generally stronger among participants who fell repeatedly than among individuals who fell only once during the follow-up year . In conclusion , poor function predisposes to  non-environmental falls  at home in older persons and , to a lesser extent , environmental falls in those who fall repeatedly . Certain functional characteristics such as poor depth perception may predispose to environmental falls to a greater extent than do other disabilities OBJECTIVES we studied visual acuity ( VA ) and co-existing hearing impairment and poor st and ing balance as predictors of falls . DESIGN prospect i ve study with 1-year follow-up . SETTING research laboratory and residential environment . PARTICIPANTS 428 women aged 63 - 76 years from the Finnish Twin Study on Aging . MEASUREMENTS participants were followed up for incidence of falls over 1 year .  VA , hearing ability and st and ing balance  were assessed at the baseline . The incidence rate ratios ( IRR ) for falls were computed using the negative binomial regression model . RESULTS during the follow-up , 47 % of participants experienced a fall . After adjusting for age and interdependence of twin sisters , participants with vision impairment ( VA of < 1.0 ) but no other sensory impairments had a higher , but non-significant , risk for falls compared to persons with normal vision ( IRR 1.5 , 95 % CI 0.6 - 4.2 ) . Co-existing vision impairment and impaired balance increased the risk ( IRR 2.7 , 95 % CI 0.9 - 8.0 ) , as also did co-existing vision and hearing impairment ( IRR 4.2 , 95 % CI 1.5 - 11.3 ) , compared to those with normal vision . Among persons with all three impairments , the IRR for falls increased to 29.4 ( 95 % CI 5.8 - 148.3 ) compared to participants with good vision . CONCLUSION the impact of vision impairment on fall risk was higher when accompanied with other sensory and balance impairments , probably because the presence of other impairments prevented the reception of compensatory information about body posture and environment being received from other sensory sources . When aim ing to prevent falls and their consequences in older people , it is important to check whether poor vision is accompanied with other impairments BACKGROUND Gonadal steroid levels decline with age in men . Whether low testosterone levels affect the development of common age-related disorders , including physical functioning and falling , is unclear . METHODS This longitudinal , observational follow-up study sought to determine whether low testosterone levels are associated with physical performance and fall risk in older men . A total of 2587 community-based men aged 65 to 99 years were selected using a stratified r and om sampling scheme from a study cohort of 5995 volunteers .  Bioavailable testosterone and estradiol levels and physical performance measures were determined from baseline . Incident falls were ascertained every 4 months during 4 years of follow-up . Generalized estimating equations were used to estimate risk ratios for the relation of sex steroids to falls . RESULTS Fifty-six percent of the men reported at least 1 fall ; many fell frequently . Lower bioavailable testosterone levels were associated with increased fall risk . Men with testosterone levels in the lowest quartile had a 40 % higher fall risk than those in the highest quartile . The effect of low testosterone levels was most apparent in younger men ( 65 - 69 years ) ( relative risk , 1.8 ; 95 % confidence interval , 1.2 - 2.7 ) ; testosterone level was not associated with falls in the oldest men ( > /=80 years ) . Lower testosterone concentrations were associated with reduced physical performance . However , the association between low testosterone levels and fall risk persisted despite adjustment for performance . CONCLUSIONS Falls were common among older men . Fall risk was higher in men with lower bioavailable testosterone levels . The effect of testosterone level was independent of poorer physical performance , suggesting that the effect of testosterone on fall risk may be mediated by other and rogen actions OBJECTIVE To determine the association between changes in visual acuity ( VA ) and  frequent falls in older women . DESIGN Prospect i ve cohort study . PARTICIPANTS Two thous and two elderly community-residing women participating in the Study of Osteoporotic Fractures with measurements of VA at baseline and a follow-up examination 4 to 6 years later ( mean of 5.6 years ) . METHODS Binocular VA with habitual correction was measured under st and ard illumination using Bailey-Lovie charts at baseline and fourth examinations . Change in VA was stratified into 5 categories : no change or VA gain , loss of 1 to 5 letters , loss of 6 to 10 letters , loss of 11 to 15 letters , and loss of > 15 letters . A separate analysis considered decline in VA as the loss of > or=10 letters ( > or=2 lines ) on the Bailey-Lovie acuity measure between baseline and follow-up examinations . MAIN OUTCOME MEASURES Data on falls were obtained from postcards sent every 4 months after the follow-up examination . Frequent falling was defined as > or=2 falls during a 1-year period after the follow-up examination . RESULTS Compared with women with stable or improved VA , women with declining acuity had significantly greater odds of experiencing frequent falling during the subsequent year . Odds ratios after adjustment for baseline acuity and other confounders were 2.08 ( 95 % confidence interval [ CI ] : 1.39 - 3.12 ) for loss of 1 to 5 letters , 1.85 ( 95 % CI : 1.16 - 2.95 ) for loss of 6 to 10 letters , 2.51 ( 95 % CI : 1.39 - 4.52 ) for loss of 11 to 15 letters , and 2.08 ( 95 % CI : 1.01 - 4.30 ) for loss of > 15 letters . In the analysis of visual decline defined as a loss of > or=10 letters , heightened risk of frequent falling was evident in each of 2 subgroups defined by splitting the sample on baseline VA , with borderline significant evidence of a more pronounced effect in those women with baseline VA of 20/40 or worse ( P value for interaction , 0.083 ) . CONCLUSIONS Loss of vision among elderly women increases the risk of frequent falls . Prevention or correction of visual loss may help reduce the number of future falls OBJECTIVE To determine the prevalence of impaired vision , peripheral sensation , lower limb muscle strength , reaction time , and balance in a large community-dwelling population of women aged 65 years and over , and to determine whether impaired performances in these tests are associated with falls . DESIGN One-year prospect i ve study . SETTING Conducted as part of the R and wick Falls and Fractures Study , in Sydney , Australia . PARTICIPANTS Four hundred fourteen women aged 65 to 99 years ( mean age 73.7 years , SD = 6.3 ) were r and omly selected from the community ; 341 of these women were included in the 1-year prospect i ve study . MAIN RESULTS The prevalence of impairment in all tests increased with age . In the year following assessment , 207 subjects ( 60.7 % ) experienced no falls , 63 subjects ( 18.5 % ) fell one time only , and 71 subjects ( 20.8 % ) fell on two or more occasions . After controlling for age , multiple falling was associated with low contrast visual acuity and contrast sensitivity , poor vibration sense and proprioception , reduced lower limb strength , slow reaction time , and impaired balance , as indicated by four sway tests and two clinical stability measures . Discriminant function analysis identified visual contrast sensitivity , proprioception in the lower limbs , quadriceps strength , reaction time , and sway on a compliant ( foam rubber ) surface with the eyes open as the variables that significantly discriminated between subjects who experienced multiple falls and subjects who experienced no falls or one fall only ( Wilks ' lambda = 0.73 ( P < 0.001 ) , canonical correlation = 0.52 ) . This procedure correctly classified 75 % of subjects into multiple faller or nonmultiple faller groups . CONCLUSIONS These findings support previous results conducted in retirement village and institutional setting and indicate that the test procedure aids in the identification of older community-dwelling women at risk of falls OBJECTIVE To determine whether older women with diabetes have an increased risk of falls and whether known risk factors for falls account for any increased risk . RESEARCH DESIGN AND METHODS This prospect i ve cohort study included 9,249 women > or = 67 years of age enrolled in the Study of Osteoporotic Fractures . Diabetes was determined by question naire at baseline . Physical performance was measured at the second examination . Subsequently , falls were ascertained every 4 months by postcard . RESULTS A total of 629 ( 6.8 % ) women had diabetes , including 99 who used insulin .  During an average of 7.2 years , 1,640 women ( 18 % ) fell more than once a year . Diabetes , stratified by insulin use , was associated with an increased risk of falling more than once a year ( age-adjusted odds ratio [ OR ] 1.68 [ 95 % CI 1.37 - 2.07 ] for non-insulin-treated diabetes ; age-adjusted OR 2.78 [ 1.82 - 4.24 ] for insulin-treated diabetes ) . In the first 2 years of follow-up , women with diabetes were not more likely to fall than women without diabetes ( 44 vs. 42 % ; P = 0.26 ) , but they had more falls ( 3.1 vs. 2.4 ; P < 0.01 ) . Women with diabetes were more likely to have other risk factors for falls , which appeared to account for the increased risk of falls associated with non-insulin-treated diabetes ( adjusted OR 1.18 [ 0.87 - 1.60 ] ) but not insulin-treated diabetes ( adjusted OR 2.76 [ 1.52 - 5.01 ] ) . CONCLUSIONS Older women with diabetes have an increased risk of falling , partly because of the increased rates of known fall risk factors , and may benefit from interventions to prevent falls . Further research is needed to determine whether diabetes treatment reduces fall risk BACKGROUND Little is known about the prevalence of falls and the related risk factors in the general population of community-living older people in Germany . OBJECTIVES To assess the prevalence and related predictors of different types of falls  in a sample of community-dwelling 65 years and older people in Germany living in a metropolitan area . Study design and setting prospect i ve cohort study in 622 community dwelling people aged > or = 65 years . RESULTS A total of 107 persons ( 17.2 % ) reported falling at least once ( occasional fallers ) , while 36 ( 5.7 % ) experienced two or more falls ( recurrent fallers ) in the last 6 months . Main predictors for all fallers were age ( OR 1.8 ; 95 % CI 1.1 - 3.0 ) , being female ( OR 1.7 ; 95 % CI 1.1 - 2.2 ) , living alone ( OR 1.9 ; 95 % CI 1.2 - 2.9 ) , poor health status ( OR 3.3 ; 95 % CI 2.1 - 5.3 ) , varifocals ( OR 1.7 ; 95 % CI 1.0 - 3.1 ) , disturbance of memory ( OR 1.7 ; 95 % CI 1.0 - 3.0 ) , depression ( OR 4.8 ; 95 % CI 2.5 - 9.2 ) , sleep disturbances ( OR 2.7 ; 95 % CI 1.7 - 4.3 ) , incontinence ( OR 2.1 ; 95 % CI 1.3 - 4.9 ) , dizziness ( OR 3.0 ; 95 % CI 1.9 - 5.0 ) , 3 medical conditions or more ( OR 3.3 ; 95 % CI 2.1 - 5.1 ) , lower physical functioning and mobility . Two of the strongest predictors were reported falls ( OR 4.9 ; 95 % CI 3.1 - 7.7 ) and recurrent falls ( OR 10.0 ; 95 % CI 5.0 - 20.0 ) in the last 6 months . CONCLUSION Older adults living at home should be screened for falls in history and problems in gait and mobility in any anamnesis to identify those who are at risk for falls OBJECTIVES To develop a classification tree for predicting the risk of recurrent falling in community-dwelling older persons using tree-structured survival analysis ( TSSA ) . DESIGN A prospect i ve cohort study . SETTING A community in the Netherl and s. PARTICIPANTS One thous and three hundred sixty-five community-dwelling older persons ( > /=65 ) from the Longitudinal Aging Study Amsterdam ( LASA ) . MEASUREMENTS In 1995 , physical , cognitive , emotional , and social aspects of functioning were assessed . Subsequently , a prospect i ve fall follow-up , specifically on recurrent falls ( two falls within 6 months ) was conducted for 3 years . RESULTS The classification tree included 11 end groups differing in risk of recurrent falling based on a minimum of two and a maximum of six predictors . The first split in the tree involved two or more falls versus fewer than two falls in the year preceding the interview . Respondents with two or more falls in the year preceding the interview ( n=193 ) and with at least two functional limitations ( n=98 ) had a 75 % risk of becoming a recurrent faller , whereas respondents with fewer than two functional limitations were further divided into a group with regular dizziness ( n=11 , risk of 68 % ) and a group with no regular dizziness ( n=84 , risk of 30 % ) . In respondents with fewer than two falls in the year preceding the interview ( n=1,172 ) , the risk of becoming a recurrent faller varied between 9 % and 70 % . Predictors in this branch of the tree were low performance , low h and grip strength , alcohol use , pain , high level of education , and high level of physical activity . CONCLUSION This classification tree included 11 end groups differing in the risk of recurrent falling based on specific combinations of a maximum of six easily measurable predictors . The classification tree can identify subjects who are eligible for preventive measures in public health strategies Background The European and American guidelines state the need for echocardiography in patients with syncope . 50 % of older adults with syncope present with a fall . Nonetheless , up to now no data have been published addressing echocardiographic abnormalities in older fallers . Method and Findings In order to determine the association between echocardiographic abnormalities and falls in older adults , we performed a prospect i ve cohort study , in which 215 new consecutive referrals ( age 77.4 , SD 6.0 ) of a geriatric outpatient clinic of a Dutch university hospital were included . During the previous year , 139 had experienced a fall . At baseline , all patients underwent routine  two-dimensional and Doppler echocardiography .  Falls were recorded during a three-month follow-up . Multivariate adjustment for confounders was performed with a Cox proportional hazards model . 55 patients ( 26 % ) fell at least once during follow-up . The adjusted hazard ratio of a fall during follow-up was 1.35 ( 95 % CI , 1.08–1.71 ) for pulmonary hypertension , 1.66 ( 95 % CI , 1.01 to 2.89 ) for mitral regurgitation , 2.41 ( 95 % CI , 1.32 to 4.37 ) for tricuspid regurgitation and 1.76 ( 95 % CI , 1.03 to 3.01 ) for pulmonary regurgitation . For aortic regurgitation the risk of a fall was also increased , but non-significantly ( hazard ratio , 1.57 [ 95 % CI , 0.85 to 2.92 ] ) . Trend analysis of the severity of the different regurgitations showed a significant relationship for mitral , tricuspid and pulmonary valve regurgitation and pulmonary hypertension . Conclusions Echo(Doppler)cardiography can be useful in order to identify risk indicators for falling . Presence of pulmonary hypertension or regurgitation of mitral , tricuspid or pulmonary valves was associated with a higher fall risk . Our study indicates that the diagnostic work-up for falls in older adults might be improved by adding an echo(Doppler)cardiogram in selected groups OBJECTIVES To examine whether anemia is associated with a higher incidence of recurrent falls . DESIGN Prospect i ve cohort study . SETTING Community-dwelling sample in The Netherl and s. PARTICIPANTS Three hundred ninety-four participants aged 65 to 88 from the Longitudinal Aging Study Amsterdam . MEASUREMENTS Anemia was defined according to World Health Organization criteria as a hemoglobin concentration less than 12 g/dL in women and less than 13 g/dL in men . Falls were prospect ively determined using fall calendars that participants filled out weekly for 3 years . Recurrent fallers were identified as those who fell at least two times within 6 months during the 3-year follow-up . RESULTS Of the 394 persons , 11.9 % ( 18 women and 29 men ) had anemia .  The incidence of recurrent falls was 38.3 % of anemic persons versus 19.6 % of nonanemic persons ( P=.004 ) . After adjustment for sex , age , body mass index , and diseases , anemia was significantly associated with a 1.91 times greater risk for recurrent falls ( 95 % confidence interval=1.09 - 3.36 ) . Poor physical function ( indicated by muscle strength , physical performance , and limitations ) partly mediated the association between anemia and incidence of recurrent falls . CONCLUSION Late-life anemia is common and associated with twice the risk of recurrent falls . Muscle weakness and poor physical performance appear to partly mediate this association The objective of this study was to identify easily measurable predictors for falls , recurrent falls , and fractures using a population -based prospect i ve cohort study of 1469 elderly , born before 1931 , in three regions of the Netherl and s. The baseline at-home interview was in 1992 . In 1995 , falls experienced in the preceding year and fractures over the preceding 38-month period were registered . In a period of 1 year , 32 % of the participants fell at least once , and 15 % fell two or more times . The rate of recurrent falls was similar in men and women up until the age of 75 years . The  total number of fractures was 85 , including 23 wrist fractures , 12 hip fractures , and 9 humerus fractures . The incidence density per 1000 person-years for any fracture was 25.1 ( 95 % confidence interval [ CI ] , 18.9 - 31.4 ) for women and 8.2 ( 95 % CI , 4.5 - 12.0 ) for men , respectively . Multiple logistic regression identified urinary incontinence , impaired mobility , use of analgetics , and use of antiepileptic drugs as the predictors most strongly associated with recurrent falls . Female gender , living alone , past fractures , inactivity , body height , and use of analgetics proved to be the predictors most strongly associated with fractures . The probabilities of recurrent falls were 4.7 % ( 95 % CI , 2.9 - 7.5 % ) to 59 . 2 % ( 95 % CI , 24.1 - 86.9 % ) with zero to four predictors , respectively . The probability of fractures ranged from 0.0 % ( 95 % CI , 0.0 - 0.4 % ) without any of the identified predictors to 12.9 % ( 95 % CI , 4.4 - 32 . 2 % ) with all six predictors present . Our study shows that the risk of recurrent falls and of fractures can be predicted using up to , respectively , four and six easily measurable predictors . This study emphasizes the importance of impaired mobility and inactivity as predictors for falls and fractures Background .Identifying and eliminating environmental hazards in the home has high face validity but little empirical support for fall prevention . Objective .The objective of this study was to determine whether environmental hazards increase the risk of nonsyncopal falls in the homes of community-living older persons . Research Design .This was a prospect i ve cohort study . Participants .The study included 1,088 men and women from a probability sample of 1,103 persons ≥72 years of age . Measures .A room-by-room assessment for 13 potential trip or slip hazards was completed at baseline and 1 year later by a trained research nurse using a st and ard instrument . Falls were ascertained monthly for 3 years using a fall calendar and follow-up phone calls . Results .The numbers of participants with a nonsyncopal fall ( by room ) were as follows : 88 ( kitchen ) , 144 ( living room ) , 41 ( hallway ) , 136 ( bedroom ) , and 59 ( bathroom ) . The risk of a nonsyncopal fall was significantly elevated for only 1 of the 13 trip or slip hazards . For exposure to ≥1 hazards per room , the relative risks adjusted for age , gender , and housing type were 0.91 ( 95 % CI , 0.58–1.43 ) for the kitchen , 1.30 ( 95 % CI , 0.92–1.83 ) for the living room , 1.73 ( 95 % CI , 0.93–3.22 ) for the hallway , 1.29 ( 95 % CI , 0.90–1.84 ) for the bedroom , and 0.57 ( 95 % CI , 0.32–1.00 ) for the bathroom . No consistent association was found between the 13 trip or slip hazards and nonsyncopal falls , even after participants were categorized by impairments in vision , balance/gait , and cognition . Conclusions .Our findings do not support an association between environmental hazards and nonsyncopal falls INTRODUCTION This is the first prospect i ve longitudinal study carried out in a Chinese elderly population with the objective of identifying the incidence and predictors of falls . MATERIAL S AND METHODS This is a population -based cohort study in Hong Kong with 1517 ambulatory elderly Chinese recruited using a multi-stage sampling method . Baseline data on demographic , comorbid diseases , drugs , Activities of Daily Living ( ADL ) [ Barthel Index and Lawton 's Instrumental Activities of Daily Living ( IADL ) ] , Geriatric Depression Scale ( GDS-15 ) , cognitive assessment by the Abbreviated Mental Test ( AMT ) , fear of falling , self-perceived mobility problem , h and grip strength , lower limb power , balance and gait tests were performed . Every subject was followed up for 1 year . RESULTS Four hundred and one falls occurred in 294 fallers ( 19.3 % ) over 1 year of follow-up . The prevalence of falls and recurrent falls were 19.3 % and 4.75 % , respectively . The incidences of falls ( i.e. , the fall events ) were 220 , 324 and 270 per 1000 person-years for men , women and both gender , respectively . The independent predictors of falls were previous history of falls , advancing age , Parkinson 's disease , knee extension power and gait speed . The independent predictors of recurrent falls were previous history of falls , self-perceived mobility problem , the knee extension strength and the Total Mobility Score of the Tinetti Balance and Gait Evaluation . CONCLUSIONS The incidence of falls in the Chinese elderly was 270 per 1000 person-years . History of falls , old age , Parkinson 's disease , decreased lower limb power and impairment in balance and gait function were important independent predictors of falls or recurrent falls in the Chinese elderly . Effective fall prevention programmes targeted at improving these risk factors for falls should be developed for the Chinese elderly in Hong Kong and Asia In this prospect i ve study , the authors determined intrinsic risk factors for falls and recurrent falls and constructed a risk profile that indicated the relative contribution of each risk factor and also estimated the probabilities of falls and recurrent falls . In 1992 , over a 28-week period , falls were recorded among 354 elderly subjects aged 70 years or over who were living in homes or apartments for the elderly in Amsterdam and the vicinity . During the study period , 251 falls were reported by 126 subjects ( 36 % ) , and recurrent falls ( > or = 2 falls ) were reported by 57 subjects ( 16 % ) . Associations of falls and recurrent falls with potential risk factors were identified in logistic regression models . Mobility impairment regarding one or more of the tested items ( i.e. , impairment of balance , leg-extension strength , and gait ) was associated with falls ( adjusted odds ratio ( OR ) = 2.6 ) and was strongly associated with recurrent falls ( OR = 5.0 ) . Dizziness upon st and ing was associated with falls ( OR = 2.1 ) and recurrent falls ( OR = 2.1 ) . However , several risk factors were associated with recurrent falls only : history of stroke ( OR = 3.4 ) , poor mental state ( OR = 2.4 ) , and postural hypotension ( OR = 2.0 ) . The authors constructed a risk profile for recurrent falls that included the five risk factors mentioned above . Inclusion of all risk factors in the profile implied an 84 % probability of recurrent falls over a period of 28 weeks , compared with 3 % when no risk factor was present . The probability of recurrent falls ranged only from 11 % to 29 % when predicted by number of falls occurring in the previous year . Physical activity , use of high-risk medication , and the use of vitamin D3 , which was r and omly allocated to the participants , were not strongly related to either falls or recurrent falls . In conclusion , a large range of probabilities of falls , especially of recurrent falls , was estimated by the risk profiles , in which mobility impairment was the major risk factor . Recurrent fallers may therefore be especially amenable to prevention based on mobility improvement BACKGROUND Falls are common in community-dwelling elderly persons and are a frequent source of morbidity . Simple indices to prospect ively stratify people into categories at different fall-risk would be useful to health care practitioners . Our goal was to develop a fall-risk index that discriminated between people at high and low risk of falling . METHODS We evaluated the risk of falling over a one-year period in 557 elderly persons ( mean age 81.6 ) living in a retirement community . On the baseline interview , we asked subjects if they had fallen in the previous year and evaluated  risk factors  in six additional conceptual categories . On the follow-up interview one year later , we again asked subjects if they had fallen in the prior year . We evaluated risk factors in the different conceptual categories and used logistic regression to determine the independent predictors of falling over a one-year period . We used these independent predictors to create a fall-risk index . We compared the ability of a prior falls history with other risk factors and with the combination of a falls history and other risk factors to discriminate fallers from nonfallers . RESULTS A fall in the previous year ( OR = 2.42 , 95 % CI = 1.49 - 3.93 ) , a symptom of either balance difficulty or dizziness ( OR = 1.83 , 95 % CI = 1.16 - 2.89 ) , or an abnormal mobility exam ( OR = 2.64 , 95 % CI = 1.64 - 4.26 ) were independent predictors of falling over the subsequent year . These three risk factors together ( c statistic = .71 ) discriminated fallers from nonfallers better than previous history of falls alone ( c statistic = .61 ) or the symptomatic and exam risk factors alone ( c statistic = .68 ) . When combined into a risk index , the three independent risk factors stratify people into groups whose risk for falling over the subsequent year ranges from 10 % to 51 % . CONCLUSION A history of falling over the prior year , a risk factor that can be obtained from a clinical history ( balance difficulty or dizziness ) , and a risk factor that can be obtained from a physical exam ( mobility difficulty ) stratify people into groups at low and high risk of falling over the subsequent year . This risk index may provide a simple method of assessing fall risk in community-dwelling elderly persons . However , it requires validation in other subjects before it can be recommended for widespread use OBJECTIVES To examine the relationship between binocular visual field loss and the risk of incident frequent falls in older white women . DESIGN A multicenter , prospect i ve cohort study . SETTING Four clinic centers within the United States in Baltimore , Maryl and ; Minneapolis , Minnesota ; Portl and , Oregon ; and the Monongahela Valley , Pennsylvania . PARTICIPANTS Four thous and seventy-one community-dwelling white women aged 70 and older participating in the Study of Osteoporotic Fractures . MEASUREMENTS Primary outcome was incident frequent falls , defined as two or more falls within 1 year . Primary risk factors were binocular visual field loss , distance visual acuity in the better eye , and contrast sensitivity at low spatial frequency in the better eye . RESULTS Of 4,071 women , 409 ( 10 % ) had severe binocular visual field loss at the eye examination , and 643 ( 16 % ) experienced frequent falls within 1 year after their eye examination . Severe binocular visual field loss was significantly associated with frequent falls when adjusting for age , study site , and cognitive function ( odds ratio=1.50 , 95 % confidence interval=1.11 - 2.02 ) . The data showed a trend for increasing odds of two or more falls with greater binocular visual field loss ( P<.001 ) . In older white women with severe binocular visual field loss  , 33.3 % of frequent falls were attributable to visual field loss . CONCLUSION Women with binocular visual field loss are at greater risk of future frequent falls . Screening for binocular visual field loss may identify individuals at high risk of falling OBJECTIVES To test the association between self-reported sleep and nap habits and risk of falls and fractures in a large cohort of older women . DESIGN Study of Osteoporotic Fractures prospect i ve cohort study . SETTING Clinical centers in Baltimore , Maryl and ; Minneapolis , Minnesota ; Portl and , Oregon ; and the Monongahela Valley , near Pittsburgh , Pennsylvania . PARTICIPANTS Eight thous and one hundred one community-dwelling Caucasian women aged 69 and older ( mean 77.0 ) . MEASUREMENTS  Sleep and nap habits  were assessed using a question naire at the fourth clinic visit ( 1993/94 ) . Fall frequency during the subsequent year was ascertained using tri-annual question naire . Incident hip and nonspinal fractures during 6 years of follow-up were confirmed using radiographic reports . RESULTS Five hundred fifty-three women suffered hip fractures , and 1,938 suffered nonspinal fractures . In multivariate models , women who reported napping daily had significantly higher odds of suffering two or more falls during the subsequent year ( odds ratio=1.32 , 95 % confidence interval (CI)=1.03 - 1.69 ) and were more likely to suffer a hip fracture ( hazard ratio (HR)=1.33 , 95 % CI=0.99 - 1.78 ) than women who did not nap daily . Those sleeping at least 10 hours per 24 hours had a higher risk of nonspinal fracture than ( HR=1.26 , 95 % CI=1.00 - 1.58 ) and a similar but nonsignificant increased risk of hip fracture to ( HR=1.43 , 95 % CI=0.95 - 2.15 ) those who reported sleeping between 8 and 9 hours . CONCLUSION Self-reported long sleep and daily napping are associated with greater risk of falls and fractures in older women . Interventions to improve sleep may reduce their risk of falls and fractures . Future research is needed to determine whether specific sleep disorders contribute to these relationships OBJECTIVES To assess the cross-sectional and longitudinal associations between alcohol consumption and risk of falls in older adults . DESIGN Cross-sectional and longitudinal analyses . SETTING Four U.S. communities . PARTICIPANTS A total of 5,841 older adults enrolled in the Cardiovascular Health Study , an ongoing , population -based , prospect i ve cohort study , participated . MEASUREMENTS  Self-reported alcohol consumption at baseline , self-reported frequent falls at baseline , and the 4-year risk of falls of participants who denied frequent falls at baseline . RESULTS Cross-sectional analysis indicated an apparent inverse association between alcohol consumption and risk of frequent falls ( adjusted odds ratio in consumers of 14 or more drinks per week=0.41 ; 95 % confidence interval (CI)=0.14 - 1.17 ; P for trend=.06 ) , but longitudinal analysis indicated a similar 4-year risk of falls in abstainers and light to moderate drinkers but a 25 % higher risk in consumers of 14 or more drinks per week ( 95 % CI=3 - 52 % ; P for trend=.07 ) . Similar results were found in analyses stratified by age , sex , race , and physical activity . CONCLUSION Consumption of 14 or more drinks per week is associated with an increased risk of subsequent falls in older adults . Cross-sectional studies may fail to identify this risk of heavier drinking , perhaps because older adults at risk for falls decrease their alcohol use over time or because heavier drinkers at risk for falls tend not to enroll in cohort studies . However , because this study relied upon annual reporting of falls , further prospect i ve studies should be conducted to confirm these findings OBJECTIVES To determine whether musculoskeletal pain increased risk for falls in older women with disabilities . DESIGN Prospect i ve population -based cohort study . SETTING The city and county of the eastern area of Baltimore . PARTICIPANTS One thous and two women aged 65 and older , participants in the Women 's Health and Aging Study , representing the one-third of older women who were living at home with disabilities , followed semiannually for 3 years beginning in 1991 . MEASUREMENTS Pain was categorized into four groups according to severity and location . Widespread pain was defined as pain in the upper and lower extremities and in the axial skeletal region , with moderate to severe pain in at least one region ( > or = 4 on a 10-point numeric rating scale , 10 = excruciating pain ) . Moderate to severe lower extremity pain that did not meet criteria for widespread pain was the next category . The reference category was no pain or mild pain in one site . The additional category of " other pain " was pain that did not fit into the other three groups . The occurrence of falls and fall-related injuries were assessed at each interview . RESULTS Of the 940 women who participated in at least one follow-up examination , 39 % fell in first year ; of the survivors , 36 % fell in Year 2 , and 39 % in Year 3 . After adjusting for several major risk factors for falls , women with widespread pain had an increased likelihood of falling during follow-up ( adjusted odds ratio ( AOR ) = 1.66 , 95 % confidence interval ( CI ) = 1.25 - 2.21 ) compared with those with no or mild pain in only one musculoskeletal site . Women who had other musculoskeletal pain but not widespread pain or lower extremity pain also had an increased risk of falls ( AOR = 1.36 , 95 % CI = 1.02 - 1.82 ) . Among women with musculoskeletal pain , risk for falls was lower in those who used daily analgesic medication . Risk for recurrent falls and self-reported fractures due to falls was also elevated in women with musculoskeletal pain , most consistently in women with widespread pain . CONCLUSIONS Musculoskeletal pain , particularly widespread pain , is a substantial risk factor for falls in older women with disabilities . These findings add an important dimension to our underst and ing of the multifactorial processes leading to falls in older persons OBJECTIVES Previous cross-sectional studies have shown a correlation between falls and fear of falling , but it is unclear which comes first . Our objectives were to determine the temporal relationship between falls and fear of falling , and to see whether these two outcomes share predictors . DESIGN A 20-month , population -based , prospect i ve , observational study . SETTING Salisbury , Maryl and . Each evaluation consisted of a home-administered question naire , followed by a 4- to 5-hour clinic evaluation . PARTICIPANTS The 2,212 participants in the Salisbury Eye Evaluation project who had baseline and 20-month follow-up clinic evaluations . At baseline , subjects were aged 65 to 84 and community dwelling and had a Mini-Mental State Examination score of 18 or higher . MEASUREMENTS Demographics , visual function , comorbidities , neuropsychiatric status , medication use , and physical performance-based measures were assessed . Stepwise logistic regression analyses were performed to evaluate independent predictors of falls and fear of falling at the follow-up evaluation , first predicting incident outcomes and then predicting fall or fear-of-falling status at 20 months with baseline falling and fear of falling as predictors . RESULTS Falls at baseline were an independent predictor of developing fear of falling 20 months later ( odds ratio ( OR ) = 1.75 ; P < .0005 ) , and fear of falling at baseline was a predictor of falling at 20 months ( OR = 1.79 ; P < .0005 ) . Women with a history of stroke were at risk of falls and fear of falling at follow-up . In addition , Parkinson 's disease , comorbidity , and white race predicted falls , whereas General Health Question naire score , age , and taking four or more medications predicted fear of falling . CONCLUSION Individuals who develop one of these outcomes are at risk for developing the other , with a result ing spiraling risk of falls , fear of falling , and functional decline . Because falls and fear of falling share predictors , individuals who are at a high risk of developing these endpoints can be identified This large prospect i ve cohort study was undertaken to construct a fall-risk model for elderly . The emphasis of the study rests on easily measurable predictors for any falls and recurrent falls . The occurrence of falls among 1285 community-dwelling elderly aged 65 years and over was followed during 1 year by means of a " fall calendar . " Physical , cognitive , emotional and social functioning preceding the registration of falls were studied as potential predictors of fall-risk . Previous falls , visual impairment , urinary incontinence and use of benzodiazepines were the strongest predictors identified in the risk profile model for any falls ( area under the curve [ AUC ] = 0.65 ) , whereas previous falls , visual impairment , urinary incontinence and functional limitations proved to be the strongest predictors in the model for recurrent falls ( AUC = 0.71 ) . The probability of recurrent falls for subsequent scores of the screening test ranged from 4.7 % ( 95 % Confidence Interval [ CI ] : 4.0 - 5.4 % ) to 46.8 % ( 95 % CI : 43.0 - 50.6 % ) . Our study provides a fall-risk screening test based on four easily measurable predictors that can be used for fall-risk stratification in community-dwelling elderly Objective : To construct a risk model in order to identify elderly individuals at risk of frequent falling . Design : Prospect i ve community-based cohort study over 12 months . Setting : Baseline measures were performed at a local community centre . Subjects : Two hundred and sixty-three community-dwelling elderly people ( mean age 72 years ) . Measurements : A variety of variables were evaluated , including medical , psychological , sensory , physical and postural control measurements . Fall incidence was monitored retrospectively and during one-year follow-up . Results : Logistic regression analysis showed that polypharmacia was the most prominent medical fall predictor with an odds ratio ( OR ) of 1.29 ( P = 0.005 ) , poor visual acuity the best sensory predictor ( OR=0.84 ; P = 0.009 ) and general fear of falling the most crucial psychological predictor ( OR=3.25 ; P B=0.001 ) . Increased postural sway in near-t and em stance with eyes open was selected as the best balance predictor for falls ( OR=5.60 ; P = 0.010 ) , followed by delayed anteroposterior movement velocity during rhythmic weight shifts ( OR=0.42 ; P = 0.004 ) . The best physical predictor was a low score on the Physical Performance Test ( OR=4.16 ; P < 0.001 ) , followed by decreased maximal h and grip strength ( OR=0.87 ; P < 0.001 ) and increased timed chair-st and s ( OR=1.13 ; P < 0.003 ) . Step-by-step regression analysis revealed a risk model for the prediction of future falls , as a combination of the Physical Performance Test and maximal h and grip strength . Conclusion : This study confirms the multicausality of falls , since medical , psychological , sensory , postural control as well as physical variables provides a predictive value . The composed fall risk model was mainly physically oriented OBJECTIVES To examine the association between  alcohol intake and problem drinking history  and bone mineral density ( BMD ) , falls and fracture risk . DESIGN Cross-sectional and prospect i ve cohort study . SETTING Six U.S. clinical centers . PARTICIPANTS Five thous and nine hundred seventy-four men aged 65 and older . MEASUREMENTS  Alcohol intake and problem drinking histories were ascertained at baseline . Follow-up time was 1 year for falls and a mean of 3.65 years for fractures . RESULTS Two thous and one hundred twenty-one participants ( 35.5 % ) reported limited alcohol intake ( < 12 drinks/y ) ; 3,156 ( 52.8 % ) reported light intake ( < 14 drinks/wk ) , and 697 ( 11.7 % ) reported moderate to heavy intake ( > or = 14 drinks/wk ) in the year before baseline . One thous and one men ( 16.8 % ) had ever had problem drinking . In multivariate models , as alcohol intake increased , so did hip and spine BMD ( P for trend < .001 ) . Greater alcohol intake was not associated with greater risk for nonspine or hip fractures . Men with light intake , but not moderate to heavy intake , had a lower risk of two or more incident falls ( light intake : relative risk ( RR ) = 0.77 , 95 % confidence interval ( CI ) = 0.65 - 0.92 ; moderate to heavy intake : RR = 0.83 , 95 % CI = 0.63 - 1.10 ) than abstainers . Men with problem drinking had higher femoral neck ( + 1.3 % ) and spine BMD ( + 1.4 % ) , and a higher risk of two or more falls ( RR = 1.59 ; 95 % CI = 1.30 - 1.94 ) than those without a history of problem drinking and similar total hip BMD and risk of fracture . CONCLUSION In older men , recent alcohol intake is associated with higher BMD . Alcohol intake and fracture risk is unclear . Light alcohol intake may decrease the risk of falling , but a history of problem drinking increased fall risk BACKGROUND Falls are a common occurrence in elderly persons , including relatively healthy , community-dwelling men and women . A significant percentage of falls result in soft-tissue injuries . Although some risk factors for falls have been identified , more research is needed on risk factors for injurious falls . In addition , there is little information from prospect i ve studies on the long-term consequences of falls other than injury . METHODS Risk factors and consequences of falls were analyzed in a 24-month prospect i ve study of 482 elderly ( mean age 74 + /- 6.7 years ) men and women living independently.in the community .  Falls and injurious falls were ascertained by telephone and by a bimonthly postcard follow-up . Predictor variables were obtained from a baseline assessment and follow-up question naire . Outcomes were defined as rates of falls and injurious falls , circumstances surrounding the fall , and the long-term correlates of falls . RESULTS Sixty-one percent of the participants ( 53.7 % of men and 65.7 % of women ) reported one or more falls during the 2-year follow-up . The crude rates of injurious falls were 11.17 per 1000 person-months in women and 7.23 per 1000 person-months in men . Age , history of fracture , low physical health , and low or high mobility level were risk factors for injurious falls in both sexes . The inability to balance unsupported on one leg was associated with injurious falls in women ( rate ratio [ RR ] = 3.0 ; 95 % confidence interval 1.9 - 4.7 ) . Self-reported cognitive , physical health , and mobility impairments were greater in female fallers compared to the nonfallers . CONCLUSIONS Falls and injurious falls without fracture are frequent events for healthy elderly people and may be associated with morbid changes in cognitive status , physical health , and mobility Objective : To explore associations between physical activity and the risk of falls and fractured bones in community-dwelling older women . Design , setting and participants : A prospect i ve observational survey with three and six-year follow-ups . The sample included 8188 healthy , community-dwelling women , aged 70–75 years in 1996 , who completed surveys as participants in the Australian Longitudinal Study on Women ’s Health . Women who reported a recent serious injury from falling were excluded . Outcomes were reports of a fall to the ground , injury from a fall , and a fractured bone in 1999 and 2002 . The main predictor variable was physical activity level in 1996 , categorised on the basis of weekly frequency as none/very low , low , moderate , high and very high . Covariates were demographic and health-related variables . Logistic regression models were computed separately for each outcome in 1999 and 2002 . Main results : In multivariable models , very high physical activity was associated with a decreased risk of reporting a fall in 1999 ( odds ratio ( OR ) 0.67 ; 95 % CI 0.47 to 0.95 ) and in 2002 ( OR 0.64 ; 95 % CI 0.43 to 0.96 ) . High/very high physical activity was associated with a decreased risk of a fractured bone in 2002 ( OR 0.53 ; 95 % CI 0.34 to 0.83 ) . No significant association was found between physical activity and injury from a fall . Conclusions : The results suggest that at least daily moderate to vigorous-intensity physical activity is required for the primary prevention of falls to the ground and fractured bones in women aged 70–75 years OBJECTIVES To determine whether current use of central nervous system (CNS)-active medications , including benzodiazepines , antidepressants , anticonvulsants , and narcotics , increases the risk for subsequent falls . DESIGN Prospect i ve cohort study . SETTING Four clinical centers in Baltimore , Maryl and ; Portl and , Oregon ; Minneapolis , Minnesota ; and the Monongahela Valley , Pennsylvania . PARTICIPANTS Eight thous and one hundred twenty-seven women aged 65 and older participating in the fourth examination of the Study of Osteoporotic Fractures between 1992 and 1994 . MEASUREMENTS Current use of CNS-active medications  was assessed with an interviewer-administered question naire with verification of use from medication containers . A computerized dictionary was used to categorize type of medication from product br and and generic names . Incident falls were reported every 4 months for 1 year after the fourth examination . RESULTS During an average follow-up of 12 months , 2,241 women ( 28 % ) reported falling at least once , including 917 women ( 11 % ) who experienced two or more ( frequent ) falls . Compared with nonusers , women using benzodiazepines ( multivariate odds ratio ( MOR ) = 1.51 , 95 % confidence interval ( CI ) = 1.14 - 2.01 ) , those taking antidepressants ( MOR = 1.54 , 95 % CI = 1.14 - 2.07 ) , and those using anticonvulsants ( MOR = 2.56 , 95 % CI = 1.49 - 4.41 ) were at increased risk of experiencing frequent falls during the subsequent year . We found no evidence of an independent association between narcotic use and falls ( MOR = 0.99 for frequent falling , 95 % CI = 0.68 - 1.43 ) . Among benzodiazepine users , both women using short-acting benzodiazepines ( MOR = 1.42 , 95 % CI = 0.98 - 2.04 ) and those using long-acting benzodiazepines ( MOR = 1.56 , 95 % CI = 1.00 - 2.43 ) appeared to be at greater risk of frequent falls than nonusers , although the CIs overlapped 1.0 . We found no evidence to suggest that women using selective serotonin-reuptake inhibitors ( MOR = 3.45 , 95 % CI = 1.89 - 6.30 ) had a lower risk of frequent falls than those using tricyclic antidepressants ( MOR 1.28 , 95 % CI = 0.90 - 1.84 ) . CONCLUSIONS Community-dwelling older women taking CNS-active  medications , including those taking benzodiazepines , antidepressants , and anticonvulsants , are at increased risk of frequent falls . Minimizing use of these CNS-active medications may decrease risk of future falls . Our results suggest that fall risk in women taking benzodiazepines  is at best marginally decreased by use of short-acting preparations . Similarly , our findings indicate that preferential use of selective serotonin-reuptake inhibitors is unlikely to reduce fall risk in older women taking antidepressants Objective . The aim of this prospect i ve study was to examine risk factors of falling in a very old home-dwelling population . Design . A prospect i ve study of home-dwelling elderly people . Methods . Baseline data were collected by home-nursing staff through postal question naires and clinical tests . Data on falls were recorded in telephone interviews every other month during a follow-up of 11 months constituting 494 person years ( PY ) . Negative binomial modeling was used to assess fall risk . Setting . General community . Subjects . A population sample of home-dwelling subjects aged 85 years or older ( n = 555 ) . Main outcome measures . Fall rate and risk factors of falls . Results . Altogether 512 falls occurred in 273 ( 49 % ) subjects , incidence rate 1.03/PY . According to a multivariate model , history of recurrent falling , trouble with vision when moving , use of antipsychotic drug , and feelings of anxiety , nervousness , or fear were independent risk factors for subsequent falls . Conclusion . Appropriate care of poor vision and feelings of anxiety , nervousness , or fear , and avoidance of use of antipsychotic drugs might be useful in the prevention of falls among the most elderly home-dwellers OBJECTIVE To define the risk factors for recurrent falls in the home-dwelling elderly . DESIGN A prospect i ve population -based study covering two years . SETTING Five rural municipalities around the city Oulu , northern Finl and . PARTICIPANTS All home-dwelling elderly persons ( N = 1,016 ) aged 70 years or older living in the municipalities . OUTCOME MEASURES The risk factors of recurrent falling by variables related to social status , life changes , housing conditions , health , functional abilities and life style , using cross-tabulations and multivariate analyses . RESULTS The recurrent fallers ( at least two falls within 365 days after the examination day ) consisted of 17 men ( 6 % of the men ) and 71 women ( 14 % ) . Logistic regression analyses showed female sex , urinary urgency , frequent fear of falling , dizziness , a poor pulse rate rise 30 seconds after st and ing up and falling during the previous year to be risk factors for recurrent falls . After the variable representing previous falls had been removed from the analysis , urinary incontinence and a change in housing conditions during the past two years emerged and urinary urgency dropped out of the model . CONCLUSIONS Women particularly are a target group for the prevention of falls among the elderly . Urinary urgency and urinary incontinence , fear of falling , dizziness and changes in the housing conditions should be inquired about to identify the elderly at risk for falling and to take preventive interventions . In addition to testing blood pressure changes after st and ing up , the changes in pulse rate should be determined to identify and treat elderly people who have orthostatic conditions OBJECTIVES To examine the association between Parkinson 's disease ( PD ) and bone mineral density ( BMD ) and risk of falls . DESIGN Cross-sectional and prospect i ve cohort study . SETTING Six U.S. clinical centers . PARTICIPANTS Five thous and nine hundred ninety-five community-dwelling , ambulatory men aged 65 and older . MEASUREMENTS History of physician-diagnosed PD was ascertained from participant self-report . BMD was measured at the hip and spine using dual energy x-ray absorptiometry ( DEXA ) and quantitative computed tomography ( QCT ) .  Incident falls were ascertained for 1 year using mailed queries . RESULTS Fifty-two participants ( 0.9 % ) reported a history of PD . In multivariate models , PD was associated with significantly lower BMD at the spine ( -4.9 % , P=.04 ) and total hip ( -5.3 % , P=.007 ) using DEXA and at the spine ( -6.7 % , P=.05 ) and total hip ( -8.2 % , P=.03 ) using QCT . PD was associated with a nearly three times greater age-adjusted risk of multiple future falls ( odds ratio (OR)=2.91 , 95 % confidence interval (CI)=1.55 - 5.46 ) . Further adjustment for history of multiple falls in the year before baseline attenuated this risk , but it remained significant ( OR=2.30 , 95 % CI=1.15 - 4.59 ) . CONCLUSION In this cohort of older men , PD was associated with lower BMD at the hip and spine , measured using areal and volumetric BMD , as well as increased falls . Clinicians should consider screening older men with PD for osteoporosis Background and aims : In the elderly , balance and walking impairments are assumed to play an important role in causing falls . We have assessed prospect ively the predictive ability of health , function and balance variables regarding falls and their location . Methods : Falls which occurred during one year in a r and om sample of 307 women aged 75 years and over ( mean 80.8 years , response rate 74.5 % ) living in the community were recorded and related to baseline registration s of health , medication and tests of walking and balance . Results : In all , 155 women ( 50.5 % ) reported 308 falls . Outdoor falls were significantly more frequent than indoor falls ( 57.5 vs 42.5 % ) . The variables having had a fall before the start of the study , osteoporosis , hypertension , feeling depressed , unable to climb 40 cm high steps and walking slowly , all independently predicted a higher number of falls overall . Regarding fall location , having experienced a fall before study start was associated with more falls indoors as well as outdoors . Vision impairment , symptoms of depression , a faster comfortable walking speed , and being able to cope with higher steps were all independent predictors of more outdoor falls also after adjustment for outdoor exposure . A slower comfortable walking speed , a higher amplitude of the center of pressure movements in the frontal plane , a poorer score on the Timed Up & Go test , multi-morbidity , poor cognition and hypertension were independent risk factors for indoor falls . Neither number of drugs used nor any specific medication appeared as independent risk factors for falls in this study . Conclusions : The findings of this study suggest that risk factors for  indoor and outdoor falls  are different . Location of fall may be an important confounder in studies of predictors of falls in the elderly which should encompass this type of information To study risk factors for falling , we conducted a one-year prospect i ve investigation , using a sample of 336 persons at least 75 years of age who were living in the community . All subjects underwent detailed clinical evaluation , including st and ardized measures of mental status , strength , reflexes , balance , and gait ; in addition , we inspected their homes for environmental hazards . Falls and their circumstances were identified during bimonthly telephone calls . During one year of follow-up , 108 subjects ( 32 percent ) fell at least once ; 24 percent of those who fell had serious injuries and 6 percent had fractures . Predisposing factors for falls were identified in linear-logistic models . The adjusted odds ratio for  sedative use was 28.3 ; for cognitive impairment , 5.0 ; for disability of the lower extremities , 3.8 ; for palmomental reflex , 3.0 ; for abnormalities of balance and gait , 1.9 ; and for foot problems , 1.8 ; the lower bounds of the 95 percent confidence intervals were 1 or more for all variables . The risk of falling increased linearly with the number of risk factors , from 8 percent with none to 78 percent with four or more risk factors ( P less than 0.0001 ) . About 10 percent of the falls occurred during acute illness , 5 percent during hazardous activity , and 44 percent in the presence of environmental hazards . We conclude that falls among older persons living in the community are common and that a simple clinical assessment can identify the elderly persons who are at the greatest risk of falling Introduction The purpose of this study was to examine the relationships of vitamin D supplementation and serum concentrations of vitamin D metabolites and parathyroid hormone ( PTH ) with neuromuscular function and falls in older community-dwelling women . Methods We examined these relationships using a 4-year prospect i ve multi-center study among 9,526 community-dwelling women enrolled in the Study of Osteoporotic Fractures ( median age : 70 years ; interquartile range : 67–75 ) and a subset of 389 women ( 97 % ) out of 400 who were r and omly selected from the entire cohort for serum measures . Measurements included :  vitamin D supplementation , serum 25-hydroxyvitamin D3 [ 25(OH)D3 ] , serum 1,25-dihydroxyvitamin D3 [ 1,25(OH ) 2D3 ] , and serum intact parathyroid hormone ( iPTH ) ; grip and quadriceps strength , chair-st and time , walking speed , reaction time , and balance-walk time ( including changes in grip strength , chair-st and time , walking speed and balance-walk time over approximately 3.7 years ) ; and incident fall rates ( number of falls/woman-years ) . Results In 9,526 women , vitamin D supplementation was not associated with any measures of neuromuscular function , change in neuromuscular function , or fall rates ( p>0.01 for all ) . In a subgroup of 389 women , there was a trend of higher 25(OH)D3 concentration with slightly weaker grip strength ( p=0.007 ) , and women in the fourth quartile of 1,25(OH)2D3 had a faster chair-st and time ( p=0.017 ) than women in the first quartile ; still , in general , concentrations of 25(OH)D3 , 1,25(OH)2D3 , and iPTH were not associated with either neuromuscular function or changes in neuromuscular function ( p>0.05 for all ) . However , higher 1,25(OH)2D3 concentration was associated with lower fall rates ( p=0.039 ) . Conclusions Higher 1,25(OH)2D3 concentration is associated with a lower fall risk in older community-dwelling women , but vitamin D supplementation , and 25(OH)D3 and iPTH concentrations are not associated with either neuromuscular function or falls The object of this article was to determine the predictive value of risk factors for recurrent falls and the construction of a fall risk model as a contribution to a mobility assessment for the identification of community-dwelling elderly at risk for recurrent falling in general practice . The design was a prospect i ve cohort study ( n = 311 ) . There were four primary health care centers . A sample stratified on previous falls , age , and gender of community-dwelling elderly persons aged 70 years or over ( n = 311 ) was taken from the respondents to a mail question naire ( n = 1660 ) . They were visited at home to assess physical and mental health , balance and gait , mobility and strength . A 36-week follow-up with telephone calls every 6 weeks was conducted . Falls and fall injuries were measured . During follow-up 197 falls were reported by 33 % of the participants : one fall by 17 % and two or more falls by 16 % . Injury due to a fall was reported by 45 % of the fallers : 2 % hip fractures , 4 % other fractures , and 39 % minor injuries . A fall risk model for the prediction of recurrent falls with an area under the curve ( AUC ) of 0.79 , based on logistic regression analysis , showed that the main determinants for recurrent falls were : an abnormal postural sway ( OR 3.9 ; 95 % Cl 1.3 - 12.1 ) , two or more falls in the previous year ( OR 3.1 ; 95 % Cl 1.5 - 6.7 ) , low scores for h and grip strength ( OR 3.1 ; 95 % Cl 1.5 - 6.6 ) , and a depressive state of mind ( OR 2.2 ; 95 % CI 1.1 - 4.5 ) . To facilitate the use of the model for clinical practice , the model was converted to a " desk model " with three risk categories : low risk ( 0 - 1 predictor ) , moderate risk ( two predictors ) , and high risk ( > or =3 predictors ) . A fall risk model converted to a " desk model , " consisting of the predictors postural sway , fall history , h and dynamometry , and depression , provides added value in the identification of community-dwelling elderly at risk for recurrent falling and facilitates the prediction of recurrent falls OBJECTIVES To determine whether genetic influences account for individual differences in susceptibility to falls in older women . DESIGN Prospect i ve twin cohort study . SETTING Research laboratory and residential environment . PARTICIPANTS Ninety-nine monozygotic ( MZ ) and 114 dizygotic ( DZ ) female twin pairs aged 63 to 76 from the Finnish Twin Cohort study . MEASUREMENTS The participants  recorded their  falls on a calendar  for an average+/-st and ard deviation of 344+/-41 days . Reported falls were verified via telephone interview , and circumstances , causes , and consequences of the fall were asked about . RESULTS The total number of falls was 434 , of which 188 were injurious ; 91 participants had two or more falls . Casewise concordance was 0.61 ( 95 % confidence interval (CI)=0.49 - 0.72 ) for MZ twins and 0.49 ( 95 % CI=0.37 - 0.62 ) for DZ twins for at least one fall , 0.38 ( 95 % CI=0.23 - 0.53 ) for MZ and 0.33 ( 95 % CI=0.17 - 0.50 ) for DZ twins for at least one injurious fall , and 0.43 ( 95 % CI=0.26 - 0.60 ) for MZ and 0.36 ( 95 % CI=0.17 - 0.55 ) for DZ twins for recurrent falls . On average , the proportion of familial influences accounting for the individual differences in susceptibility to at least one fall was 30 % and to recurrent falls was 40 % ; nongenetic familial and nonfamilial factors alone accounted for susceptibility to at least one injurious fall . CONCLUSION In community-dwelling older women , familial factors underlie the risk of falling but not the risk of injurious falls To determine how accurately elderly subjects recall recent falls , we studied 304 ambulatory men and women over the age of 60 years who completed a 12-month prospect i ve study of risk factors for falling . We developed a system of weekly follow-up and home visits to record and confirm all falls . During the study , 179 participants suffered at least one fall that was confirmed by home visit . At the end of the study , all subjects were interviewed by telephone about whether they had suffered a fall during the preceding 3 , 6 , or 12 months . Depending on the time period of recall , 13 % to 32 % of those with confirmed falls did not recall falling during the specific period of time . Recall was better for the preceding 12 months than for 3 or 6 months . There were only weak correlations ( r = 0.28 to 0.59 ) between the number of falls that were documented and the number that the subjects recalled during each of these periods . Those with lower scores on the Mini-Mental State Examination were more likely to forget falls . We conclude that elderly subjects often do not recall falls that occurred during specific periods of time over the preceding 3 to 12 months . Research ers and clinicians should consider using methods besides long-term recall for ascertaining and counting falls over specific periods of time OBJECTIVES This study was undertaken to determine whether vigorous and frail older people who identify environmental hazards in their homes have an increased risk for falls . METHODS A 1-year prospect i ve study was conducted among 266 female and 59 male community-dwelling volunteers aged 60 to 93 years who had fallen at least once during the previous year . Composite measures of home safety and of frailty were derived using principal components analysis . Participants were divided into vigorous and frail groups , and associations between baseline home safety measures and falls at home over the follow-up year were compared between the two groups . RESULTS Frail individuals were more than twice as likely as vigorous individuals to fall during follow-up ( rate ratio [ RR ] = 2.24 ; 95 % confidence interval [ CI ] = 1.54 , 3.27 ) . In the study group as a whole , falls were not strongly associated with the presence of home hazards . However , when compared with vigorous older persons living with fewer home hazards , vigorous older persons living with more home hazards were more likely to fall . The increased risk for falls among vigorous elderly was limited to falls where home hazards were present . By contrast , living with more home hazards was not associated with increased likelihood of falls among frail older persons . CONCLUSIONS While frail older persons experience higher overall fall rates , vigorous older persons should not be overlooked in fall prevention projects OBJECTIVES To compare the value of dual tasking in predicting falling in the general population of oldest old with that of easy-to-administer single tasks . DESIGN Prospect i ve population -based follow-up study . SETTING Municipality of Leiden , the Netherl and s. PARTICIPANTS Representative cohort of 380 individuals , all aged 85 at baseline . MEASUREMENTS During enrollment , walking time over a 12-meter distance was measured , as well as the verbal fluency to recite names of animals or professions during a 30-second period . In the dual task , performance was assessed when participants combined walking with reciting names . Incidence of falls and fractures was assessed by interviewing participants and checking their medical histories . RESULTS After 1 year of follow-up , 42 % of the participants reported one or more falls , and 4 % suffered a fracture . Total walking time , number of steps , and verbal fluency were all strongly related to incident falls ( P for trend for all < .01 ) , but dual-task performance was not a better predictor for incident falls than single-task performance . CONCLUSION The dual-task test in this study had no predictive value above that of a single-task test to predict falling . Dual tasks with more-sensitive measures of impaired dual-task execution might have better test characteristics . In this study , history of falls and performance on an easy-to-administer single walking task identified old persons at higher risk for falling who could benefit from fall preventive strategies OBJECTIVE Fall risk assessment is important because the consequences , such as a fracture , may be devastating . The objective of this study was to find the test or tests that best predicted falls in a population -based sample of elderly women . STUDY DESIGN AND SETTING The fall-predictive ability of a question naire , a subjective estimate of biologic age and objective functional tests ( gait , balance [ Romberg and sway test ] , thigh muscle strength , and visual acuity ) were compared in 984 r and omly selected women , all 75 years of age . RESULTS A recalled fall was the most important predictor for future falls . Only recalled falls and intake of  psycho-active drugs  independently predicted future falls . Women with at least five of the most important fall predictors ( previous falls , conditions affecting the balance , tendency to fall , intake of psychoactive medication , inability to st and on one leg , high biologic age ) had an odds ratio of 11.27 ( 95 % confidence interval 4.61 - 27.60 ) for a fall ( sensitivity 70 % , specificity 79 % ) . CONCLUSION The more time-consuming objective functional tests were of limited importance for fall prediction . A simple clinical history , the inability to st and on one leg , and a subjective estimate of biologic age were more important as part of the fall risk assessment OBJECTIVE Scant attention has been paid to the risk factors for recurrent falls among the home-dwelling elderly , although there are remarkable age and sex differences according to whether or not the falls recur . In this report we describe and analyse the risk factors for recurrent falls by selected clinical variables and the history of falling during the previous year . DESIGN A community-based prospect i ve study covering two years . SETTING All home-dwelling persons ( N = 1016 ) aged 70 years or older living in five municipalities in northern Finl and . OUTCOME MEASURES The risk factors of recurrent falling by selected clinical variables using cross-tabulations and multivariate analyses . RESULTS Previous falls , peripheral neuropathy , use of psychotropic medication and slow walking speed were independent risk factors for recurrent falling . The risk of recurrent falling increased with an increasing number of previous falls . CONCLUSIONS Early preventive measures should be taken among the elderly persons who are prone to falling . In order to reduce the risk of recurrent falls among the elderly , the attending physician should take a critical view of the use of psychotropic medications , and attempts should be made to treat conditions underlying peripheral neuropathies and abnormal gait BACKGROUND Falls frequently occur in the elderly and are a major cause of morbidity and mortality . OBJECTIVE The objective of the study was to prospect ively investigate the association between serum 25-hydroxyvitamin D [ 25(OH)D ] levels and risk of recurrent falling  in older men and women . DESIGN This was a prospect i ve cohort study . SETTING An age- and sex-stratified r and om sample of the Dutch older population was determined . SUBJECTS Subjects included 1231 men and women ( aged 65 yr and older ) participating in the Longitudinal Aging Study Amsterdam . MEASUREMENTS Baseline serum 25(OH)D was determined by a competitive protein binding assay . During 1 yr , falls were prospect ively recorded by means of a fall calendar . RESULTS Low 25(OH)D ( < 10 ng/ml ) was associated with an increased risk of falling . After adjustment for age , sex , education level , region , season , physical activity , smoking , and alcohol intake , the odds ratios ( 95 % confidence interval ) were 1.78 ( 1.06 - 2.99 ) for subjects who experienced two falls or more as compared with those who did not fall or fell once and 2.23 ( 1.17 - 4.25 ) for subjects who fell three or more times as compared with those who fell two times or less . There was a statistically significant effect modification by age , and stratified analyses ( < 75 and > or = 75 yr ) showed that the associations were particularly strong in the younger age group ; the odds ratios ( 95 % confidence interval ) were 5.21 ( 2.03 - 13.40 ) for two falls or more and 4.96 ( 1.52 - 16.23 ) for three falls or more . CONCLUSIONS Poor vitamin D status is independently associated with an increased risk of falling  in the elderly , particularly in those aged 65 - 75 yr Background : While central nervous system ( CNS ) active medications such as psychotropics and narcotic analgesics have been implicated in contributing to falls in older adults , the combined effect of multiple CNS-active medications has not been investigated . The purpose of this study was to examine the influence , in community-dwelling elderly , of ( 1 ) taking multiple CNS-active medications  on fall liability and ( 2 ) individual classes of CNS-active medications ( using discrete drug classification ) on the risk of falls after controlling for important confounders – age , mobility , cognition and depression . Methods : 305 community-dwelling male veterans ( age : 70–104 ) were screened at study entry for mobility , cognition and depression .  CNS-active medications were categorized as benzodiazepines , other sedative-hypnotics , neuroleptics , tricyclic antidepressants , and opioid analgesics . Subjects were prospect ively followed for 6 months to monitor falls ; at the end of this time period , subjects were classified as fallers ( at least one fall ) or nonfallers . The relationship between CNS-active drug use and falls was examined using multivariable analyses . Results : The risk of falls was significantly greater in  CNS-active medication users as compared with nonusers . Adjusted odds ratio for one CNS-active drug was 1.54 ( 95 % confidence interval 1.07–2.22 ) and for two or more agents 2.37 ( 95 % confidence interval 1.14–4.94 ) . Conclusions : In community-dwelling elderly , the use of multiple CNS-active medications is associated with enhanced falls liability , over and above the use of one CNS-active drug alone . This apparent dose-response relationship provides support for causality
target: ORs were generally higher for recurrent fallers than for all fallers .
  This meta- analysis provides comprehensive evidence -based assessment of risk factors for falls in older people , confirming their multifactorial etiology .
  Some nonspecific indicators of high baseline risk were also strong predictors of the risk of falling
background: BACKGROUND Falls are the main cause of accidental death in persons aged 65 years or older .