Prevalence and Determinants of Falls in Community-dwelling Older
Adults in Türkiye: A Population-based Cross-sectional Study Conducted
between 2014-2015
Authors: Catikkas Nezahat Muge , Erdogan Tugba Obekli , Reginster Jean Yves , Oren Meryem Merve , Aydin Caglar Ozer , Sacar Duygu Erbas , Ozkok Serdar , Kilic Cihan , Karan Mehmet Akif , Bahat Gulistan 
Published: January 2023

Purpose:

Falls are a common public health problem in older adults regarding increased
morbidity, mortality, and healthcare costs. Determining the factors associated with falls is of utmost
importance for detecting at risk people. We present here a field study conducted to examine
the prevalence of falls and the associated factors among community-dwelling older adults.

Methods:

In this population-based cross-sectional study, we included adults aged > 60 years living
in the Fatih District of the Istanbul Province between November 2014-May 2015, through a simple
random sampling method. We noted age, sex, falls, fear of falling, number of diseases and medications,
the presence of diabetes, hypertension, dyslipidemia, urinary and fecal incontinence, and chronic
pain. Frailty was assessed with the FRAIL questionnaire. Functional capacity was evaluated by
Katz’s 6-item ADL and Lawton Brody’s 8-item IADL scales. The European quality-5 dimension
(EQ-5D) questionnaire was used for the quality of life assessment. The cognitive status screening was
conducted with a Mini-cog test. Depressive mood was evaluated with the Geriatric Depression scale
short form (GDS-SF). Malnutrition screening was conducted by the mini-nutritional assessment short
form. Handgrip strength (HGS) was measured with a hand dynamometer. Body composition was assessed
through a bioimpedance analysis. The 4-meter usual gait speed was recorded. The European
Working Group on Sarcopenia in Older People2 (EWSGOP2) criteria was used for the sarcopenia
definition. The Romberg and the postural instability tests were evaluated for balance and gait. Continuous
variables were expressed as mean ± standard deviation or median and interquartile range for descriptive
statistics, while categorical variables were expressed as the number and percentages. The differences
between groups were determined through an independent sample t-test or Mann-Whitney U
test when required, and Chi-square and Fisher’s exact tests were applied for categorical variables. A
multivariate logistic regression analysis was used to determine the independent factors associated with
falls among the factors identified as significant in univariate analyses.

Results:

The prevalence of falls was 28.5% [mean age: 75.4 ± 7.3 (range: 61-101 years), 53.6%
female], and a significant association was identified between falls and the number of diseases and
medications, diabetes, chronic pain, frailty, ADL, IADL, and EQ-5D scores, dementia, GDS-SF
score and level of ambulation in univariate analyses (p = 0.001, 0.030, 0.030, 0.010, 0.004, 0.040,
0.007, 0.003, 0.030 and 0.007, respectively). In the multivariate analysis, positive dementia (OR =
3.66, 95% CI = 1.40-9.53; p = 0.010) and frailty screenings (OR =1.47, 95% CI = 1.05-2.06; p =
0.020) were identified as associates of falls.

Conclusion:

Falls were independently associated with positive dementia and frailty screening.
These results will help develop specific and tailored precautions for at-risk groups to prevent the
negative outcomes of falls.