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A prospective study on the variation in falling and fall risk among community-dwelling older citizens in 12 European countries
  1. Carmen B Franse1,
  2. Judith AC Rietjens1,
  3. Alex Burdorf1,
  4. Amy van Grieken1,
  5. Ida J Korfage1,
  6. Agnes van der Heide1,
  7. Francesco Mattace Raso2,
  8. Ed van Beeck1,
  9. Hein Raat1
  1. 1 Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
  2. 2 Department of Internal Medicine, Erasmus University Medical Center, Section of Geriatric Medicine, Rotterdam, The Netherlands
  1. Correspondence to Dr Carmen B Franse; c.franse{at}erasmusmc.nl

Abstract

Objectives The rate of falling among older citizens appears to vary across different countries, but the underlying aspects causing this variation are unexplained. We aim to describe between-country variation in falling and explore whether intrinsic fall risk factors can explain possible variation.

Design Prospective study on data from the cross-national Survey of Health, Ageing and Retirement in Europe (SHARE).

Setting Twelve European countries (Austria, Belgium, Czech Republic, Denmark, Estonia, France, Germany, Italy, The Netherlands, Spain, Sweden, Switzerland).

Participants Community-dwelling persons aged ≥65 years (n=18 596).

Measurements Socio-demographic factors (age, gender, education level and living situation) and intrinsic fall risk factors (less than good self-rated health (SRH), mobility limitations, limitations with activities of daily living (ADL), dizziness, impaired vision, depression and impaired cognition) were assessed in a baseline interview. Falling was assessed 2 years later by asking whether the participant had fallen within the 6 months prior to the follow-up interview.

Results There was significant between-country variation in the rate of falling (varying from 7.9% in Switzerland to 16.2% in the Czech Republic). The prevalence of intrinsic fall risk factors varied twofold to fourfold between countries. Associations between factors age ≥80 years, less than good SRH, mobility limitations, ADL limitations, dizziness and depression, and falling were different between countries (p<0.05). Between-country differences in falling largely persisted after adjusting for socio-demographic differences but strongly attenuated after adjusting for differences in intrinsic fall risk factors.

Conclusion There is considerable variation in the rate of falling between European countries, which can largely be explained by between-country variation in the prevalence of intrinsic fall risk factors. There are also country-specific variations in the association between these intrinsic risk factors and falling. These findings emphasise the importance of addressing intrinsic fall risk in (inter)national fall-prevention strategies, while highlighting country-specific priorities.

  • epidemiology
  • geriatric medicine
  • preventive medicine

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Contributors CF designed the study, did the main quantitative analyses, and wrote the first draft and final draft of the manuscript. HR designed the study, advised on quantitative analysis, contributed to the interpretation of findings, made critical revisions and approved the final version. JR designed the study, contributed to the interpretation of findings, made critical revisions and approved the final version. EB contributed to the interpretation of findings, made critical revisions, and approved the final version. AB contributed to the interpretation of findings, made critical revisions, and approved the final version. FMR contributed to the interpretation of findings, made critical revisions, and approved the final version. AvdH contributed to the interpretation of findings, made critical revisions, and approved the final version. AvG contributed to the interpretation of findings, made critical revisions, and approved the final version. IK contributed to the interpretation of findings, made critical revisions, and approved the final version.

  • Competing interests None declared.

  • Patient consent This article uses anonymised data.

  • Ethics approval Institutional review board at University of Mannheim.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data are available upon request from the SHARE website (see http://www.share-project.org/data-access/user-registration.html).

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