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Comment: Diabetes Medications Related to an Increased Risk of Falls and Fall-Related Morbidity in the Elderly REPLY
Abstract
To review literature regarding the effect of diabetes medications as a contributing risk for falls and fall-related morbidity in elderly patients with type 2 diabetes.
Primary literature was identified through PubMed MEDLINE (1966-November 2009) using the search terms elderly, aged, older adults, diabetes type 2, diabetes mellitus, falls, fractures, medication, hypoglycemia, and vitamin B(12) deficiency. Each drug class and the individual agents within the classes were also included in the search. Additional references were obtained through review of references from articles obtained.
Clinical studies evaluating diabetes medications and their association with falls, as well as studies evaluating their association with the complications of falls, were considered for inclusion. Selection emphasis was placed on randomized studies evaluating diabetes medications and falls.
There is no direct link between metformin and falls; however, an indirect association caused by neuropathy secondary to vitamin B(12) deficiency may be of concern. Although hypoglycemia is a risk factor, to date, there are no trials specifically linking insulin secretagogues to falls. Insulin use has been demonstrated to increase the risk of falls in the elderly. Thiazolidinediones increase fracture risk and thus may worsen fall-related outcomes. There are no studies to date linking other agents to an increased risk of falls.
Special considerations should be made when treating elderly patients with diabetes. At this time, a patient's functional level and risk factors for falls should weigh into decision-making regarding drug selection. The risk of falls and fall-related complications associated with diabetes medications should not be ignored.
... For example, Thiazolidinediones (TZDs) have been shown to increase fracture risk, as TZDs impair bone metabolism by decreasing osteoblast activities, causing a reduction in bone mass (22). Additionally, some anti-diabetic medications, such as insulin and sulfonylureas, have been associated with an increased fracture risk due to an increased chance for a fall from temporary hypoglycemia (23)(24)(25)(26)(27). With other medications, such as meglitinides, dipeptidyl peptidase-4 (DPP4) inhibitors (28,29), glucagon-like peptide-1 (GLP-1) receptor agonists (30), and α-blockers, there is currently either no evidence, or a contradictory evidence of their associations with alterations in fracture risk. ...
... Insulin users may also have higher level of severity in diabetes / diabetic complications (25) that are not accounted for covariates considered here. Although the difference in longitudinal HbA1c was normalized when considering the effects of medications, insulin use can also lead to temporary hypoglycemia (subsequently recovered) and a consequent increase in the risk of fall related fractures (23,24). Interestingly, sulfonylureas, which is also likely to induce temporary hypoglycemia and known to increase fracture risk (27), appeared to have no association with fracture risk in our model. ...
Context
Fracture risk is underestimated in people with type 2 diabetes (T2D).
Objective
To investigate the longitudinal relationship of glycated hemoglobin (HbA1c) and common medications on fracture risk in people with T2D.
Design
Retrospective cohort study was conducted using de-identified claims and EHR data obtained from the OptumLabs ® Data Warehouse during 01/01/2007 to 09/30/2015. For each individual, the study was conducted within a two-year HbA1c observation period and a two-year fracture follow-up period.
Setting
Population-based study.
Participants
157,439 individuals with T2D [age ≥ 55 years with mean HbA1c value ≥ 6%] were selected from 4,018,250 US Medicare Advantage/Commercial enrollee with T2D diagnosis.
Main Outcome Measures. All fractures and fragility fractures were measured.
Results
With covariates adjusted, poor glycemic control in T2D individuals was associated with an 29% increase of all fracture risk, compared to T2D individuals with adequate glycemic control (HR: 1.29, 95% CI 1.22-1.36). Treatment with metformin (HR: 0.88, 95% CI 0.85-0.92) and DPP4 inhibitors (HR: 0.93, 95% CI 0.88-0.98) were associated with a reduced all fracture risk, while insulin (HR: 1.26, 95% CI 1.21-1.32), thiazolidinediones (HR: 1.23, 95% CI 1.18-1.29), meglitinides (HR: 1.12, 95% CI 1.00-1.26) were associated with an increased all fracture risk (All p-value < 0.05). Bisphosphonates were associated similarly with increased fracture risk in T2D group and in non-diabetic group.
Conclusions
Longitudinal two-year HbA1c is independently associated with an elevated all fracture risk in T2D individuals during a two-year follow-up period. Metformin and DPP4 inhibitors can be used for management of T2D fracture risk.
... указали, что вазодиляторы, диуретики, альфа-блокаторы и антипсихотики являются значимыми предикторами падений [24]. В других исследованиях показано, что НПВП, инсулин, антигипертензивные препараты, антиаритмики повышают риск падений [25][26][27]. Полученные данные свидетельствуют, что высокий риск падений у пожилых людей необходимо связывать не только с применением психотропных препаратов, но и с более часто используемыми в нашей стране препаратами -гипотензивными, НПВП и др. ...
Aim to evaluate the structure of drug therapy in patients with falls and to identify the associations of falls with drug administration. Material and methods. This work is a subanalysis of the epidemiological study EVKALIPT. 4301 patients who had information about presence or absence of falls in the previous year were selected. The patients were divided into 2 groups: 1 group (n = 1307) having falls, 2 group (n = 2994) without falls. We studied the complaints and medical history, conducted general examination and analyzed medical documentation to get the information on drug treatment. A regular intake of 5 or more drugs was considered polypharmacy. Results. All patients had chronic diseases. In patients with falls, most diseases were more common, the Charlson Comorbidity Index was higher (5.532.4 versus 4.732.03, p0.001), as well as the proportion of high comorbidity (62.2% versus 47.7%, p0.001). All study participants took medications, on average 5.4 2.6 drugs. The patients with falls received higher number of drugs (5.732.6 versus 5.32.5, p0.001). The frequency of polypharmacy was 64.6% and 56.7% (p0.001) in groups 1 and 2, respectively. The patients with falls were more likely to take sartans, beta-blockers, diuretics, centrally acting antihypertensives, anticoagulants, nitrates, amiodarone, insulin, NSAIDs, proton pump inhibitors, calcium, vitamin D, anti-osteoporrotic therapy. Administration of a number of drugs was associated with falls (OR 1.18-2.15). For some drugs, a trend in favor of falls was revealed. Only statin therapy was associated with a 24% reduction in the odds of falling. The presence of polypharmacy increased the risk of falls by 1.3 times (OR 1.27, 95% CI 1.10-1.46, p=0.001). Conclusion. Polypharmacy and drug evaluation are important in assessing the risk of falls. In clinical practice, it is necessary to regularly conduct an audit of medications in elderly patients.
... 28 Elderly people with diabetes are at higher risk of falls, with the possible risk factors including retinopathy, the most common cause of vision loss in adult age, peripheral neuropathy, which increases postural instability, and hypoglycemia, resulting in dizziness. 29 People taking medication in either of these categories should especially benefit from exercise interventions designed to prevent falls. Exercise interventions in elderly people have been observed to reduce the risk of falls. ...
Purpose:
The aim of this study was to analyze factors affecting spatio-temporal gait parameters in elderly people of both genders and different ages with different risks of fall, fall history, and medications.
Patients and methods:
A total of 210 community-dwelling older adults (156 females, 54 males; mean age 72.84±6.26 years) participated in this study. To assess the risk of falls, the Downton Fall Risk Index was used. An additional question about medication intake (all prescribed drugs) was asked. To assess the spatio-temporal gait parameters, the Zebris FDM platform was used. Gait parameters and Downton Fall Risk Index, stratified by participants' history of falls, multiple medication use (0/1/2+), gender, age, and medication categories, were statistically analyzed using the Mann-Whitney U-test and Kruskal-Wallis test.
Results:
When comparing different medication categories, a Downton Fall Risk Index score indicating a high risk of falls was observed in the psychotropic medication category (3.56±1.67). A gait velocity suggesting a higher risk of falls (≤3.60 km/h) was observed in the psychotropic (2.85±1.09 km/h) and diabetes (2.80±0.81 km/h) medication categories, in the age groups 70-79 years (3.30±0.89 km/h) and 80+ years (2.67±0.88 km/h), and in participants using two or more medications (3.04±0.93 km/h).
Conclusion:
The results of this study confirm previous observations and show that higher age and multiple medication negatively affect the gait, and that the higher risk of falls is associated with psychotropic and diabetes medication use. These results provide important information for future fall preventive programs for the elderly that would be especially beneficial for elderly people taking psychotropic and diabetes medication.
... Insulin-treated people from the general population have been reported to have an increased risk of falls compared to non-diabetic controls with a reported relative risk of 2.76 (95% CI (1.52, 5.01)). Although metformin has not been directly linked to falls, it has been associated with neuropathy secondary to vitamin B12 deficiency, which can place people at higher risk for falls (299). ...
Effective antiretroviral therapy (ART) has prolonged life expectancy among people living with HIV (PLWH) in most parts of Europe, but as PLWH are ageing, this group is now starting to experience signs of compromised health, with particular concerns around possible increased rates of frailty, falls and fractures. In this thesis I use data from the Pharmacokinetic and Clinical Observations in People Over Fifty (POPPY) study (699 older (≥50 years) PLWH, 374 younger (<50 years) PLWH and 304 HIV-negative controls (≥50 years)) to examine some of the challenges of ageing in PLWH in England and Ireland. In particular, I investigate frailty, falls, bone mineral density (BMD), fractures and fracture (hip and major-osteoporotic) risk among PLWH and HIV-negative controls, and examine their associations with demographic, clinical, lifestyle and HIV-specific factors. Results highlight that older PLWH experience increased frailty, a higher prevalence of falls and a greater loss of BMD than younger PLWH and similarly-aged HIV-negative controls. Furthermore, this thesis highlights the importance of demographic characteristics, lifestyle traits, depressive symptoms, physical functioning and HIV-specific factors for the development of frailty, falls and low BMD in PLWH. Among PLWH, I also explore whether the effect of age on the prevalence of frailty could be explained by the effect of HIV parameters by investigating the association of HIV-specific parameters with each of the outcomes considered. Finally, I explore the link between pharmacokinetic (PK) parameters of commonly used nucleoside reverse transcriptase inhibitors (NRTIs) with BMD and with the 10-year probability of fracture. This thesis identified groups at heightened risk for frailty, falls and low BMD, fractures and fracture risk experiencing poor health outcomes against the backdrop of overall improvement of life span among PLWH and aims to inform policy for optimising treatment, tailored to the needs of this population.
... Taking diabetes medication increased the risk of falls by 3.842 times compared to not taking diabetes medicine, which is consistent with the results of Berlie's study [28]. Falls occur in older adults after taking too much diabetes medication. ...
Background:
To investigate the prevalence of falls and associated factors among older adults in urban and rural areas and to facilitate the design of fall prevention interventions.
Methods:
We used cluster random sampling to investigate the sociodemographic information, living habits, medical status, falls, home environment, and balance ability among 649 older adult participants. Univariate and multivariate logistic regression were used to examine the associated factors of falls.
Results:
The incidence of falls among older adults in Shantou City was 20.65%. Among them, the incidence was 27.27% in urban areas and 16.99% in rural areas. The rate of injury from falls among older adults was 14.48%, with18.61% in urban area and 12.20% in rural area. Multivariate analysis showed that the associated factors of falls among older adults in Shantou City included a high school or below education level (OR = 2.387, 95% CI: 1.305-4.366); non-farming as the previous occupation (OR = 2.574, 95% CI: 1.613-4.109); incontinence(OR = 2.881, 95% CI: 1.517-5.470); lack of fall prevention education (OR = 1.856, 95% CI: 1.041-3.311); and reduced balance ability (OR = 3.917, 95% CI: 2.532-6.058).
Discussion:
Older adults have a higher rate of falling in Shantou City, compared to the average rate in China. There are similarities and differences in the associated factors of falls among older adults between urban and rural areas of Shantou City. Targeted interventions for older adults in different regions may be more effective in reducing the risk of falls.
... Dal punto di vista clinico, le ipoglicemie severe possono accrescere il rischio di morte improvvisa nelle persone con DM2, ma probabilmente anche in quelle con DM1 (5) . Nelle persone anziane possono essere responsabili di un aumentato rischio di danno cardiovascolare, cerebrovascolare, demenza, incidenti e cadute (5)(6)(7)(8) . Possono contribuire inoltre allo sviluppo delle complicanze croniche del diabete anche attraverso meccanismi indiretti, legati all'impatto negativo sulla qualità di vita e quindi sull'adesione alle terapie e il raggiungimento dei target terapeutici (9,10) . ...
AIM Purpose of the survey was to investigate the attitudes of diabetologists with respect to the issue of severe hypoglycemia. MATERIALS AND METHODS A 29-item survey was distributed via the web. The first part of the questionnaire was aimed at describing the sample of clinicians involved (age, gender, specialty, practice setting, etc.). The second part analyzed the perception of “hypoglycemia” as an issue, the management of episodes, educational interventions, the expected possibilities for improvement. One hundred and sixty-five clinicians participated in the survey, mostly diabetologists (81.5% of the sample), with long experience in the field (over 73% have been working as diabetologists for more than 15 years). RESULTS More than 77% of participants claimed to collect information about severe hypoglycemia episodes on electronic records, especially for patients with type1 diabetes (DM1), less frequently for type 2 diabetes (DM2). Hypoglycemia unawareness is still the main concern both for clinicians and for the patients, and repeated educational interventions are the main response strategy. However, the use of validated questionnaires to investigate hypoglycemia is still not widespread. The prescription of glucagon is generally reserved to patients with DM1 only (32.1% of participants), for any patient treated with insulin, regardless of the type of diabetes (29.7% of participants), and for any patient treated with drugs potentially at risk of hypoglycemia (17.6%). Seventeen percent of clinicians prescribe glucagon only to patients with DM1 with previous episodes of severe hypoglycemia. On a 0 to 10 scale, the most important measures to improve the management of severe hypoglycemia are considered: availability of drugs with low risk of hypoglycemia (average value 8.9), increased awareness of risk factors (average value 8.8), use of systems for continuous monitoring of blood glucose (average value 8.5), the availability of easier-to-administer glucagon formulations and the increased availability (average value 8.3) of educational material (average value 7.4). Most of the physicians participating in the survey were also aware of the economic problem related to hypoglycemia. CONCLUSIONS Hypoglycemia represents a relevant clinical problem for the management of patients with diabetes, of which clinicians are well aware and with respect to which therapeutic, educational and management improvements are desirable for the reduction of events and associated costs. KEY WORDS hypoglycemia; clinical records; glucagon; education; survey.
Clinicians managing diabetes in any adult, woman, or child need to implement a chronic disease approach, understanding the connections and impact between the person and the disease. For the older population, we require to magnify these considerations, providing a team effort that engages the older patient (and family/caregivers as applicable) while offering a geriatrics approach to the individual, not just the disease. To successfully accomplish this goal, we need to incorporate the four geriatric domains (medical, functional, mental, and social), which are intertwined, impacting each other, modifying clinical and personal factors that will impact the decisions for individualized targets and strategic interventions. This chapter addresses the complex scenario of diabetes in the older adult, the need for a comprehensive geriatric assessment, geriatric domains associated with diabetes, and patient-centered outcomes that are relevant to the older population with diabetes.KeywordsHealthy older adultOlder adult with complex health scenarioGeriatric syndromesHypoglycemia—polypharmacy—fallsCognitive impairmentActivities of daily livingComorbiditiesDepressionPainUrinary incontinenceGait problems
Circadian rhythms play a role in time-of day differences in risk, presenting severity and outcomes of stroke. However, injury time of day effects on occurrence, presenting severity and acute hospital outcomes have not been yet reported in neurotrauma patients. Therefore, acute post-spinal cord injury hospitalization records of 759 patients from the prospective NACTN registry that contained information about the time of injury were analyzed. No major demographic differences were observed between groups with time of injury between 6:00-12:00, 12:00-18:00, 18:00-24:00 or 0:00-6:00. Two etiological factors including falls or sports/recreation-related accidents showed significant effects of time of injury with peaks in the 6:00-12:00 or 18:00-24:00 groups, respectively. History of diabetes or drug abuse was also significantly related to injury timing peaking in 6:00-12:00 or 18:00-24:00 groups, respectively. ASIA score-determined presenting severity during the first week post injury was not significantly affected by timing of injury. However, pairwise comparisons revealed worse motor but not sensory ASIA scores after injuries at 24:00-6:00 than any other group. These data suggest diurnal modulation of spinal cord injury risk due to specific mechanisms such as falls or sports-related accidents. Moreover, some co-morbidities may interact with those injury mechanisms as exemplified by the established risk elevation of falls in diabetics. Finally, while diurnal timing of the injury may modulate presenting severity, more patient records are needed to verify those effects.
Background and aim:
Falls are common among older adults in India. Several primary studies on its risk factors have been conducted in India. However, no systematic review has been conducted on this topic. Thus, the objective of this systematic review was to synthesize the existing evidence on the risk factors for falls among older adults in India.
Methods:
JBI and Preferred Reporting Items for Systematic Reviews and Meta-Analyse guidelines were followed, and two independent reviewers were involved in the process. This review included observational studies conducted among older adults (aged ≥ 60 years) residing in India, reporting any risk factor for falls as exposure and unintentional fall as the outcome. MEDLINE, EMBASE, PsycInfo, CINAHL, and ProQuest Dissertations and Theses were searched until September 24, 2020. Where possible, data were synthesized using random-effects meta-analysis.
Results:
The literature search yielded 3445 records. Twenty-two studies met the inclusion criteria of this systematic review, and 19 studies were included in the meta-analysis. Out of the 22 included studies in the systematic review, 12 (out of 18) cross-sectional studies, two case-control studies, and two cohort studies met more than 70% criteria in the respective Joanna Briggs Institute (JBI) checklists. Risk factors for falls among older adults in India included sociodemographic factors, environmental factors, lifestyle factors, physical and/or mental health conditions, and medical interventions.
Conclusions:
This systematic review and meta-analysis provided a holistic picture of the problem in India by considering a range of risk factors such as sociodemographic, environmental, lifestyle, physical and/or mental health conditions and medical intervention. These findings could be used to develop falls prevention interventions for older adults in India.
Systematic review and meta‐analysis registration:
The systematic review and meta-analysis protocol was registered with PROSPERO (registration number-CRD42020204818).
This paper introduces a transition flow model to study fall-related emergency department (ED) revisits for elderly patients with diabetes. Five diabetes classes are used to classify patients at discharge, within 7-day revisits, and between 8 and 30-day revisits. Analytical formulas to evaluate patient revisiting risks are derived. To reduce revisits, sensitivity analysis is introduced to identify the most critical, i.e., dominant, factors whose changes can lead to the largest reduction in revisits. In addition, a case study at University of Wisconsin (UW) Hospital ED is described to illustrate the applicability of the model.
Background Improved blood-glucose control decreases the progression of diabetic microvascular disease, but the effect on macrovascular complications is unknown. There is concern that sulphonylureas may increase cardiovascular mortality in patients with type 2 diabetes and that high insulin concentrations may enhance atheroma formation. We compared the effects of intensive blood-glucose control with either sulphonylurea or insulin and conventional treatment on the risk of microvascular and macrovascular complications in patients with type 2 diabetes in a randomised controlled trial. Methods 3867 newly diagnosed patients with type 2 diabetes, median age 54 years (IQR 48-60 years), who after 3 months' diet treatment had a mean of two fasting plasma glucose (FPG) concentrations of 6.1-15.0 mmol/L were randomly assigned intensive policy with a sulphonylurea (chlorpropamide, glibenclamide, or. glipizide) or with insulin, or conventional policy with diet. The aim in the intensive group was FPG less than 6 mmol/L. in the conventional group, the aim was the best achievable FPG with diet atone; drugs were added only if there were hyperglycaemic symptoms or FPG greater than 15 mmol/L. Three aggregate endpoints were used to assess differences between conventional and intensive treatment: any diabetes-related endpoint (sudden death, death from hyperglycaemia or hypoglycaemia, fatal or non-fatal myocardial infarction, angina, heart failure, stroke, renal failure, amputation [of at least one digit], vitreous haemorrhage, retinopathy requiring photocoagulation, blindness in one eye,or cataract extraction); diabetes-related death (death from myocardial infarction, stroke, peripheral vascular disease, renal disease, hyperglycaemia or hypoglycaemia, and sudden death); all-cause mortality. Single clinical endpoints and surrogate subclinical endpoints were also assessed. All analyses were by intention to treat and frequency of hypoglycaemia was also analysed by actual therapy. Findings Over 10 years, haemoglobin A(1c) (HbA(1c)) was 7.0% (6.2-8.2) in the intensive group compared with 7.9% (6.9-8.8) in the conventional group-an 11% reduction. There was no difference in HbA(1c) among agents in the intensive group. Compared with the conventional group, the risk in the intensive group was 12% lower (95% CI 1-21, p=0.029) for any diabetes-related endpoint; 10% lower (-11 to 27, p=0.34) for any diabetes-related death; and 6% lower (-10 to 20, p=0.44) for all-cause mortality. Most of the risk reduction in the any diabetes-related aggregate endpoint was due to a 25% risk reduction (7-40, p=0.0099) in microvascular endpoints, including the need for retinal photocoagulation. There was no difference for any of the three aggregate endpoints the three intensive agents (chlorpropamide, glibenclamide, or insulin). Patients in the intensive group had more hypoglycaemic episodes than those in the conventional group on both types of analysis (both p<0.0001). The rates of major hypoglycaemic episodes per year were 0.7% with conventional treatment, 1.0% with chlorpropamide, 1.4% with glibenclamide, and 1.8% with insulin. Weight gain was significantly higher in the intensive group (mean 2.9 kg) than in the conventional group (p<0.001), and patients assigned insulin had a greater gain in weight (4.0 kg) than those assigned chlorpropamide (2.6 kg) or glibenclamide (1.7 kg). Interpretation Intensive blood-glucose control by either sulphonylureas or insulin substantially decreases the risk of microvascular complications, but not macrovascular disease, in patients with type 2 diabetes. None of the individual drugs had an adverse effect on cardiovascular outcomes. All intensive treatment increased the risk of hypoglycaemia.
Insulin induced neuropathy has been reported previously in people with diabetes treated with insulin, and subsequently reported in patients with insulinomas. However, neuropathy caused by rapid glycaemic control in patients with poorly controlled diabetes with chronic hyperglycaemia is not a widely recognised entity among clinicians worldwide. It is expected that this phenomenon of paradoxical complication of neuropathy in the face of drastic decreases in glycosylated haemoglobin concentrations will assume greater importance with clinicians achieving glycaemic targets at a faster pace than before.
although the majority of hip fractures are the result of a fall, whether repeated falls in the year post-fracture adversely influence recovery of social participation is not known.
analysis of data from a longitudinal cohort study.
community-dwelling women aged > or = 65 years, admitted to one of two hospitals in Baltimore with a new, non-pathological fracture of the proximal femur between 1992 and 1995.
information on falls was collected from a falls diary. At the baseline, 6- and 12-month evaluations, subjects were asked about the number of times in the 2 weeks prior to the evaluation they had participated in 10 categories of social activities. We examined the association of repeated falls with social participation using generalized estimating equations. The effect of physical and psychological functions was examined by including measures of lower extremity functional performance and depressive symptoms into the model.
the analyses included 196 women, mean age = 80.2 years. Eighty-one subjects fell. The subjects with >1 fall between evaluations participated in a mean (95% CI) of 3.5 (0.12, 6.9) and 4.3 (0.9, 7.7) fewer social activities at 6 and 12 months post-fracture, respectively, compared to those who did not fall (P = 0.0003). These results were attenuated by adjustment for depressive symptoms, but not by lower extremity functional performance.
in the year post-fracture, repeated falls in women were associated with decreased social participation independent of lower extremity function. Depressive symptoms in repeated fallers may partly explain this association.
Falls are a major health problem in the elderly community; however, questions regarding incidence, risk factors, and provider response to falls exist. The purpose of this study was to examine the incidence of falls, associated factors, health care costs, and provider response to falls among Medicare beneficiaries.
The participants were 12,669 respondents to the Medicare Current Beneficiaries Survey (MCBS).
Categories of number of falls (none, one, recurrent) and injury type (medically injurious versus not medically injurious) were created from the falls supplement to the MCBS. Means and proportions for the entire Medicare population were estimated using sampling weights. The association between sociodemographic variables and fall status was modeled using ordinal or binary logistic regression. Aggregate health costs by fall category were estimated from claims data.
Population estimates of falls reported in 2002 ranged from 3.7 million (single fall) to 3.1 million (recurrent falls), with an estimated 2.2 million people having a medically injurious fall. Recurrent falls were more likely with increased age, being female, being nonwhite, reporting fair or poor health, and increased number of limitations in personal activities of daily living and instrumental activities of daily living and comorbidities. Although estimates of the actual costs of falls could not be determined, "fallers" consistently had larger utilization costs than "nonfallers" for the year 2002. Fewer than half (48%) of the beneficiaries reported talking to a health care provider following a fall, and 60% of those beneficiaries reported receiving fall prevention information.
Falls are common and may be associated with significant health care costs. Most importantly, health care providers may be missing many opportunities to provide fall prevention information to older people.
We wanted to determine the risk of non-vertebral fracture associated with type and duration of diabetes mellitus, adjusting for other known risk factors. This is a population-based 6-year follow-up of 27,159 subjects from the municipality of Tromsø, followed from 1994 until 2001. The age range was 25–98 years. Self-reported diabetes cases were validated by review of the medical records. All non-vertebral fractures were registered by computerized search in radiographic archives. A total of 1,249 non-vertebral fractures was registered, and 455 validated cases of diabetes were identified. Men with type I diabetes had an increased risk of all non-vertebral [relative risk (RR) 3.1 (95% CI 1.3–7.4)] and hip fractures [RR 17.8 (95% CI 5.6–56.8)]. Diabetic women, regardless of type of diabetes, had significantly increased hip fracture risk [RR 8.9 (95% CI 1.2–64.4) and RR 2.0 (95% CI 1.2–3.6)] for type I and type II diabetes, respectively. Diabetic men and women using insulin had increased hip fracture risk. Duration of disease did not alter hip fracture risk. An increased risk of all non-vertebral fractures and, especially, hip fractures was associated with diabetes mellitus, especially type I. Type II diabetes was associated with increased hip fracture risk in women only.
this study estimated the frequency of recent falls and prevalence of fear of falling among adults aged 65 and older.
a cross-sectional, list-assisted random digit dialling telephone survey of US adults from 2001 to 2003.
1,709 adults aged 65 or older who spoke either English or Spanish. Methods: prevalence estimates were calculated for recent falls, fall injuries, fear of falling and fall prevention beliefs and behaviours.
an estimated 3.5 million, or 9.6%, of older adults reported falling at least once in the past 3 months. About 36.2% of all older adults said that they were moderately or very afraid of falling. Few older adults who fell in the past 3 months reported making any changes to prevent future falls.
the high prevalence of falls and fear of falling among US older adults is of concern. Both can result in adverse health outcomes including decreased quality of life, functional limitations, restricted activity and depression. Older adults' fear of falling and their reluctance to adopt behaviours that could prevent future falls should be considered when designing fall prevention programmes.