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Unintentional Falls in Older Adults: A Methodological Historical Review

Published online by Cambridge University Press:  01 March 2011

Mark Speechley
Mark Speechley*
Affiliation:
The University of Western Ontario
*
*Correspondence and requests for offprints should be sent to / La correspondance et les demandes de tirés-à-part doivent être adressées à: Mark Speechley, Ph.D. Dept. of Epidemiology & Biostatistics Room K201, Kresge Bldg. The University of Western Ontario London, ON N6A 5C1 (mark.speechley@schulich.uwo.ca)
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Abstract

PubMed lists over 6,000 references (700 reviews) on unintentional falls in older adults. This article traces key methodological milestones in the application of epidemiologic methods since the earliest publications in the late 1940s. Within the context of advances in case definition, sampling, measurement, research design, and statistical analysis, the article reviews estimates of frequency of occurrence, risk factor associations, morbidity and mortality consequences, demonstration of the multiple risk factor theory of falls using fall prevention interventions, and the challenges of fall risk prediction models. Methodological explanations are provided for observed heterogeneities, and the case is presented for moving beyond undifferentiated lists of risk factors by focusing on balance and gait as the factors through which the mechanistic effects of distal risk factors can be understood. Moreover, the case is made to advance our statistical analyses by looking at interactions among intrinsic risk factors and between intrinsic, extrinsic, and environmental factors.

Résumé

PubMed fournit plus de 6,000 références (700 critiques) sur les chutes accidentelles des personnes âgées. Cet article retrace les jalons principaux et méthodologiques dans l’application de méthodes épidémiologiques depuis les premières publications dans ce domaine, à la fin des années quarante. Dans le contexte des avances faites en définition des cas médicaux, échantillonnage, mesure, conception de la recherche et l’analyse statistique, l’article passe en revue les estimations de fréquence d’apparition, les associations de facteurs de risque, les conséquences de la morbidité et de la mortalité, la démonstration de la théorie des facteurs multirisques à l’aide des interventions sur la prévention des chutes et les défis de modèles de prédiction des risques de chutes. Les explications méthodologiques sont fournies pour les hétérogénéités observées et le cas médical est présenté en faveur d’aller au-delà des listes indifférenciées des facteurs de risque, en mettant l’accent sur l’équilibre et la démarche comme les facteurs par lesquels on peut mieux comprendre les effets mécanistes des facteurs de risque distaux. En outre, l’affaire est faite pour faire avancer nos analyses statistiques en examinant les interactions parmi les facteurs de risque intrinsèques et entre les facteurs intrinsèques, extrinsèques et environnementaux.

Keywords

chutes accidentellesprévention des chutespersonnes âgéesméthodologieépidémiologieaccidental fallsfall preventionolder adultsmethodologyepidemiology
Type
Special Section: Falls Prevention / Section spéciale: Prévention des chutes
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 30 , Issue 1 , March 2011 , pp. 21 - 32
Copyright
Copyright © Canadian Association on Gerontology 2011

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