Analysis of risk factors for falls in geriatric patients: a single institutional experience

Osama Shukir Muhammed Amin, Asso Faraidoon Ali Amin, Saad Kazim Karim, Saad Suud Shwani, Raed Thandoon


Background: In elderly people, falls have been recognized as one of the major causes of disability and potentially preventable mortality. Authors analyzed the incidence of falls in elderly diabetic people who have been receiving insulin therapy versus those on oral hypoglycaemic agents (OHGAs).

Methods: This observational study was conducted at the department of neurology of Shorsh military general teaching hospital and its outpatients’ department, Iraq, from April 1st to September 30st, 2016. A total of 100 diabetic patients older than 65 years of age, who had a history of one or more falls, were included in the study. The duration of diabetes, mode of its treatment, and its complications all were analyzed in addition to the risk factors for falls.

Results: Females (n=57) outnumbered males (n=43) and the mean age of the patients was (71.2±3.6) years. Increasing patient’s age, long-standing diabetes, poor glycaemic control, insulin therapy, and polypharmacy (of 3 and more antidiabetic agents) were significantly and statistically encountered and associated parameters for the risk of falls. The presence of additional risk factors for falls (e.g., previous stroke, alcoholism, cardiac dysrhythmia, and osteoarthrosis) augmented this risk.

Conclusions: Diabetes and its treatment render older people more liable for falls. The longer duration of the disease and the higher patients’ age (which were the commonest risks) are irreversible and non-correctable parameters for falls. Further analytic studies are required to unveil the role of each risk factor authors have detected.


Diabetes, Elderly, Fall

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Gibson MJ, Andres RO, Isaacs B, Radebaugh T, Worm-Petersen J. The prevention of falls in later life. A report of the Kellogg International Work Group on the prevention of falls by the elderly. Dani Med Bullet. 1987;34:1-24.

Jin J. Prevention of falls in older adults. JAMA. 2018;319(16):1734.

Al-Aama T. Falls in the elderly: spectrum and prevention. Can Fam Physician. 2011;57(7):771-6.

Burns ER, Stevens JA, Lee R. The direct costs of fatal and non-fatal falls among older adults-United States. J Safety Res. 2016;58:99-103.

Bueno-Cavanillas A, Padilla-Ruiz F, Jimenez-Moleon JJ, Peinado-Alonso CA, Galvez-Vargas R. Risk factors in falls among the elderly according to extrinsic and intrinsic precipitating causes. Europ J Epidemiol. 2000;16(9):849-59.

Brown AF, Mangione CM, Saliba D, Sarkisian CA. Guidelines for improving the care of the older person with diabetes mellitus. J Am Geriatr Soc. 2003;51:265-80.

Hausdorff JM, Rios DA, Edelberg HK. Gait variability and fall risk in community-living older adults: a 1-year prospective study. Archiv Physic Med Rehabilit. 2001;82(8):1050-6.

Gregg EW, Beckles GL, Williamson DF, Leveille SG, Langlois JA, Engelgau MM, et al. Diabetes and physical disability among older US adults. Diab Care. 2000;23(9):1272-7.

Strotmeyer ES, Cauley JA, Schwartz AV, Nevitt MC, Resnick HE, Bauer DC, et al. Nontraumatic fracture risk with diabetes mellitus and impaired fasting glucose in older white and black adults: the health, aging, and body composition study. Archiv Int Med. 2005;165(14):1612-7.

Durán JA. Prevalence of diabetes mellitus in geriatric patients in nursing homes of Cádiz. Diagerca study. Rev Esp Geriatr Gerontol. 2012;47(3):114-8.

Kamel MH, Abdulmajeed AA, Ismail SE. Risk factors of falls among elderly living in Urban Suez-Egypt. Pan African Med J. 2013;14(1).

Hope SV, Strain WD. Hypoglycemia in the elderly. Diab Hypog. 2013;6(1):3-10.

Kennedy RL, Henry J, Chapman AJ, Nayar R, Grant P, Morris AD. Accidents in patients with insulin-treated diabetes: increased risk of low-impact falls but not motor vehicle crashes-a prospective register-based study. J Trauma Acute Care Surg. 2002;52(4):660.

Bramlage P, Gitt AK, Binz C, Krekler M, Deeg E, Tschöpe D. Oral antidiabetic treatment in type-2 diabetes in the elderly: balancing the need for glucose control and the risk of hypoglycemia. Cardiovasc Diab. 2012;11(1):122.

Berlie HD, Garwood CL. Diabetes medications related to an increased risk of falls and fall-related morbidity in the elderly. Annals Pharm. 2010;44(4):712.

Meier C, Kraenzlin ME, Bodmer M, Jick SS, Jick H, Meier CR. Use of thiazolidinediones and fracture risk. Archiv Int Med. 2008;168(8):820-5.

Lecka-Czernik B. Bone as a target of type 2 diabetes treatment. Curr Opin Investig Drugs. 2009;10:1085-90.

McLaren LA, Quinn TJ, McKay GA. Diabetes control in older people. BMJ. 2013;346:f2625.

Tilling LM, Darawil K, Britton M. Falls as a complication of diabetes mellitus in older people. J Diab Complicat. 2006;20(3):158-62.

Schwartz AV, Vittinghoff E, Sellmeyer DE, Feingold KR, De Rekeneire N, Strotmeyer ES, Shorr RI, et al. Diabetes-related complications, glycemic control, and falls in older adults. Diab Care. 2008;31(3):391-6.

Gregg EW, Beckles GL, Williamson DF, Leveille SG, Langlois JA, Engelgau MM, et al. Diabetes and physical disability among older US adults. Diab Care. 2000;23(9):1272-7.

Miller DK, Lui LY, Perry HM, Kaiser FE, Morley JE. Reported and measured physical functioning in older inner-city diabetic African Americans. J Gerontol A Biol Sci Med Sci. 1999;54:M230-6.

Malmivaara A, Heliövaara M, Knekt P, Reunanen A, Aromaa A. Risk factors for injurious falls leading to hospitalization or death in a cohort of 19,500 adults. Am J Epidemiol. 1993;138(6):384-94.

Herndon JG, Helmick CG, Sattin RW, Stevens JA, DeVito C, Wingo PA. Chronic medical conditions and risk of fall injury events at home in older adults. J Am Geriatr Soci. 1997;45(6):739-43.

Huang ES, Karter AJ, Danielson KK, Warton EM, Ahmed AT. The association between the number of prescription medications and incident falls in a multi-ethnic population of adult type-2 diabetes patients: the diabetes and aging study. J General Int Med. 2010;25(2):141-6.

Lord SR, Rogers MW, Howland A, Fitzpatrick R. Lateral stability, sensorimotor function and falls in older people. J Am Geriatr Soc. 1999;47(9):1077-81.

Ivers RQ. Visual impairment and falls in older adults: the Blue Mountains Eye Study. J Am Geriatr Soc. 1998;46:58-64.

Mayne D, Stout NR, Aspray TJ. Diabetes falls and fractures. Age Aging. 2010;39:522-5.

Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. New Eng J Med. 1988;319(26):1701-7.

Huang ES, Karter AJ, Danielson KK, Warton EM, Ahmed AT. The association between the number of prescription medications and incident falls in a multi-ethnic population of adult type-2 diabetes patients: the diabetes and aging study. J Gen Intern Med. 2010;25:141-6.

Leipzig RM, Cumming RG, Tinetti ME. Drugs and falls in older people: a systematic review and meta‐analysis: I. Psychotropic drugs. J Am Geriatr Soc. 1999;47(1):30-9.

Lawlor DA, Patel R, Ebrahim S. Association between falls in elderly women and chronic diseases and drug use: cross sectional study. BMJ. 2003;327:712-7.

Friedman SM, Munoz B, West SK, Rubin GS, Fried LP. Falls and fear of falling: which comes first? A longitudinal prediction model suggests strategies for primary and secondary prevention. J Am Geriatr Soc. 2002;50(8):1329-35.

Tinetti ME. Factors 3associated with serious injury during falls by ambulatory nursing home residents. J Am Geriatr Soc. 1987;35:644-8.

Salkeld G. Quality of life related to fear of falling and hip fracture in older women: a time trade off study. BMJ. 2000;320:341-6.

Friedman SM. Increased fall rates in nursing home residents after relocation to a new facility. J Am Geriatr Soc. 1995;43:1237-42.

Roman de Mettelinge T, Cambier D. Understanding the relationship between walking aids and falls in older adults: a prospective cohort study. J Geriat Physical Therapy. 2015;38(3):127-32.

Ettinger MP. Aging bone and osteoporosis: strategies for preventing fractures in the elderly. Arch Int Med. 2003;163(18):2237-46.

Council on Scientific Affairs, American Medical Association. Alcoholism in the elderly. JAMA. 1996;275:797-801.