Falls in people with chronic obstructive pulmonary disease: an observational cohort study

Abstract

Study objective: To investigate incidence, risk factors and impact of falls on health related quality of life (HRQoL) in patients with chronic obstructive pulmonary disease (COPD).

Design: Observational cohort study.

Methods: Patients completed these questionnaires at baseline and at 6-months: Medical Outcomes Study Short Form 36 (SF-36), Chronic Respiratory Questionnaire (CRQ), Activities Balance Confidence (ABC) Scale and a form to record demographic data, medications, co-morbidities, oxygen use, acute exacerbations, fall history and assistive device use. Physical activity was measured with the Physical Activity Scale for the Elderly (PASE) only at baseline. Fall incidence was monitored through monthly fall diaries. Patients were categorized as non-fallers (0 falls) or fallers (≥ 1 falls).

Results: Data from 101 patients with a forced expiratory volume in 1 s of 46.4 ± 21.6% predicted were analyzed. Thirty-two patients (31.7%) reported at least one fall during the 6-months. Fall incidence rate was 0.1 (95% CI: 0.06-0.14) falls per person-month. Fallers tended to be older (p = 0.04), female (p = 0.04) and oxygen dependent (p = 0.02), have a history of previous falls (p < 0.001), more co-morbidities (p = 0.007) and take more medications (p = 0.001). Previous falls (OR = 7.36; 95% CI: 2.39-22.69) and diagnosis of coronary heart disease (OR = 7.07; 95% CI: 2.14-23.36) were the most important predictors of falls. The Dyspnea Domain of the CRQ declined significantly more (p = 0.02) in the fallers group at 6-months.

Conclusions: Patients with COPD have a high susceptibility to falls, which is associated with a worsening of dyspnea perception as related to HRQoL. Fall prevention programs in COPD are recommended.

Copyright © 2010 Elsevier Ltd. All rights reserved.

Figures

Figure 1

Flow chart showing the different stages of the recruitment process and the study

Figure 2

Trajectory of the SF-36 physical functioning (a) and CRQ dyspnea (b) scores in fallers (solid line) and non-fallers (dashed line) during the 6-months. Compared to non-fallers, fallers showed a tendency (p=0.15) towards a more pronounced decline in the SF-36 physical functioning domain during the 6-months (a). The decline in the CRQ dyspnea domain was significantly larger (p=0.02) in the fallers group (b).