A poor performance in comprehensive geriatric assessment is associated with increased fall risk in elders with hypertension: a cross-sectional study

Jiao-Jiao Chu, Xu-Jiao Chen, Shan-Shan Shen, Xue-Feng Zhang, Ling-Yan Chen, Jing-Mei Zhang, Jing He, Jun-Feng Zhao, Jiao-Jiao Chu, Xu-Jiao Chen, Shan-Shan Shen, Xue-Feng Zhang, Ling-Yan Chen, Jing-Mei Zhang, Jing He, Jun-Feng Zhao

Abstract

Background: Fall and serious fall injuries have become a major health concern for elders. Many factors including blood pressure and anti-hypertensive medication application were reported as hazards of fall. The purpose of this study was to determine if age related systemic functional decline related with increased fall risks in elderly patients with hypertension.

Methods: A total of 342 elderly hypertension patients (age 79.5 ± 6.7 years, male 63.8%) were recruited to the study. Comprehensive geriatric assessment (CGA), including measurements about activity of daily living (ADL), nutrition, cognition, depression, numbers of prescription medication and number of clinical diagnosis, was conducted to evaluate the physical and mental status of each participants. Fall risk was evaluated by Morse fall scale, Tinetti performance oriented mobility assessment (POMA) and history of fall in the recent year. Participants were grouped into tertiles according to CGA score. Correlation between CGA and fall risk was analyzed through SPSS 18.0.

Results: Participants with higher CGA score were likely to be older, had a lower body mass index (BMI), and a higher prevalence of cardiovascular disease, chronic obstructive pulmonary disease (COPD), cerebrovascular disease and osteoarthropathia. Participants in higher tertile of CGA score got increased prevalence of fall risk than those in lower tertile (P < 0.01 T3 vs. T1, P < 0.01 T3 vs. T2). Correlation analysis and regression analysis showed significant association between CGA and Morse fall scale (P < 0.001), as well as CGA and POMA (P < 0.001). Meanwhile, CGA components also showed co-relationships with increase fall risks. After adjusting age, BMI, benzodiazepine use, cardiovascular disease, cerebrovascular disease, COPD and osteoarthropathia, both history of fall in the recent year and rising Morse fall scale were significantly associated with ADL impairment (OR: 2.748, 95%CI: 1.598-4.725), (OR: 3.310, 95%CI: 1.893-5.788). Decreased Tinetti POMA score was associated with Mini-Mental State Examination (MMSE) (OR: 4.035, 95%CI: 2.100-7.751), ADL (OR: 2.380, 95%CI: 1.357-4.175) and shortened MNA form (MNA-SF) impairment (OR: 2.692, 95%CI: 1.147-6.319).

Conclusions: In elderly adults with hypertension, impaired physical and mental function is associated with increased fall risk. Further study is required to investigate possible mediators for the association and effective interventions.

Keywords: Comprehensive geriatric assessment; Elderly patient; Fall risk; Hypertension.

References

    1. Fletcher PC, Guthrie DM, Berg K, et al. Risk factors for restriction in activity associated with fear of falling among seniors within the community. J Patient Saf. 2010;6:187–191.
    1. Scuffham P, Chaplin S, Legood R. Incidence and costs of unintentional falls in older people in the United Kingdom. J Epidemiol Community Health. 2003;57:740–744.
    1. Kwan MM, Close JC, Wong AK, et al. Falls incidence, risk factors, and consequences in Chinese older people: a systematic review. J Am Geriatr Soc. 2011;59:536–543.
    1. Guideline for the prevention of falls in older persons. American Geriatrics Society, British Geriatrics Society, and American Academy of Orthopaedic Surgeons Panel on Falls Prevention. J Am Geriatr Soc. 2001;49:664–672.
    1. O'Loughlin JL, Robitaille Y, Boivin JF, et al. Incidence of and risk factors for falls and injurious falls among the community-dwelling elderly. Am J Epidemiol. 1993;137:342–354.
    1. Bangalore S, Messerli FH, Franklin SS, et al. Pulse pressure and risk of cardiovascular outcomes in patients with hypertension and coronary artery disease: an INternational VErapamil SR-trandolapril STudy (INVEST) analysis. Eur Heart J. 2009;30:1395–1401.
    1. Denardo SJ, Gong Y, Nichols WW, et al. Blood pressure and outcomes in very old hypertensive coronary artery disease patients: an INVEST sub-study. Am J Med. 2010;123:719–726.
    1. Smith SC, Jr, Benjamin EJ, Bonow RO, et al. AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation. Circulation. 2011;124:2458–2473.
    1. Goldstein LB, Bushnell CD, Adams RJ, et al. Guidelines for the primary prevention of stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011;42:517–584.
    1. Tinetti ME, McAvay GJ, Fried TR, et al. Health outcome priorities among competing cardiovascular, fall injury, and medication-related symptom outcomes. J Am Geriatr Soc. 2008;56:1409–1416.
    1. Sibley KM, Voth J, Munce SE, et al. Chronic disease and falls in community-dwelling Canadians over 65 years old: a population-based study exploring associations with number and pattern of chronic conditions. BMC Geriatr. 2014;14:22.
    1. Forrest GP, Chen E, Huss S, et al. A comparison of the functional independence measure and morse fall scale as tools to assess risk of fall on an inpatient rehabilitation. Rehabil Nurs. 2013;38:186–192.
    1. Chien MH, Guo HR. Nutritional status and falls in community-dwelling older people: a longitudinal study of a population-based random sample. PLoS One. 2014;9:e91044.
    1. Rubenstein LZ, Stuck AE, Siu AL, et al. Impacts of geriatric evaluation and management programs on defined outcomes: overview of the evidence. J Am Geriatr Soc. 1991;39:8S–16S; Discussion 17S–18S.
    1. Liu LS, Writing Group of 2010 Chinese Guidelines for the Management of Hypertension 2010 Chinese guidelines for the management of hypertension. Zhonghua Xin Xue Guan Bing Za Zhi. 2011;39:579–615.
    1. Morse J. Preventing Patients Falls. 1st edition. California, USA: Sage Publications; 1997.
    1. Tinetti ME, Baker DI, McAvay G, et al. A multifactorial intervention to reduce the risk of falling among elderly people living in the community. N Engl J Med. 1994;331:821–827.
    1. Mahoney FI, Barthel DW. Functional evaluation: the barthel index. Md State Med J. 1965;14:61–65.
    1. Lobo A, Ezquerra J, Gomez Burgada F, et al. Cognocitive mini-test (a simple practical test to detect intellectual changes in medical patients) Actas Luso Esp Neurol Psiquiatr Cienc Afines. 1979;7:189–202.
    1. Shah A, Herbert R, Lewis S, et al. Screening for depression among acutely ill geriatric inpatients with a short geriatric depression scale. Age Ageing. 1997;26:217–221.
    1. Rubenstein LZ, Harker JO, Salva A, et al. Screening for under-nutrition in geriatric practice: developing the short-form mini-nutritional assessment (MNA-SF) J Gerontol A Biol Sci Med Sci. 2001;56:M366–M372.
    1. Tinetti ME, Han L, Lee DS, et al. Antihypertensive medications and serious fall injuries in a nationally representative sample of older adults. JAMA Intern Med. 2014;174:588–595.
    1. Zang G. Antihypertensive drugs and the risk of fall injuries: a systematic review and meta-analysis. J Int Med Res. 2013;41:1408–1417.
    1. Callisaya ML, Sharman JE, Close J, et al. Greater daily defined dose of antihypertensive medication increases the risk of falls in older people--a population-based study. J Am Geriatr Soc. 2014;62:1527–1533.
    1. Padubidri A, Al Snih S, Samper-Ternent R, et al. Falls and cognitive decline in Mexican Americans 75 years and older. Clin Interv Aging. 2014;9:719–726.
    1. Avelino-Silva TJ, Farfel JM, Curiati JA, et al. Comprehensive geriatric assessment predicts mortality and adverse outcomes in hospitalized older adults. BMC Geriatr. 2014;3:129.
    1. Ellis G, Whitehead MA, O'Neill D, et al. Comprehensive geriatric assessment for older adults admitted to hospital. Cochrane Database Syst Rev. 2011;6:CD006211.

Source: PubMed

Sponsorzy i współpracownicy

Warunki medyczne

Interwencje lekowe

3
Subskrybuj