A regression tree for identifying combinations of fall risk factors associated to recurrent falling: a cross-sectional elderly population-based study

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• 作者：A. Kabeshova (1) (2)
  C. Annweiler (1) (3)
  B. Fantino (1)
  T. Philip (4)
  V. A. Gromov (5)
  C. P. Launay (1) (2)
  O. Beauchet (1)
  
• 关键词：Recurrent falls ; Older adults ; Community ; dwelling ; Risk factor
• 刊名：Aging Clinical and Experimental Research
• 出版年：2014
• 出版时间：June 2014
• 年：2014
• 卷：26
• 期：3
• 页码：331-336
• 全文大小：
• 参考文献：1. Beauchet O, Dubost V, Revel Delhom C, Berrut G, Belmin J, French Society of Geriatrics and Gerontology (2011) How to manage recurrent falls in clinical practice: guidelines of the French Society of Geriatrics and Gerontology. J Nutr Health Aging 15:79-4 CrossRef
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  3. Panel on Prevention of Falls in Older Persons, American Geriatrics Society and British Geriatrics Society (2011) Summary of the Updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons. J Am Geriatr Soc 59:148-57 CrossRef
  4. Rubenstein LZ (2006) Falls in older people: epidemiology, risk factors and strategies for prevention. Age Ageing 35(Suppl 2):ii37–ii41
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  8. Adoubi F, Launay C, Anneler C, Fanion B, Kabeshova A, Beauchet O (2013) Fear of falling, falls, and gait variability in older community-dwelling individuals: is there an association? J Am Geriatr Soc 61:1236-368 CrossRef
  9. Haubois G, de Decker L, Anneler C, Launay C, Allali G, Herrmann FR, Beauchet O (2012) Derivation and validation of a Short form of the Mini-Mental State Examination for the screening of dementia in older adults with a memory complaint. Eur J Neurol 20:588-90 CrossRef
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  16. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA, Cardiovascular Health Study Collaborative Research Group (2001) Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 56:M146–M156 CrossRef
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  18. Beauchet O, Anneler C, Allali G et al (2008) Recurrent falls and dual task-related decrease in walking speed: is there a relationship? J Am Geriatr Soc 56:1265-269 CrossRef
  19. Beauchet O, Rossat A, Bongue B, Dupré C, Colvez A, Fanion B, Fanion B (2010) Change in arm position during one-leg balance test: a predictor of recurrent falls in community-dwelling older adults. J Am Geriatr Soc 58:1598-600 CrossRef
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• 作者单位：A. Kabeshova (1) (2)
  C. Annweiler (1) (3)
  B. Fantino (1)
  T. Philip (4)
  V. A. Gromov (5)
  C. P. Launay (1) (2)
  O. Beauchet (1)
  
  1. Division of Geriatric Medicine, Department of Neuroscience, Angers University Hospital, 49933, Angers cedex 9, France
  2. UPRES EA 4336, UNAM, Angers University Hospital, Angers, France
  3. Robarts Research Institute, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
  4. Department of Primary Care, Angers Medical School, University of Angers, Angers, France
  5. Computational Mathematics and Mathematical Cybernetics Department, Faculty of Applied Mathematics, Oles Honchar Dnepropetrovsk National University Dnepropetrovsk, Dnepropetrovsk, Ukraine
  
• ISSN：1720-8319

文摘

Background Regression tree (RT) analyses are particularly adapted to explore the risk of recurrent falling according to various combinations of fall risk factors compared to logistic regression models. The aims of this study were (1) to determine which combinations of fall risk factors were associated with the occurrence of recurrent falls in older community-dwellers, and (2) to compare the efficacy of RT and multiple logistic regression model for the identification of recurrent falls. Methods A total of 1,760 community-dwelling volunteers (mean age?±?standard deviation, 71.0?±?5.1?years; 49.4?% female) were recruited prospectively in this cross-sectional study. Age, gender, polypharmacy, use of psychoactive drugs, fear of falling (FOF), cognitive disorders and sad mood were recorded. In addition, the history of falls within the past year was recorded using a standardized questionnaire. Results Among 1,760 participants, 19.7?% (n?=?346) were recurrent fallers. The RT identified 14 nodes groups and 8 end nodes with FOF as the first major split. Among participants with FOF, those who had sad mood and polypharmacy formed the end node with the greatest OR for recurrent falls (OR?=?6.06 with p?<?0.001). Among participants without FOF, those who were male and not sad had the lowest OR for recurrent falls (OR?=?0.25 with p?<?0.001). The RT correctly classified 1,356 from 1,414 non-recurrent fallers (specificity?=?95.6?%), and 65 from 346 recurrent fallers (sensitivity?=?18.8?%). The overall classification accuracy was 81.0?%. The multiple logistic regression correctly classified 1,372 from 1,414 non-recurrent fallers (specificity?=?97.0?%), and 61 from 346 recurrent fallers (sensitivity?=?17.6?%). The overall classification accuracy was 81.4?%. Conclusions Our results show that RT may identify specific combinations of risk factors for recurrent falls, the combination most associated with recurrent falls involving FOF, sad mood and polypharmacy. The FOF emerged as the risk factor strongly associated with recurrent falls. In addition, RT and multiple logistic regression were not sensitive enough to identify the majority of recurrent fallers but appeared efficient in detecting individuals not at risk of recurrent falls.