RISK FACTORS OF FALL IN ELDERLY PEOPLE

Falls are the leading accidental cause of death among elderly people in their homes. Falls and their consequences are the primary reason in 40% of admissions to hospitals for people older than 65 years. The study population consisted of 77 randomly selected patients of both genders older then 65 years. Each patient was tested in his/her home and was completely informed about the methodology and the goals of investigation. Based on the exclusion criteria, three patients were excluded from the study, which means the investigation was conducted on 27 males (35.06%) and 50 females (64.94%) with the average age being 71.23 +/- 5.63 years. For each patient, a specially prepared questionnaire about risk factors was filled in. The sum of affirmative answers represented a relative index of fall risk. All patients were evaluated through Folstein's Mini-Mental State Examination Test that is suitable for on-sight use in patient's home. The score value over 20 excludes dementias, delirium, schizophrenia and affective disorders. Considering the values of the risk factor, scores obtained by the questionnaire and MMSE test scores, statistically significant differences were found between males and females (p < 0.005, respectively p < 0.01), "fallers" and "non-fallers" (p < 0.001, respectively p < 0.01), while considering the relation to the way of living (alone or with family), there were no statistically significant differences (p > 0.05).


Introduction
Rapid industrialization and urbanization, as well as a rapid improvement in technology, have put elderly people on periphery of the interest in health institutions.One of the most important problems in this population group is fall, i.e. the consequences of falling.The outcome of falls in the elderly is devastating.Fall is the leading cause of death resulting from different kinds of injures in people older than 65 years, while in people older than 75 years, almost 70% of interventions in emergency centres are related to fall (1).Normal postural control include the control of a relative position of body parts directed by skeletal muscles in relation to gravitation and one opposed to other (2).Falls are more frequently the result of a complex interaction between damaged body functions and surrounding elements.A twisted plank does not represent a problem for a normal, healthy person while the changes in body balance, muscle tonicity and cognition typical for elderly people may be sufficient to cause falling and a hip fracture (3).

The aim of paper
The aim of paper is to explore the most common risk factors that predispose falling in the elderly and to conduct Folstein's Mini-Mental State Examination Test.

Subjects and methods
The conducted study is clinical, and it contains manipulative, prospective and control research.The research included 80 randomly chosen patients of both genders and older than 65 years.The criteria for including into the study were: age over 65 years and mobility with or without aids (cane).The exclusion criteria were death of the subjects or occurrence of some disease that could influence the functional ability of the subjects during the period of study.All the subjects have been examined by the physical therapist.For each patient, a specially prepared questionnaire about risk factors was filled in (Appendix 1).The questionnaire contains 22 questions that are scored dichotomically ("yes" or "no").The sum of affirmative answers represents a relative index of fall risk.This estimation is based on investigators' observation, patients' answers and the data from the accessible medical documentation.All the patients were evaluated by Folstein's Mini-Mental State Examination Test (a test of cognitive functions)4 -Appendix 2. This test was adjusted to the conditions at home.The standardization of test has shown that the score over 20 excludes dementia, delirium, schizophrenia and affective disorders (5).The results were statistically processed with SPSS program, Version 9.0, and shown in the form of tables and graphs.For each clinical test, distribution, frequency and the measures of central tendency, specificity, sensitivity, positive and negative predictive value, the percent of falsely positive and negative results.With the t test, it has been established that the examined variables significantly differ statistically.With the aim of establishing the in-

RISK FACTORS OF FALL IN ELDERLY PEOPLE
Dijana Avdi}1* , D`emal Pecar 1 , Emela Muji}-Skiki} 2dividual variables that predict the fall, a logistic regression analysis has been conducted, and dependent variable was represented by the information about fall (0-no fall, 1 -with fall).

Results
Out of 80 subjects, 3 (3.75%)were excluded from the study: one subject had MMSE test score less than 20, one died, and one had a stroke.The study included 77 subjects, 27 males (35.06%) and 50 females (64.94%).The distribution of examined subjects by gender is shown in Graph 1.The average age was 71.23 ± 5.63 years (range from 65 to 90 years): for females 71.22 ± 5.80 years (range from 65 to 90 years), and for males, 72.67 ± 5.26 years (range from 65 to 82 years).The mean values of age, body weight, and blood pressure are shown in Table 1.Table 1.The mean values of age, weight, height, and blood pressure in subjects Two subjects (both women) had no any kind of specialist's training, 30 subjects completed primary school only (38.96%), 34 subjects had intermediate specialist's training (44.16%), and 11 subjects had advanced or university-level specialist's training (14.29%).The level of education in relation to gender is shown in Table 2.In the study period, 21 subjects (27.27%) fell two or more times, while the same number reported about only one fall.Out of 27 males, 4 subjects reported about fall (14.81%)where 1 lives alone and 3 with family.Out of 50 females, 17 reported about fall (34%) where 9 live with family and 8 alone.The data about fall related to gender and the way of living (alone or with family) are given in the Tables 3 and 4. The mean values of the parameters (age, weight, systolic and diastolic blood pressure related to the information about fall) are given in Table 5.Table 5.The mean values of age, weight, systolic and diastolic blood pressure in relation to the information about fall The mean values of risk factor gained trough questionnaire and MMSE Test results are given in Tables 6-8.Regarding the values of the risk factor scores gained trough questionnaire and MMSE Test, there are statistically significant differences between males and females, as well as between the subjects who fell and did not fall, while related to the way of living (alone or with family) there are no significant differences (Tables 9-11).

Discussion
In the old age, the psychophysical abilities of humans gradually decrease and the ability to adjust to endogenous and exogenous strains declines as well.In 1987, Harada et al. (6) have established that in the USA, 9.5 million persons have difficulties in performing the activities of everyday life, and 59% (5.6 million) is older than 65 years.In the age group from 65 to 74 years, each 10th person has difficulties, and in the age group of 75 to 84 years, it is every 4th person.For the persons older than 85, this ra-tio is 3 out of 5 persons.The study included 77 randomly chosen subjects of both genders and average age 71.73 ± 5.63 years (range 65 to 90 years).Each patient was questioned in his/her own home and was completely introduced to the methodology and the aims of research.The perceptual presence of females was 64.94% (50 subjects), and males 35.06% (27 subjects), which is in accordance to the demographic data about this population group in accordance to our conditions (1).In other studies, the gender structure was different, so Harada et al. (6) observed that females represented 87% of subjects in their research group.Regarding the age difference, there was no statistically significant difference related to gender.Although the average values of systolic and diastolic pressure in females and males were different clinically, that difference was not statistically significant.The measured values were a bit higher than the normal values, especially in females, which indicate an inadequate medical treatment.For the body weight parameter, a significant difference has been observed between males and which confirms a constitutional, i.e. anthropologic difference.However, the process of osteoporosis in females must not be excluded since none of the examined females was using means to prevent osteoporosis.Considering education, i.e. the level of education, a statistically significant difference is evident between males and females (p < 0.001).Even 56% of females from the examined group had only primary education related to 7.41% of males.The lower level of education in females belonging to the group of elderly people can be observed in the context of social, cultural and sub-cultural circumstances in our geographic areas where it was common that female children were less often sent to school.This was especially present in rural areas where most of our subjects came from.The primary education, in the time when the subjects had to go to school, was not compulsory, so the number of those that had intermediate, advanced or university-level specialist's training was smaller.Thus, for example, 4% of females had advanced or university-level specialist's training in comparison to 33.33% of males from the study group.Between the subjects who live alone and the subjects who live with family there was no statistically significant difference related to the age group, body weight and the values of systolic and diastolic blood pressure.The results of this study are different from the data in other literature since only 29.87% of the subjects lived alone, while that percent in other studies was two to three times higher (7,8).The discrepancy can be explained through cultural and economic differences of our society since it is usual in our geographic areas that the younger generations live with parents, which is different from the trend in Western countries, and the lack of the place for living partially imposes such a solution.Furthermore, in our geographical areas there are no conditions that would make the life alone of the elderly easer, which is different from the Western countries.It could be expected that the percentage of the older persons who live alone would be even smaller, but the war contributed migrating of younger generations that led to the increasing in the number of the elderly who live alone.The mean risk factor score and MMSE Test were significantly statistically different in relation to gender and the data about fall, which is opposite to the data about the way of living.It is interesting that the average score of MMSE Test of the subjects in this study is quite higher than that in the other studies that used this criterion (5,9,10,11,12,13) (after adjusting it to the age).Since the test score depends on education, and in the mentioned studies this parameter was not used, it is not possible to make an adequate comparison, and it can only be supposed that the level of education was lower in those studies.
2. Considering the age difference, there were no significantly statistically differences related to gender.Although the mean values of systolic and diastolic blood pressure were clinically different, that difference was not statistically significant.The measured values were a bit higher than the normal values, especially in females, which indicate an inadequate medical treatment.
3. Considering education or the level of education statistically significant difference is evident between males and females (p < 0.001): Even 56% of females from the examined group have a primary education only related to 7.41% of males, while 4% of females had advanced or university-level specialist's training in comparison to 33.33% of in the research group.
4. Between the subjects who live alone (29.87%), and the subjects who live with family (70.13%)there were no statistically significant difference related to the age group, body weight and the values of systolic and diastolic blood pressure.
5. In the study period, 21 subjects (27.27%) fell two or more times, while the same number reported about only one fall.Out of 27 men, 4 subjects reported about fall (14.81%)where 1 lives alone and 3 in a family.Out of 50 women, 17 reported about fall (34%) where 9 live with family, and 8 alone.44% of women who live alone fell two or more times in the period of study compared to 20% of men who live alone.
6. Between the subjects who fell and who did not fall there were no statistically significant difference considering age, body weight and the values of systolic and diastolic blood pressure.
7. Considering the risk factor score values, which have been obtained trough questionnaire and the MMSE Test results, there were statistically significant differences between males and females (p < 0.005, i.e. p < 0.01), as well as in the subjects who did not fall (p < 0.001, i.e. p < 0.01), while in the case of the way of living (alone or with family) there were no statistically significant differences (p > 0.05).