The purpose of this study is to determine the prevalence of falls and its associated factors among elderly diabetes type 2 patients attending a tertiary center in Malaysia. We conducted a cross-sectional study among 288 elderly diabetes type 2. The data collected includes data on sociodemographic, diabetes history, comorbid diseases, drug use, and activity of daily living (Barthel’s index). The patient also was examined physically, and balance and gait assessment was carried out. Prevalence of falls among elderly diabetes was 18.8%. Female gender (OR: 2.54, ), age group more than 75 (OR: 2.97, ), retinopathy (OR: 2.19, ), and orthostatic hypotension (OR: 2.87, ) were associated with higher risk for falls. High balance and gait score was associated with reduced risk of fall in elderly diabetes (OR: 0.89, ). In conclusion, the factors that are associated with higher risk for falls among elderly diabetes were female sex, age group more than 75, presence of retinopathy, and orthostatic hypotension. Those who had higher balance and gait score were found to be less likely to fall compared with those with lower score. 1. Introduction The number of elderly people within a population is increasing worldwide especially in developing countries. Falls are a major problem in the elderly because they cause significant morbidity and mortality. This is due to complications arising from falls causing a significant decrease in functional status, serious injury, and increased utilization of medical services [1, 2]. Diabetes mellitus (DM) is highly prevalent in older people [3]. The current burden of diabetes is greatest in the population ≥65 years of age, where more than half of direct medical expenditures were on diabetes [4]. As diabetes increasingly becomes a disease of elderly people, some of its related complications must be addressed. These include cognitive disorders and physical disability, falls and fractures, and other geriatric syndromes in the elderly [5]. There is evidence that shows that diabetes mellitus is a predictor of falls risk [6–8]. A number of studies have reported that older people with diabetes have a higher risk of falls compared with those without diabetes [3, 8]. Diabetes-related complications such as peripheral neuropathy [9, 10], reduced vision [6], diabetic foot ulcers, and impaired renal function [11] are the potential mechanism for falls. Reduced balance, strength and gait, are also likely conditions associated with diabetes-related complications and risk of falls [6, 8, 12]. The consequences of falls are said to be more severe in the
References
[1]
M. C. Nevitt, S. R. Cummings, and E. S. Hudes, “Risk factors for injurious falls: a prospective study,” Journals of Gerontology, vol. 46, no. 5, pp. M164–M170, 1991.
[2]
M. E. Tinetti, J. Doucette, E. Claus, and R. Marottoli, “Risk factors for serious injury during falls by older persons in the community,” Journal of the American Geriatrics Society, vol. 43, no. 11, pp. 1214–1221, 1995.
[3]
D. K. Miller, L. Y. L. Lui, H. M. Perry, F. E. Kaiser, and J. E. Morley, “Reported and measured physical functioning in older inner-city diabetic African Americans,” Journals of Gerontology, vol. 54, no. 5, pp. M230–M236, 1999.
[4]
M. Harris, C. Cowie, M. Stern, E. Boyko, G. Reiber, and P. Bennet, “Diabetes in America. In: Department of Health and Human Services,” N.I.o.H. (Ed.), 1995.
[5]
E. W. Gregg, M. M. Engelgau, and V. Narayan, “Complications of diabetes in elderly people,” British Medical Journal, vol. 325, no. 7370, pp. 916–917, 2002.
[6]
A. V. Schwartz, T. A. Hillier, D. E. Sellmeyer et al., “Older women with diabetes have a higher risk of falls: a prospective study,” Diabetes Care, vol. 25, no. 10, pp. 1749–1754, 2002.
[7]
E. W. Gregg, G. L. A. Beckles, D. F. Williamson et al., “Diabetes and physical disability among older U.S. adults,” Diabetes Care, vol. 23, no. 9, pp. 1272–1277, 2000.
[8]
S. Volpato, S. G. Leveille, C. Blaum, L. P. Fried, and J. M. Guralnik, “Risk factors for falls in older disabled women with diabetes: the women's health and aging study,” Journals of Gerontology, vol. 60, no. 12, pp. 1539–1545, 2005.
[9]
E. S. Huang, A. J. Karter, K. K. Danielson, E. M. Warton, and A. T. Ahmed, “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,” Journal of General Internal Medicine, vol. 25, no. 2, pp. 141–146, 2009.
[10]
C. Wallace, G. E. Reiber, J. LeMaster et al., “Incidence of falls, risk factors for falls, and fall-related fractures in individuals with diabetes and a prior foot ulcer,” Diabetes Care, vol. 25, no. 11, pp. 1983–1986, 2002.
[11]
A. V. Schwartz, E. Vittinghoff, D. E. Sellmeyer et al., “Diabetes-related complications, glycemic control, and falls in older adults,” Diabetes Care, vol. 31, no. 3, pp. 391–396, 2008.
[12]
S. A. Quandt, J. M. Stafford, R. A. Bell, S. L. Smith, B. M. Snively, and T. A. Arcury, “Predictors of falls in a multiethnic population of older rural adults with diabetes,” Journals of Gerontology, vol. 61, no. 4, pp. 394–398, 2006.
[13]
C. S. Rosenberg, “Wound healing in the patient with diabetes mellitus,” Nursing Clinics of North America, vol. 25, no. 1, pp. 247–261, 1990.
[14]
A. V. Schwartz, D. E. Sellmeyer, K. E. Ensrud et al., “Older women with diabetes have an increased risk of fracture: a prospective study,” Journal of Clinical Endocrinology and Metabolism, vol. 86, no. 1, pp. 32–38, 2001.
[15]
M. S. Maurer, J. Burcham, and H. Cheng, “Diabetes mellitus is associated with an increased risk of falls in elderly residents of a long-term care facility,” Journals of Gerontology, vol. 60, no. 9, pp. 1157–1162, 2005.
[16]
M. E. Tinetti, T. Franklin Williams, and R. Mayewski, “Fall risk index for elderly patients based on number of chronic disabilities,” American Journal of Medicine, vol. 80, no. 3, pp. 429–434, 1986.
[17]
C. Collin, D. T. Wade, S. Davies, and V. Horne, “The barthel ADL index: a reliability study,” International Disability Studies, vol. 10, no. 2, pp. 61–63, 1988.
[18]
L. M. Tilling, K. Darawil, and M. Britton, “Falls as a complication of diabetes mellitus in older people,” Journal of Diabetes and its Complications, vol. 20, no. 3, pp. 158–162, 2006.
[19]
K. M. Chan, W. S. Pang, C. H. Ee, Y. Y. Ding, and P. Choo, “Epidemiology of falls among the elderly community dwellers in Singapore,” Singapore Medical Journal, vol. 38, no. 10, pp. 427–431, 1997.
[20]
L. W. Chu, I. Chi, and A. Y. Y. Chiu, “Incidence and predictors of falls in the Chinese elderly,” Annals of the Academy of Medicine Singapore, vol. 34, no. 1, pp. 60–72, 2005.
[21]
A. Bueno-Cavanillas, F. Padilla-Ruiz, J. J. Jiménez-Moleón, C. A. Peinado-Alonso, and R. Gálvez-Vargas, “Risk factors in falls among the elderly according to extrinsic and intrinsic precipitating causes,” European Journal of Epidemiology, vol. 16, no. 9, pp. 849–859, 2000.
[22]
T. Conner-Kerr and M. S. Templeton, “Chronic fall risk among aged individuals with type 2 diabetes,” Ostomy Wound Management, vol. 48, no. 3, pp. 28–34, 35, 2002.
[23]
C. A. Reyes-Ortiz, S. Al Snih, J. Loera, L. A. Ray, and K. Markides, “Risk factors for falling in older Mexican Americans,” Ethnicity and Disease, vol. 14, no. 3, pp. 417–422, 2004.
[24]
M. S. Maurer, S. Cohen, and H. Cheng, “The degree and timing of orthostatic blood pressure changes in relation to falls in nursing home residents,” Journal of the American Medical Directors Association, vol. 5, no. 4, pp. 233–238, 2004.
[25]
L. Z. Rubenstein, K. R. Josephson, and A. S. Robbins, “Falls in the nursing home,” Annals of Internal Medicine, vol. 121, no. 6, pp. 442–451, 1994.
[26]
R. Q. Ivers, R. G. Cumming, P. Mitchell, and K. Attebo, “Visual impairment and falls in older adults: the blue mountains eye study,” Journal of the American Geriatrics Society, vol. 46, no. 1, pp. 58–64, 1998.
[27]
S. R. Cummings, M. C. Nevitt, and S. Kidd, “Forgetting falls. The limited accuracy of recall of falls in the elderly,” Journal of the American Geriatrics Society, vol. 36, no. 7, pp. 613–616, 1988.
