Risk factors for falls in community-dwelling older people : a systematic review and meta-analysis

BACKGROUND: Falls are the main cause of accidental death in persons aged 65 years or older. METHODS: Using MEDLINE and previous reviews, we searched for prospective studies investigating risk factors for falls among community-dwelling older people. For risk factors investigated by at least 5 studies in a comparable way, we computed pooled odds ratios (ORs) using random-effects models, with a test for heterogeneity. RESULTS: A total of 74 studies met the inclusion criteria and 31 risk factors were considered, including sociodemographic, mobility, sensory, psychologic, and medical factors and medication use. The strongest associations were found for history of falls (OR = 2.8 for all fallers; OR = 3.5 for recurrent fallers), gait problems (OR = 2.1; 2.2), walking aids use (OR = 2.2; 3.1), vertigo (OR = 1.8; 2.3), Parkinson disease (OR = 2.7; 2.8), and antiepileptic drug use (OR = 1.9; 2.7). For most other factors, the ORs were moderately above 1. ORs were generally higher for recurrent fallers than for all fallers. For some factors, there was substantial heterogeneity among studies. For some important factors (eg, balance and muscle weakness), we did not compute a summary estimate because the measures used in various studies were not comparable. CONCLUSIONS: This meta-analysis provides comprehensive evidence-based assessment of risk factors for falls in older people, confirming their multifactorial etiology. Some nonspecific indicators of high baseline risk were also strong predictors of the risk of falling.