Age and Sex Significantly Influence Fall Risk in Community‐dwelling Elderly People in Japan

To the Editor: The methodology for assessment, intervention, and prevention of falls in community-dwelling elderly people has been intensely debated in the field of geriatric medicine.1,2 Falling is the third leading cause of elderly people becoming bedridden and is among the principal causes of morbidity in elderly people in Japan.3 To detect early risk for falls in elderly people, the Working Group for Fall Prevention in the Japanese Ministry of Health, Welfare and Labor developed a validated Fall Risk Index (FRI). The FRI consists of 21 questionnaire-based items identified through a search of international and Japanese research articles that surveyed the history of falls within 1 year on a yes or no basis.4–6 The 21 items included in the FRI encompassed physical, cognitive, emotional, and social aspects of functioning and environmental factors and included history of stumbling, ability to climb stairs, walking speed, ability to cross the road within green signal time interval, ability to walk 1 km without rest, ability to stand on one leg for 5 seconds, use of cane, ability to squeeze a towel, dizziness, hunched back, knee joint pain, visual disturbance, hearing disturbance, forgetfulness, fear of falling, use of five or more prescription medications, sensation of darkness inside home, presence of obstacles inside house, presence of barriers on the floor, daily stair use at home, and steep slopes around the house (Appendix). Each of the 21 items received a score of 1 (risk present) or 0 (risk absent), and the sum of all items constituted the FRI, which ranged from 0 (low fall risk) to 21 (high fall risk). FRI was assessed in community-dwelling elderly people, and significant age- and sex-dependent differences were found. The study population consisted of 4,773 community-dwelling subjects aged 65 and older (2,014 male, 2,759 female, mean age 75.5±7.0) living in three towns in Japan (Tosa, Odai, and Urausu). Response rates of the eligible population in each town were 79%, 83%, and 90%, respectively. Statistical analysis was performed using SPSS (SPSS, Inc., Chicago, IL). P<.05 indicated statistical significance. A comparison of FRI according to age groups for male and female subjects is displayed in Figure 1. Significant differences in mean FRI were found across age groups for men and women and were found to increase with age. Mean FRI for women was significantly higher than in men in each age group of age 70 and older. Women scored 7.2 (vs 6.1 in men), 8.3 (vs 7.2), 9.6 (vs 8.0), and 11.5 (vs 9.8) in age groups 70 to 74, 75 to 79, 80 to 84, and 85 and older, respectively. Sex differences in mean FRI also increased with age (0.34, 1.08, 1.14, 1.61, 1.96 in each age group). Comparison of Fall Risk Index (FRI) according to age group in community-dwelling elderly men and women in Japan. Significant differences in FRI were found at P<.001 between age groups in men and women using one-way analysis if variance and post hoc test using Fisher protected least significant difference. *P<.001 between men and women in Student t-test. Activities of daily living (ADLs) in elderly people are known to decrease with age and are sex-dependent.7 Age and ADLs are closely correlated to incidences of falling in community-dwelling elderly people.6 Although the FRI was primarily developed for early detection of fall risk in elderly people, the data suggest that this index could be a useful indicator to estimate total geriatric functional status. Aside from an estimation of fall risk, effects of age and sex on living environment-related ADLs may also be determined. We thank all the elderly people who participated in this study. We would also like to extend our heartfelt thanks to the public health nurses in each town for preparing the examinations. This study was partly supported by the Grant-in-Aid of the JSPS Global COE Program (E-04): In Search for Sustainable Humanosphere in Asia and Africa, and Grant-in-Aid of Research Institute for Humanity and Nature (3-4 FR): Human Life, Aging, and Disease in High-Altitude Environments: Physio-medical, Ecological and Cultural Adaptation in the Great Highland Civilizations. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this letter. Author Contribution: All authors contributed to this paper. Sponsor's Role: None. Q1. History of stumbling within 1 year Q2. Can you climb stairs without help? Q3. Do you feel your walking speed declined recently? Q4. Can you cross the road within the green signal interval? Q5. Can you walk 1 kilometer continuously? Q6. Can you stand on one foot for about 5 seconds? Q7. Do you use a cane when you walk? Q8. Can you squeeze a towel tightly? Q9. Do you feel dizzy? Q10. Is your back bent? Q11. Do you have knee pain? Q12. Do you have vision problems? Q13. Do you have hearing problems? Q14. Do you think you are forgetful? Q15. Do you feel anxious to fall when you walk? Q16. Do you take more than five kinds of prescribed medicines? Q17. Does your home feel dark when you are walking in it? Q18. Are there any obstacles within the house? Q19. Are there any uneven surfaces within your house (e.g., stairs, thresholds)? Q20. Do you have to use stairs in daily living? Q21. Do you have a steep slope around your house?