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I. Simonné Wiesl Department of Chronic Internal Medicine of the Károlyi Sándor Hospital, Budapest, Hungary

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P. Kis-Kós Department of Chronic Internal Medicine of the Károlyi Sándor Hospital, Budapest, Hungary

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Zs. Gyombolai Schools of PhD Studies, Health Sciences, Semmelweis University, Budapest, Hungary

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A. Kubik Schools of PhD Studies, Health Sciences, Semmelweis University, Budapest, Hungary

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Sz. Báthory Schools of PhD Studies, Health Sciences, Semmelweis University, Budapest, Hungary

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É. Kovács Department of Morphology and Physiology, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary

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https://orcid.org/0000-0002-3250-8664
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Abstract

Purpose

Falls in older age are the result of the interaction of several modifiable and nonmodifiable risk factors. Risk factors for falls may vary in frequency not only in different economic and cultural contexts but also in different forms of care services among the older population. The aim of the present cross-sectional descriptive observational study was to assess the prevalence of risk factors for falls among older ambulant patients on a chronic inpatient ward in Hungary.

Material/Methods

Data associated with risk factors for falls, such as age, sex, chronic physical and mental illness, acute illness, incontinence, history of falls, balance and gait disorder, and visual impairment, were collected from 82 participants. The frequency of these risk factors in our sample was compared with their prevalence in the elderly population living at home — based on data available in the literature and statistical databases — using chi-square tests.

Results

Our results show that the prevalence of hypertension, cerebrovascular events, dementia and diabetes are significantly higher in the elderly population in chronic inpatient care than in the elderly population living at home. There is also a significantly higher prevalence of balance disorders and the use of sedatives/sleeping pills/neuroleptics in the studied population. Cardiovascular diseases, osteoporosis, and Parkinson's disease are equally prevalent in both populations.

Conclusions

In the case of many of the patients admitted to chronic inpatient care, there is a real chance that their physical condition will improve or stabilise to the point where they can return to their own homes or be moved to a nursing home. This kind of rehabilitation approach to chronic inpatient care would require many more qualified nurses, physiotherapists, occupational therapists, dietitians and social workers than are currently available.

Abstract

Purpose

Falls in older age are the result of the interaction of several modifiable and nonmodifiable risk factors. Risk factors for falls may vary in frequency not only in different economic and cultural contexts but also in different forms of care services among the older population. The aim of the present cross-sectional descriptive observational study was to assess the prevalence of risk factors for falls among older ambulant patients on a chronic inpatient ward in Hungary.

Material/Methods

Data associated with risk factors for falls, such as age, sex, chronic physical and mental illness, acute illness, incontinence, history of falls, balance and gait disorder, and visual impairment, were collected from 82 participants. The frequency of these risk factors in our sample was compared with their prevalence in the elderly population living at home — based on data available in the literature and statistical databases — using chi-square tests.

Results

Our results show that the prevalence of hypertension, cerebrovascular events, dementia and diabetes are significantly higher in the elderly population in chronic inpatient care than in the elderly population living at home. There is also a significantly higher prevalence of balance disorders and the use of sedatives/sleeping pills/neuroleptics in the studied population. Cardiovascular diseases, osteoporosis, and Parkinson's disease are equally prevalent in both populations.

Conclusions

In the case of many of the patients admitted to chronic inpatient care, there is a real chance that their physical condition will improve or stabilise to the point where they can return to their own homes or be moved to a nursing home. This kind of rehabilitation approach to chronic inpatient care would require many more qualified nurses, physiotherapists, occupational therapists, dietitians and social workers than are currently available.

Introduction

In economically developed countries, including Hungary, the age distribution of the population is changing. In Hungary, the proportion of people aged 65 and over was 18.3% of the total population in 1975 and almost 20% in 2000, and is estimated to rise to more than 36% by 2050 [1]. As people get older, the prevalence of falls increases. In geriatric medicine, a fall is defined as “an unexpected event in which the participants come to rest on the ground, floor, or lower level” [2, 3].

According to the international literature, approximately 30% of people aged 65 and over living at home, and 50% of institutionalised older people, fall at least once a year [4]. Similar figures apply to Hungary. In a survey conducted among 314 elderly people living alone in their homes in a county in Southern Transdanubia, 37% (116) responded that they had fallen during the previous three months [5]. Another study measured the incidence of falls among residents of two nursing homes during a one-year prospective follow-up period [6]. A total of 1,013 falls occurred among the 1,016 residents. The study did not investigate multiple falls, thus the proportion of elderly people who suffered a fall is not known.

Almost one-third of falls result in some kind of injury. In one survey of older people living at home, 47% of those who had had a fall were injured: 6% suffered a fracture and 34% some kind of soft tissue injury [5]. Similar figures have been found among institutionalised older people: 4% suffered a fracture and 34% a soft tissue injury as a result of a fall [6].

Besides physical injuries, falls also have psychological consequences. Whether or not they have experienced an earlier fall, elderly people tend to be afraid of falling [7, 8]. Fear of falling is a condition in which an older person constantly thinks about falling, or about the risk of falling, causing them to restrict their daily activities [9]. This can lead to the weakening of muscles and a functional decline in the balance control system, thus increasing the risk of a fall in the future. This process jeopardises an elderly person's ability to live independently and increases the likelihood of long-term institutional care [8–10].

Falls in older age result from the interaction of several risk factors. Fabre grouped the risk factors identified earlier in retrospective research as either nonmodifiable or modifiable [11]. According to this classification, age, female sex, and physical and mental chronic diseases in old age are nonmodifiable risk factors. However, the most important risk factors in terms of prevention are those that are partially or completely modifiable with appropriate intervention. These include acute illnesses, incontinence, previous falls, balance and gait problems, visual impairment, taking more than three medications, inappropriate footwear, and hazards in the physical environment [11].

The frequency of risk factors for falls may vary not only in different economic and cultural contexts but also in different forms of care services among the older population. Walk-in patients in chronic inpatient wards typically return to their own homes or move to a nursing home that provides long-term care.

The aim of our cross-sectional descriptive observational study was to assess the prevalence of risk factors for falls among ambulant elderly patients on a chronic inpatient ward in Hungary, for which no scientifically collected data previously existed. We then compared the prevalence in our sample with the prevalence among the elderly population in Hungary (Table 1) [12].

Table 1.

Prevalence of chronic diseases in the elderly population in Hungary

DiseasePrevalence
Osteoporosis21.6%
Alzheimer's disease6.9%
Cerebrovascular26.4%
Cardiovascular48.9%
Hypertension92.0%
Parkinson's disease2.0%

Compiled by the authors based on data from the Hungarian Central Statistical Office.

For the prevalence of dementia, diabetes, balance and gait problems, and regular use of sedatives/sleeping pills/neuroleptics, we relied on data published in the Hungarian literature. The prevalence of dementia of various origins (e.g., Alzheimer's disease, vascular dementia) in the population aged 65 years and over is 30.7% [13]. In a public health survey conducted in 2014, almost one in five people aged 65 and over reported having diabetes [14]. Data for gait disorders among older people in Hungary were collected in a 2010 survey, in which 43% of people aged 65 and over reported being barely able to walk 500 m on flat ground without a walking aid or help from another person [15].

We hypothesised that the prevalence of risk factors for falls among older ambulant patients on the investigated chronic inpatient ward would not differ significantly from the data found in the Hungarian literature for older people living at home.

Methods

Participants

Our study was conducted on a general medical ward for patients with chronic conditions, with the approval of the management of the institution. The average age of the patients was over 80 years: the youngest participant was 57 and the oldest was 97 years old. Slightly more than half the samples were women. Participation was voluntary, and anonymity was ensured. The study included patients who were cared for on the ward between 1 September 2019 and 30 June 2020 and who were independently mobile with or without a walking aid. From among the 235 patients, we were able to include 82 people based on this criteria.

Data collection

Data on what are considered risk factors for falls, such as age, sex, chronic physical and mental illness, acute illness, incontinence, a history of falls, balance and gait disorders, and visual impairment were collected from the medical records of the selected patients (medical charts, previous discharge summaries, fever charts, nursing records, nursing discharge summaries).

Statistical analysis

Descriptive statistics for the sample included mean (standard deviation), absolute and relative frequencies (%), based on data quality. The frequencies of the risk factors for falls in our sample were compared with the frequencies reported in the literature and statistical databases using chi-square tests. Results were considered significant below a P value of 0.05. The statistical calculations were performed using PASW Statistics for Windows, Version 18.0 statistical software (Released 2009. Chicago: SPSS Inc.).

Results

A total of 82 older patients were included in the study. The members of the sample group had been living in the institution for various periods of time, ranging from 52 months to one month, with an average stay of 13.5 months. The demographic characteristics of the sample are summarised in Table 2.

Table 2.

Characteristics of the sample (n = 82)

ParticipantsValues
Age (years), mean (standard deviation)80.3 (9.3)
Sex, female, n (%)57 (69.5)
BMIa (cm kg−2), mean (standard deviation)25.2 (4.26)
Duration of institutionalisation (months), mean (standard deviation)13.6 (10.8)
Family status
 Married, n (%)8 (9.8)
 Widowed, n (%)40 (48.8)
 Divorced, n (%)7 (8.5)
 Single, n (%)27 (32.9)

a) BMI: body mass index.

Polypragmasy was found to be frequent among patients on the investigated ward (Table 3). The most commonly taken drugs were antihypertensives and anticoagulants. The former were taken regularly by more than 70% of the patients, and the latter by almost 60%. The proportion of patients taking diuretics and sedatives/sleeping pills/neuroleptics was close to 40%. More than a quarter of sample members took antidepressants regularly. On average, the patients in the sample took more than six medications, while the proportion taking more than three medications was over 80%.

Table 3.

Use of medications that are a risk factor for falls

MedicationValues
Antihypertensives, n (%)58 (70.7)
Anticoagulants, n (%)47 (57.3)
Diuretics, n (%)38 (40.3)
Sedatives/sleeping pills/neuroleptics, n (%)32 (39.0)
Antidepressants, n (%)21 (25.6)
Antiparkinson agents, n (%)2 (2.4)
Medications per capita, mean (standard deviation)6.6 (3.1)
Taking more than three medicines, n (%)67 (81.7)

Among the chronic diseases and conditions that become more common in older age, hypertension and post-cerebrovascular disease state had the highest prevalence, at around 80% (Table 4). More than half the survey participants had cardiac disease and dementia. Diabetes and lower-limb osteoarthritis affected more than one-third of the sample, and osteoporosis almost a quarter. Balance and gait disorders were present in nearly 80% of the patients. The prevalence of incontinence in the sample was over 70%, with similar proportions by sex: 40 of the 57 female participants (70%) and 18 of the 25 male participants (72%) suffered from incontinence. Nearly 80% of the sample used some form of walking aid: most used a walker or cane, although some used wheeled walkers and wheelchairs. In our sample, 12% used no walking aid, even in cases where it would have been necessary.

Table 4.

Physical and mental attributes that increase the risk of falls

AttributesValues
Chronic illnesses
 Hypertension, n (%)66 (80.5)
 Cerebrovascular disease, n (%)65 (79.3)
 Cardiac disease, n (%)48 (59.8)
 Dementia, n (%)46 (56.1)
 Diabetes, n (%)28 (34.1)
 Lower-limb osteoarthritis, n (%)27 (32.9)
 Osteoporosis, n (%)18 (22.0)
 Parkinson's disease, n (%)4 (4.9)
Other disorders
 Balance disorder, n (%)65 (78.0)
 Incontinence, n (%)58 (70.7)
 Hearing impairment, n (%)13 (15.9)
Wearing glasses
 No glasses, n (%)21 (26.6)
 Only for reading, n (%)58 (70.7)
 Only for watching TV, n (%)1 (1.2)
 Continuously, n (%)2 (2.4)
Walking aid
 No walking aid, n (%)29 (35.4)
 One cane, n (%)12 (14.6)
 Walker, n (%)25 (30.5)
 Wheeled walker, n (%)1 (1.2)
 Wheelchair, n (%)5 (6.1)
 Not using a walking aid but should be, n (%)10 (12.2)

The physical and mental attributes associated with the risk of falling for which a benchmark specific to older people living at home or in institutions was found in the literature or databases were further analysed.

The prevalence of hypertension in our sample (80.5%) was significantly higher than the published figure of 60% for the population aged 65 years and over (χ2 = 10.954, P = 0.002). Symptoms and dysfunction following a brain event were significantly more prevalent in our sample (n = 65, 79.3%) than the figure of 26% given in the literature for the elderly population in general (χ2 = 56.167, P < 0.001). The proportion of people with cardiac disease (n = 49, 59.8%) was not significantly different from the proportion reported among the elderly population in general practice (48.9%) (χ2 = 2.394, P = 0.121). A diagnosis of dementia was found in significantly more elderly people in our sample (n = 46, 56.1%) than the estimated prevalence of 30.7% given in the literature, based on data from a survey of patients over 60 years of age in general practice in Hungary (χ2 = 56.167, P < 0.001). The prevalence of diabetes was also significantly higher in our sample (n = 28, 34.1%) than the 12% prevalence found in the literature (χ2 = 14.071, P < 0.001). The proportion of patients with osteoporosis (n = 18, 22%) corresponded to the 21% estimated in the literature based on data from general practice in Hungary for people aged 65 years and over (χ2 = 0.029, P = 0.863). Also, the proportion of people with Parkinson's disease in our sample (n = 4, 4.9%) did not differ significantly from the 2% rate among older people living at home (χ2 = 1.263, P = 0.261).

Significantly more people in the sample were taking sedatives/sleeping pills/neuroleptics (n = 32, 39%) than the 15% estimated in the literature (χ2 = 14.610, P < 0.001). There was a significantly higher prevalence of balance or gait disorders in our sample (n = 65, 78%) compared to the estimated prevalence in the elderly population living at home (43%) (χ2 = 25.630, P < 0.001).

In the 12 months prior to the survey, 41.5% of our sample (n = 34) had fallen at least once. This frequency is higher than the 30% rate for older people living at home, although the significance of the difference is marginal (χ2 = 2.880, P = 0.081). Among those who had had a fall, 17 (50%) suffered a fracture, which is a significantly higher proportion than in both the international literature for older people living at home (6%, χ2 = 48.015, P < 0.001) and the Hungarian data for older people living in nursing homes (4%, χ2 = 53.067, P < 0.001). Twenty-four people in our sample (70.6%) had suffered a fracture or soft tissue injury requiring medical attention.

Discussion

In our descriptive study, based on a sample of older people being cared for on a chronic inpatient ward, we investigated the prevalence of risk factors for falls that are also characteristic of elderly people living at home. We compared the frequency of those risk factors found in the sample, for which we also found data in the literature, with their prevalence in the elderly population living at home. Our results show that the prevalence of hypertension, cerebrovascular events, dementia and diabetes were significantly higher in the elderly population in chronic inpatient care than in the elderly population living at home. There was also a significantly higher prevalence of balance disorders and of the use of sedatives/sleeping pills/neuroleptics in the studied population. Cardiovascular diseases, osteoporosis, and Parkinson's disease were equally prevalent in both populations.

The prevalence of falls in the 12-month period preceding the survey was almost the same in the sample and in the elderly population living at home, although the severity of the falls was significantly higher in the sample.

According to the National Health Insurance Fund of Hungary, “Chronic care is defined as care designed to stabilise, maintain, or restore health. The duration or termination of care is usually unplanned, and care is typically of long duration” [16]. Chronic inpatient units can thus realistically aim to prepare elderly patients to participate as actively as possible in the basic activities of self-care once they have returned to their own home or moved into a nursing home. An essential element in this process is to reduce the risk of falls. The presence of risk factors for falls should be taken into account when designing effective preventive measures — in other words, the impact of nonmodifiable risk factors can be reduced only by reducing the modifiable risk factors [11].

In the literature, chronic physical and mental illnesses are classified among nonmodifiable risk factors, together with age and sex. Modifiable risk factors include acute illnesses, incontinence, previous falls, balance and gait problems, visual impairment, medication, footwear, and the physical environment [11].

Chronic diseases

In the context of cardiovascular disease, one of the most common diseases among older people is hypertension. According to professional guidelines, the prevalence of hypertension is estimated at between 30% and 45% of the adult population, and its prevalence increases progressively with age [17]. Although the prevalence among people aged 60 years and above is over 60% in the general population, in our sample it was significantly higher. Hypertension increases the risk of falls, partly due to the increased incidence of orthostatic hypotension and partly due to the side effects of medication [18]. The existence of other risk factors for falls should thus be carefully explored and addressed where possible. Partly because of possible fluctuations in blood pressure and partly because of the mechanism of drug action, cardiovascular diseases increase not only the risk but also the severity of falls [11, 19, 20]. The risk of falls rises by 60% when using antiarrhythmic calcium channel blockers; by 20% when taking drugs containing digoxin; and by 10% when taking diuretics [15, 21]. Based on our sample data and data for the elderly population living at home, it can be stated that one in two elderly people suffer from cardiovascular disease [22].

The incidence of ischaemic stroke in Hungary is remarkably high, at double the rates in Finland and Italy (43.3/100,000 inhabitants) [23]. Stroke is the third leading cause of death in Hungary. The incidence of the disease increases with advancing age, the over 65s being the most affected age group [24, 25].

An elderly person with declining cognitive function is at twice the risk of falling compared to an elderly person with intact cognitive ability. Dementia causes structural and neurochemical changes in the brain that negatively affect gait and balance control [26]. It may also be associated with impaired judgement, visual perception or orientation [27]. In our sample, the prevalence of people with dementia was significantly higher compared to the data for older people living at home.

The prevalence of diabetes also increases with advancing age. Almost 13% of people aged between 51 and 60 have diabetes. The proportion rises to 19% among people aged between 61 and 70, and to 20% among people aged 71 and over, meaning that one in five people aged 60 and above have diabetes. In 2014, more than 60% of people with type 2 diabetes were over 60 years of age [14]. Diabetes also leads to an increased risk of falls due to its impact on balance control (cerebrovascular consequences, peripheral neuropathy, retinopathy, and sensory impairments) [28].

The proportion of people with osteoporosis was equally high in our sample and among the elderly population living at home. Not only do older people with osteoporosis suffer more serious injuries in falls, but there is also evidence that they fall more often [29, 30]. One reason for this is their fear of falling, which, by triggering the cycle described above, increases the likelihood of a fall. Another reason for the high prevalence of falls may be that vertebral compression, even if painless, increases kyphosis, which alters the balance of the body [29, 30]. This is associated with a weakening of the muscles in the trunk and lower limbs.

There was no significant difference between the prevalence of Parkinson's disease in the sample and the prevalence in the elderly population living at home. Prevalence increases with advancing age [31]. It is of paramount importance to maintain physical function for as long as possible with appropriate medication and regular exercise.

Lower-limb osteoarthritis increases the risk of falls as it causes difficulty in walking and muscle weakness [4]. Between 60 and 69 years of age, 10% of men and 14% of women suffer from osteoarthritis of the knee joint; between the ages of 70 and 79 this increases to 15% and 24% respectively; while over the age of 80, the prevalence exceeds 20% in men and 30% in women. In our sample, we did not differentiate the prevalence of lower-limb osteoarthritis according to sex and age group, although overall we recorded a prevalence of almost 33%. The impact of lower-limb osteoarthritis on falls in old age is illustrated by the following data: where osteoarthritis is present in a single joint there is a 53% higher risk of falling; where it is present in two joints there is a 74% higher risk; and where three to four joints are affected, there is an 85% higher risk of falling compared to those with no disorder in the lower-limb joints [32]. Balance and gait problems increase the risk of falling by almost three times [4].

In a survey in Hungary, 43% of people over the age of 65 reported finding it difficult or barely manageable to walk 500 m on flat ground without a walking aid or help. Among patients in chronic inpatient care, 78% experience a degree of imbalance that makes walking significantly more difficult [15].

In this context, individually selected walking aids for patients are particularly important, as a poorly adjusted or incorrectly used walking aid increases the risk of falls by 2.6 times [4]. The literature suggests that 75% of people living in nursing homes and 20% of people living in non-institutionalised settings require the use of a walking aid [15]. Poorly chosen footwear is a common problem that does not receive sufficient attention. The risk of falling is 45% higher when wearing shoes with high heels or slippery soles, slippers, or footwear that does not fit properly [33, 34]. One review recommends the wearing of low-heeled, non-slip, well-fitting footwear both indoors and outdoors [35].

Although the incidence of falls in the 12 months prior to the survey was higher among the older people in chronic inpatient care, the difference showed borderline significance. However, the prevalence of serious consequences was significantly higher in the sample compared to the data published in the literature [5, 6].

The number of medications taken regularly, regardless of the type of medication, is associated with the risk of falls. Those taking more than three medications are at double the risk of falling [36]. There is evidence of an increased risk of falling if certain medications are taken regularly. This increased risk is due partly to the side effects of the drugs and partly to drug interactions. The risk of falling is 66% higher when taking psychoactive drugs [21, 22, 37]. In terms of medication, the most common cause of falls is the regular use of antidepressants: serotonin reuptake inhibitors in particular increase the risk of falls [38]. Benzodiazepines and tranquillisers, which are taken regularly by 15% of older people, increase the risk of falls by 8% [21, 37, 38]. Drugs that affect the central nervous system, such as those used to treat Parkinson's disease, as well as narcotic painkillers, also increase the risk of falls.

The results of our study highlight the importance of assessing risk factors for falls among older people who have a realistic chance of returning to their own homes in the near future and including them in a targeted falls prevention programme.

Limitations of the research

The present study has certain limitations. Firstly, all the data for the study were collected retrospectively, which means that no causal relationships can be identified between the variables. A further limitation of our research is that the sample is neither complete nor representative. Nevertheless, since admission to chronic inpatient wards generally takes place in a similar way (by a referral from a general practitioner, from the elderly person's own home, or from an active ward) and for the same reasons (the patients are unable to care for themselves safely and require continuous supervision) throughout the country, and since there are no significant differences in terms of the staffing and facilities on such wards, the results of our study are applicable to other elderly patients admitted to chronic inpatient wards.

Conclusions

The provision of health and social care for an increasingly elderly population, and the financing of these services, are challenging tasks for society and will become even more difficult in the future. In the case of many of the patients admitted to chronic inpatient care, there is a realistic chance that their condition will improve or stabilise to the point where they can return to their own home or be moved to a nursing home. Such a rehabilitation approach to chronic inpatient care would require many more qualified nurses, physiotherapists, occupational therapists, dietitians and social workers than there are at present, whose work would enable members of the older generation to enjoy a better quality of life.

Authors' contributions

ISW and ÉK summarised the scientific background to the paper; ISW and PKK collected the data; ISW, ÉK and ZSGY carried out the statistical analyses; ZSGY, AK and SZB finalised the text.

Ethical approval

This study was conducted in accordance with the 2008 revision of the 1975 Declaration of Helsinki.

Conflicts of interest

The authors declare no conflict of interest.

Acknowledgements

We would like to thank the Department of Chronic Internal Medicine at the Károlyi Sándor Hospital for enabling and supporting the research. We would also like to thank the staff of the hospital for their help in data collection, which has enabled us to contribute to the health of the elderly population and of future generations.

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    A 2014-ben végrehajtott európai lakossági egészségfelmérés eredményei. Összefoglaló adatok. [Results from the 2014 European health Interview survey. Summary data]. [Internet] [cited 2021 Jan 20] Available from: https://www.ksh.hu/docs/hun/xftp/idoszaki/elef/elef2014_osszefoglalo.pdf.

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  • 16.

    Farsang Cs, Járai Z. A hypertoniabetegség ellátásának irányelvei. In: Farsang J (szerk). A Magyar Hypertonia Társaság szakmai irányelve.Hipertonia és nephrologia. 2018;22(Suppl.5):S1–S36. [Internet] [cited 2020 Nov 20] Available from: http://www.hypertension.hu/upload/hypertension/document/mht_szakmai_iranyelv_2018_20190312.pdf?web_id=.

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  • 17.

    Gangavati A, Hajjar I, Quach L, et al. Hypertension, orthostatic hypotension, and the risk of falls in a community-dwelling elderly population: the maintenance of balance, independent living, intellect, and zest in the elderly of Boston study. J Am Geriatr Soc 2011;59:383389. https://doi.org/10.1111/j.1532-5415.2011.03317.x, Erratum in: J Am Geriatr Soc. 2011;59:960.

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    • Export Citation
  • 18.

    Lipsitz LA. Abnormalities in blood pressure homeostasis that contribute to falls in the elderly. Clin Geriatr Med 1985;1:637648.

  • 19.

    Mikos M, Winnicki K, Henry BM, Sanchis-Gomar F. Link between cardiovascular disease and the risk of falling: A comprehensive review of the evidence. Pol Arch Intern Med 2021;131:369376. https://doi.org/10.20452/pamw.15849.

    • Search Google Scholar
    • Export Citation
  • 20.

    de Jong MR, Van der Elst M, Hartholt KA. Drug-related falls in older patients: Implicated drugs, consequences, and possible prevention strategies. Ther Adv Drug Saf 2013;4:147154. https://doi.org/10.1177/2042098613486829.

    • Search Google Scholar
    • Export Citation
  • 21.

    Michalcova J, Vasut K, Airaksinen M, Bielakova K. Inclusion of medication-related fall risk in fall risk assessment tool in geriatric care units. BMC Geriatr 2020;20:454. https://doi.org/10.1186/s12877-020-01845-9.

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    • Export Citation
  • 22.

    Szőcs I, Bereczki D, Belicza É. A stroke-ellátás hazai eredményei a nemzetközi adatok tükrében. [Results of stroke care in Hungary in the frame of international comparison.]. Orv Hetil 2016;157:16351641. https://doi.org/10.1556/650.2016.30558, [Article in Hu].

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    • Export Citation
  • 23.

    Vokó Z, Széles Gy, Kardos L, Németh R, Ádány R. Az agyérbetegségek epidemiológiája Magyarországon az ezredfordulót követően. [The epidemiology of cerebrovascular diseases in Hungary after the Millennium.]. LAM 2008;18:3138, [Article in Hu].

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    Nagy Z, Magyar G, Óváry C, Radnóti L. A magyar stroke adatbank –4 epidemiológiai vizsgálat a hazai stroke-ellátás helyzetének felmérésére. [The Hungarian Stroke Database -4 epidemiological study to assess the situation of stroke care in Hungary.]. Agyérbetegségek 2000;6:210, [Article in Hu].

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    Fernando E, Fraser M, Hendriksen J, Kim CH, Muir-Hunter SW. Risk factors associated with falls in older adults with dementia: A systematic review. Physiother Can 2017;69:161170. https://doi.org/10.3138/ptc.2016-14.

    • Search Google Scholar
    • Export Citation
  • 26.

    Oki M, Matsumoto M, Yoshikawa Y, Fukushima M, Nagasawa A, Takakura T, Suzuki Y. Risk factors for falls in patients with Alzheimer disease: A retrospective study of balance, cognition, and visuospatial ability. Dement Geriatr Cogn Dis Extra 2021;11:5863. https://doi.org/10.1159/000514285.

    • Search Google Scholar
    • Export Citation
  • 27.

    Bergland A, Jarnlo GB, Wyller TB. Egenrapportert gangfunksjon, balansetester og risiko for fall hos eldre [Self-reported walking, balance testing and risk of fall among the elderly]. Tidsskr Nor Laegeforen 2006;126:176178, [Article in Norwegian].

    • Search Google Scholar
    • Export Citation
  • 28.

    Smulders E, van Lankveld W, Laan R, Duysens J, Weerdesteyn V. Does osteoporosis predispose falls? A study on obstacle avoidance and balance confidence. BMC Musculoskelet Disord 2011;12:1. https://doi.org/10.1186/1471-2474-12-1.

    • Search Google Scholar
    • Export Citation
  • 29.

    Resnick B, Nahm ES, Zhu S, et al. The impact of osteoporosis, falls, fear of falling, and efficacy expectations on exercise among community-dwelling older adults. Orthop Nurs 2014;33:277286. quiz 287-8 https://doi.org/10.1097/NOR.0000000000000084.

    • Search Google Scholar
    • Export Citation
  • 30.

    Hirsch L, Jette N, Frolkis A, Steeves T, Pringsheim T. The incidence of Parkinson's disease: A systematic review and meta-analysis. Neuroepidemiology 2016;46:292300. https://doi.org/10.1159/000445751.

    • Search Google Scholar
    • Export Citation
  • 31.

    Doré AL, Golightly YM, Mercer VS, Shi XA, Renner JB, Jordan JM, Nelson AE. Lower-extremity osteoarthritis and the risk of falls in a community-based longitudinal study of adults with and without osteoarthritis. Arthritis Care Res (Hoboken) 2015;67:633639. https://doi.org/10.1002/acr.22499.

    • Search Google Scholar
    • Export Citation
  • 32.

    Koepsell TD, Wolf ME, Buchner DM, et al. Footwear style and risk of falls in older adults. J Am Geriatr Soc 2004;52:14951501. https://doi.org/10.1111/j.1532-5415.2004.52412.x.

    • Search Google Scholar
    • Export Citation
  • 33.

    Menant JC, Steele JR, Menz HB, Munro BJ, Lord SR. Effects of footwear features on balance and stepping in older people. Gerontology 2008;54:1823. https://doi.org/10.1159/000115850.

    • Search Google Scholar
    • Export Citation
  • 34.

    Menant JC, Steele JR, Menz HB, Munro BJ, Lord SR. Optimizing footwear for older people at risk of falls. J Rehabil Res Dev 2008;45:11671181.

    • Search Google Scholar
    • Export Citation
  • 35.

    Ie K, Chou E, Boyce RD, Albert SM. Fall risk-increasing drugs, polypharmacy, and falls among low-Income community-dwelling older adults. Innov Aging 2021;5:igab001. https://doi.org/10.1093/geroni/igab001.

    • Search Google Scholar
    • Export Citation
  • 36.

    Lee J, Negm A, Peters R, Wong EKC, Holbrook A. Deprescribing fall-risk increasing drugs (FRIDs) for the prevention of falls and fall-related complications: A systematic review and meta-analysis. BMJ Open 2021;11:e035978. https://doi.org/10.1136/bmjopen-2019-035978.

    • Search Google Scholar
    • Export Citation
  • 37.

    Marcum ZA, Perera S, Thorpe JM, et al. Antidepressant use and recurrent falls in community-dwelling older adults: Findings from the health ABC study. Ann Pharmacother 2016;50:525533. https://doi.org/10.1177/1060028016644466.

    • Search Google Scholar
    • Export Citation
  • 38.

    Díaz-Gutiérrez MJ, Martínez-Cengotitabengoa M, Sáez de Adana E, et al. Relationship between the use of benzodiazepines and falls in older adults: A systematic review. Maturitas 2017;101:1722. https://doi.org/10.1016/j.maturitas.2017.04.002.

    • Search Google Scholar
    • Export Citation
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    Farsang Cs, Járai Z. A hypertoniabetegség ellátásának irányelvei. In: Farsang J (szerk). A Magyar Hypertonia Társaság szakmai irányelve.Hipertonia és nephrologia. 2018;22(Suppl.5):S1–S36. [Internet] [cited 2020 Nov 20] Available from: http://www.hypertension.hu/upload/hypertension/document/mht_szakmai_iranyelv_2018_20190312.pdf?web_id=.

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    Gangavati A, Hajjar I, Quach L, et al. Hypertension, orthostatic hypotension, and the risk of falls in a community-dwelling elderly population: the maintenance of balance, independent living, intellect, and zest in the elderly of Boston study. J Am Geriatr Soc 2011;59:383389. https://doi.org/10.1111/j.1532-5415.2011.03317.x, Erratum in: J Am Geriatr Soc. 2011;59:960.

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    Lipsitz LA. Abnormalities in blood pressure homeostasis that contribute to falls in the elderly. Clin Geriatr Med 1985;1:637648.

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    Mikos M, Winnicki K, Henry BM, Sanchis-Gomar F. Link between cardiovascular disease and the risk of falling: A comprehensive review of the evidence. Pol Arch Intern Med 2021;131:369376. https://doi.org/10.20452/pamw.15849.

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    • Export Citation
  • 20.

    de Jong MR, Van der Elst M, Hartholt KA. Drug-related falls in older patients: Implicated drugs, consequences, and possible prevention strategies. Ther Adv Drug Saf 2013;4:147154. https://doi.org/10.1177/2042098613486829.

    • Search Google Scholar
    • Export Citation
  • 21.

    Michalcova J, Vasut K, Airaksinen M, Bielakova K. Inclusion of medication-related fall risk in fall risk assessment tool in geriatric care units. BMC Geriatr 2020;20:454. https://doi.org/10.1186/s12877-020-01845-9.

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    • Export Citation
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    Szőcs I, Bereczki D, Belicza É. A stroke-ellátás hazai eredményei a nemzetközi adatok tükrében. [Results of stroke care in Hungary in the frame of international comparison.]. Orv Hetil 2016;157:16351641. https://doi.org/10.1556/650.2016.30558, [Article in Hu].

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    • Export Citation
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    Vokó Z, Széles Gy, Kardos L, Németh R, Ádány R. Az agyérbetegségek epidemiológiája Magyarországon az ezredfordulót követően. [The epidemiology of cerebrovascular diseases in Hungary after the Millennium.]. LAM 2008;18:3138, [Article in Hu].

    • Search Google Scholar
    • Export Citation
  • 24.

    Nagy Z, Magyar G, Óváry C, Radnóti L. A magyar stroke adatbank –4 epidemiológiai vizsgálat a hazai stroke-ellátás helyzetének felmérésére. [The Hungarian Stroke Database -4 epidemiological study to assess the situation of stroke care in Hungary.]. Agyérbetegségek 2000;6:210, [Article in Hu].

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    • Export Citation
  • 25.

    Fernando E, Fraser M, Hendriksen J, Kim CH, Muir-Hunter SW. Risk factors associated with falls in older adults with dementia: A systematic review. Physiother Can 2017;69:161170. https://doi.org/10.3138/ptc.2016-14.

    • Search Google Scholar
    • Export Citation
  • 26.

    Oki M, Matsumoto M, Yoshikawa Y, Fukushima M, Nagasawa A, Takakura T, Suzuki Y. Risk factors for falls in patients with Alzheimer disease: A retrospective study of balance, cognition, and visuospatial ability. Dement Geriatr Cogn Dis Extra 2021;11:5863. https://doi.org/10.1159/000514285.

    • Search Google Scholar
    • Export Citation
  • 27.

    Bergland A, Jarnlo GB, Wyller TB. Egenrapportert gangfunksjon, balansetester og risiko for fall hos eldre [Self-reported walking, balance testing and risk of fall among the elderly]. Tidsskr Nor Laegeforen 2006;126:176178, [Article in Norwegian].

    • Search Google Scholar
    • Export Citation
  • 28.

    Smulders E, van Lankveld W, Laan R, Duysens J, Weerdesteyn V. Does osteoporosis predispose falls? A study on obstacle avoidance and balance confidence. BMC Musculoskelet Disord 2011;12:1. https://doi.org/10.1186/1471-2474-12-1.

    • Search Google Scholar
    • Export Citation
  • 29.

    Resnick B, Nahm ES, Zhu S, et al. The impact of osteoporosis, falls, fear of falling, and efficacy expectations on exercise among community-dwelling older adults. Orthop Nurs 2014;33:277286. quiz 287-8 https://doi.org/10.1097/NOR.0000000000000084.

    • Search Google Scholar
    • Export Citation
  • 30.

    Hirsch L, Jette N, Frolkis A, Steeves T, Pringsheim T. The incidence of Parkinson's disease: A systematic review and meta-analysis. Neuroepidemiology 2016;46:292300. https://doi.org/10.1159/000445751.

    • Search Google Scholar
    • Export Citation
  • 31.

    Doré AL, Golightly YM, Mercer VS, Shi XA, Renner JB, Jordan JM, Nelson AE. Lower-extremity osteoarthritis and the risk of falls in a community-based longitudinal study of adults with and without osteoarthritis. Arthritis Care Res (Hoboken) 2015;67:633639. https://doi.org/10.1002/acr.22499.

    • Search Google Scholar
    • Export Citation
  • 32.

    Koepsell TD, Wolf ME, Buchner DM, et al. Footwear style and risk of falls in older adults. J Am Geriatr Soc 2004;52:14951501. https://doi.org/10.1111/j.1532-5415.2004.52412.x.

    • Search Google Scholar
    • Export Citation
  • 33.

    Menant JC, Steele JR, Menz HB, Munro BJ, Lord SR. Effects of footwear features on balance and stepping in older people. Gerontology 2008;54:1823. https://doi.org/10.1159/000115850.

    • Search Google Scholar
    • Export Citation
  • 34.

    Menant JC, Steele JR, Menz HB, Munro BJ, Lord SR. Optimizing footwear for older people at risk of falls. J Rehabil Res Dev 2008;45:11671181.

    • Search Google Scholar
    • Export Citation
  • 35.

    Ie K, Chou E, Boyce RD, Albert SM. Fall risk-increasing drugs, polypharmacy, and falls among low-Income community-dwelling older adults. Innov Aging 2021;5:igab001. https://doi.org/10.1093/geroni/igab001.

    • Search Google Scholar
    • Export Citation
  • 36.

    Lee J, Negm A, Peters R, Wong EKC, Holbrook A. Deprescribing fall-risk increasing drugs (FRIDs) for the prevention of falls and fall-related complications: A systematic review and meta-analysis. BMJ Open 2021;11:e035978. https://doi.org/10.1136/bmjopen-2019-035978.

    • Search Google Scholar
    • Export Citation
  • 37.

    Marcum ZA, Perera S, Thorpe JM, et al. Antidepressant use and recurrent falls in community-dwelling older adults: Findings from the health ABC study. Ann Pharmacother 2016;50:525533. https://doi.org/10.1177/1060028016644466.

    • Search Google Scholar
    • Export Citation
  • 38.

    Díaz-Gutiérrez MJ, Martínez-Cengotitabengoa M, Sáez de Adana E, et al. Relationship between the use of benzodiazepines and falls in older adults: A systematic review. Maturitas 2017;101:1722. https://doi.org/10.1016/j.maturitas.2017.04.002.

    • Search Google Scholar
    • Export Citation
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Senior Editors

Editor-in-Chief: Zoltán Zsolt NAGY
Vice Editors-in-Chief: Gabriella Bednárikné DÖRNYEI, Ákos KOLLER
Managing Editor: Johanna TAKÁCS

Editorial Board

  • Zoltán BALOGH (Department of Nursing, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary)
  • Klára GADÓ (Department of Clinical Studies, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary)
  • István VINGENDER (Department of Social Sciences, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary)
  • Attila DOROS (Department of Imaging and Medical Instrumentation, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary)
  • Judit Helga FEITH (Department of Social Sciences, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary)
  • Mónika HORVÁTH (Department of Physiotherapy, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary)
  • Illés KOVÁCS (Department of Clinical Ophthalmology, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary)
  • Ildikó NAGYNÉ BAJI (Department of Applied Psychology, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary)
  • Tamás PÁNDICS (Department for Epidemiology, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary)
  • József RÁCZ (Department of Addictology, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary)
  • Lajos A. RÉTHY (Department of Family Care Methodology, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary)
  • János RIGÓ (Department of Clinical Studies in Obstetrics and Gynaecology, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary)
  • Andrea SZÉKELY (Department of Oxyology and Emergency Care, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary)
  • Márta VERESNÉ BÁLINT (Department of Dietetics and Nutritional Sicences, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary)
  • Gyula DOMJÁN (Department of Clinical Studies, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary)
  • Péter KRAJCSI (Department of Morphology and Physiology, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary)
  • György LÉVAY (Department of Morphology and Physiology, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary)
  • Csaba NYAKAS (Department of Morphology and Physiology, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary)
  • Vera POLGÁR (Department of Morphology and Physiology, InFaculty of Health Sciences, Semmelweis University, Budapest, Hungary)
  • László SZABÓ (Department of Family Care Methodology, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary)
  • Katalin TÁTRAI-NÉMETH (Department of Dietetics and Nutrition Sciences, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary)
  • Katalin KOVÁCS ZÖLDI (Department of Social Sciences, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary)
  • Gizella ÁNCSÁN (Library, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary)
  • András FALUS (Department of Genetics, Cell- and Immunbiology, Faculty of Medicine, Semmelweis University, Budapest, Hungary)
  • Zoltán UNGVÁRI (Department of Public Health, Faculty of medicine, Semmelweis University, Budapest, Hungary)
  • Romána ZELKÓ (Faculty of Pharmacy, Semmelweis University, Budapest, Hungary)
  • Mária BARNAI (Faculty of Health Sciences and Social Studies, University of Szeged, Szeged, Hungary)
  • László Péter KANIZSAI (Department of Emergency Medicine, Medical School, University of Pécs, Pécs, Hungary)
  • Bettina FŰZNÉ PIKÓ (Department of Behavioral Sciences, Faculty of Medicine, University of Szeged, Szeged, Hungary)
  • Imre SEMSEI (Faculty of Health, University of Debrecen, Debrecen, Hungary)
  • Teija-Kaisa AHOLAAKKO (Laurea Universities of Applied Sciences, Vantaa, Finland)
  • Ornella CORAZZA (University of Hertfordshire, Hatfield, Hertfordshire, United Kingdom)
  • Oliver FINDL (Department of Ophthalmology, Hanusch Hospital, Vienna, Austria)
  • Tamás HACKI (University Hospital Regensburg, Phoniatrics and Pediatric Audiology, Regensburg, Germany)
  • Xu JIANGUANG (Shanghai University of Traditional Chinese Medicine, Shanghai, China)
  • Paul GM LUITEN (Department of Molecular Neurobiology, University of Groningen, Groningen, Netherlands)
  • Marie O'TOOLE (Rutgers School of Nursing, Camden, United States)
  • Evridiki PAPASTAVROU (School of Health Sciences, Cyprus University of Technology, Lemesos, Cyprus)
  • Pedro PARREIRA (The Nursing School of Coimbra, Coimbra, Portugal)
  • Jennifer LEWIS SMITH (Collage of Health and Social Care, University of Derby, Cohehre President, United Kingdom)
  • Yao SUYUAN (Heilongjiang University of Traditional Chinese Medicine, Heilongjiang, China)
  • Valérie TÓTHOVÁ (Faculty of Health and Social Sciences, University of South Bohemia, České Budějovice, Czech Republic)
  • Tibor VALYI-NAGY (Department of Pathology, University of Illonois of Chicago, Chicago, IL, United States)
  • Chen ZHEN (Central European TCM Association, European Chamber of Commerce for Traditional Chinese Medicine)

2020  

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2019  
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Developments in Health Sciences
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Developments in Health Sciences
Language English
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Foundation
2018
Volumes
per Year
1
Issues
per Year
2
Founder Semmelweis Egyetem
Founder's
Address
H-1085 Budapest, Hungary Üllői út 26.
Publisher Akadémiai Kiadó
Publisher's
Address
H-1117 Budapest, Hungary 1516 Budapest, PO Box 245.
Responsible
Publisher
Chief Executive Officer, Akadémiai Kiadó
ISSN 2630-9378 (Print)
ISSN 2630-936X (Online)

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