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Fall Risk in Adult Family Practice Non-Attenders: A Cross-Sectional Study from Slovenia

Nina RUŽIĆ-GORENJEC
Nina RUŽIĆ-GORENJEC
, 
Zalika KLEMENC KETIŠ
Zalika KLEMENC KETIŠ
, 
Rok BLAGUS
Rok BLAGUS
 and 
Antonija POPLAS SUSIČ
Antonija POPLAS SUSIČ
   | Mar 15, 2023
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Article Category: Original scientific article
Published Online: Mar 15, 2023
Page range: 76 - 86
Received: Jun 09, 2022
Accepted: Dec 22, 2022
DOI: https://doi.org/10.2478/sjph-2023-0011
Keywords
© 2023 Nina RUŽIĆ-GORENJEC et al., published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Supplementary Figure 1.

Sensitivity analysis − Logarithm of odds for an increased fall risk (black line) with 95% confidence intervals (grey area) in the multivariate logistic model without covariate dependence in daily activities (Supplementary Table 3), where the other variables in the model are fixed to their modes or medians (gender to female, age to 62.7, systolic blood pressure to 130, diastolic blood pressure to 72, self-assessment of current health to 8, and all the others to values indicating a healthy individual).
Sensitivity analysis − Logarithm of odds for an increased fall risk (black line) with 95% confidence intervals (grey area) in the multivariate logistic model without covariate dependence in daily activities (Supplementary Table 3), where the other variables in the model are fixed to their modes or medians (gender to female, age to 62.7, systolic blood pressure to 130, diastolic blood pressure to 72, self-assessment of current health to 8, and all the others to values indicating a healthy individual).

Figure 1.

Logarithm of odds for an increased fall risk (black line) with 95% confidence intervals (grey area) in the multivariate logistic model (Table 3).
Logarithm of odds for an increased fall risk (black line) with 95% confidence intervals (grey area) in the multivariate logistic model (Table 3).

Comparison of the outcome (fall risk) and demographic characteristics between the subsample used in the multivariate model for fall risk (n=1,474) and the subsample that was omitted from the model on the account of missing values for the covariates in the model (n=471). Note that there were no missing values regarding the outcome or demographic characteristics.

Characteristic Subsample used in the model (n=1,474) Subsample omitted from the model (n=471)
Increased fall risk, n (%) 382 (25.9) 100 (21.2)
Gender: female, n (%) 941 (63.8) 289 (61.4)
Age (years), median (IQR) 62.7 (41.6 - 77.6) 60.4 (43.3 - 74.2)

Multivariate logistic model for fall risk - interpretable coefficients: sample size n=1474 with 382 (25.9%) with increased fall risk, AUC=0.938 (bias-corrected 0.930), pseudo R2=64.0% (bias-corrected 61.0%), calibration curve based on the out-of-bag samples with intercept -0.048 and slope 0.917, likelihood ratio test p<0.001.

Variable OR 95% CI p value
Age <0.001
  Nonlinear 0.157
Gender (female vs. male) 1.08 [0.74, 1.59] 0.672
Body mass index 0.096
  Underweight vs. normal 0.70 [0.27, 1.81] 0.472
  Overweight vs. normal 0.84 [0.54, 1.29] 0.423
  Obese vs. normal 1.43 [0.90, 2.28] 0.133
Systolic blood pressure 0.047
  Nonlinear 0.019
Diastolic blood pressure 0.740
  Nonlinear 0.611
Poor family function 1.87 [1.12, 3.11] 0.016
Increased risk of malnutrition 2.09 [1.17, 3.73] 0.013
Chronic diseases 0.027
  1 disease vs. no disease 1.33 [0.82, 2.15] 0.251
  2 diseases vs. no disease 1.83 [1.09, 3.09] 0.023
  3 or more diseases vs. no disease 2.25 [1.26, 4.05] 0.006
Pain intensity <0.001
  Nonlinear 0.429
Self-assessment of current health 0.002
  Nonlinear 0.001
Feelings of loneliness 0.108
  Nonlinear 0.037
Dependence in daily activities with transformation log2 16.22† [9.04, 30.83] <0.001

Multivariate logistic model for fall risk - all coefficients: sample size n=1,474 with 382 (25.9%) with increased fall risk, AUC=0.938 (bias-corrected 0.930), pseudo R2=64.0% (bias-corrected 61.0%), calibration curve based on the out-of-bag samples with intercept -0.048 and slope 0.917, likelihood ratio test p<0.001.

Variable OR 95% CI p value
Age <0.001
  Linear term 1.12 [1.02, 1.26] 0.027
  Nonlinear term 1 0.85 [0.65, 1.07] 0.177
  Nonlinear term 2 1.63 [0.89, 3.12] 0.123
Gender (female vs. male) 1.08 [0.74, 1.59] 0.672
Body mass index 0.096
  Underweight vs. normal 0.70 [0.27, 1.81] 0.472
  Overweight vs. normal 0.84 [0.54, 1.29] 0.423
  Obese vs. normal 1.43 [0.90, 2.28] 0.133
Systolic blood pressure 0.047
  Linear term 0.95 [0.90, 1.01] 0.096
  Nonlinear term 1 1.08 [0.90, 1.30] 0.386
  Nonlinear term 2 0.86 [0.43, 1.74] 0.673
Diastolic blood pressure 0.740
  Linear term 1.02 [0.95, 1.09] 0.607
  Nonlinear term 1 1.00 [0.81, 1.22] 0.985
  Nonlinear term 2 0.95 [0.54, 1.69] 0.861
Poor family function 1.87 [1.12, 3.11] 0.016
Increased risk of malnutrition 2.09 [1.17, 3.73] 0.013
Chronic diseases 0.027
  1 disease vs. no disease 1.33 [0.82, 2.15] 0.251
  2 diseases vs. no disease 1.83 [1.09, 3.09] 0.023
  3 or more diseases vs. no disease 2.25 [1.26, 4.05] 0.006
Pain intensity <0.001
  Linear term 1.12 [0.83, 1.51] 0.448
  Nonlinear term 1 1.43 [0.59, 3.51] 0.429
Self-assessment of current health 0.002
  Linear term 1.16 [0.88, 1.54] 0.300
  Nonlinear term 1 0.87 [0.51, 1.50] 0.619
  Nonlinear term 2 0.10 [0.00, 4.35] 0.241
Feelings of loneliness 0.108
  Linear term 0.74 [0.56, 0.98] 0.036
  Nonlinear term 1 2.89 [1.08, 7.89] 0.037
Dependence in daily activities with transformation log2 16.22† [9.04, 30.83] <0.001

Increased fall risk according to the demographic, clinical, and psychosocial characteristics of the participants (categorical variables).

Characteristic (n=number of non-missing values) All participants n (%) Participants with increased fall risk n (%) Participants without increased fall risk n (%)
Gender:(n=1,945) Female 1,230 (63.2) 324 (26.3) 906 (73.7)
Male 715 (36.8) 158 (22.1) 557 (77.9)
Body mass index:(n=1,916) Underweight 116 (6.1) 34 (29.3) 82 (70.7)
Normal 687 (35.9) 158 (23.0) 529 (77.0)
Overweight 678 (35.4) 154 (22.7) 524 (77.3)
Obese 435 (22.7) 124 (28.5) 311 (71.5)
Family function:(n=1,931) Poor 232 (12.0) 104 (44.8) 128 (55.2)
Good 1,699 (88.0) 373 (22.0) 1,326 (78.0)
Increased risk of malnutrition:(n=1,577) Yes 211 (13.4) 84 (39.8) 127 (60.2)
No 1,366 (86.6) 345 (25.3) 1,021 (74.7)
Chronic diseases:(n=1,921) No diseases 1,054 (54.9) 92 (8.7) 962 (91.3)
1 disease 421 (21.9) 140 (33.3) 281 (66.7)
2 diseases 261 (13.6) 123 (47.1) 138 (52.9)
3 or more diseases 185 (9.6) 117 (63.2) 68 (36.8)
Cardiovascular disease:(n=1,939) Yes 247 (12.7) 162 (65.6) 85 (34.4)
No 1,692 (87.3) 318 (18.8) 1,374 (81.2)
Diabetes:(n=1,943) Yes 208 (10.7) 94 (45.2) 114 (54.8)
No 1,735 (89.3) 387 (22.3) 1,348 (77.7)
Hypertension:(n=1,942) Yes 621 (32.0) 289 (46.5) 332 (53.5)
No 1,321 (68.0) 192 (14.5) 1,129 (85.5)
COPD:(n=1,943) Yes 49 (2.5) 28 (57.1) 21 (42.9)
No 1,894 (97.5) 453 (23.9) 1,441 (76.1)
Asthma:(n=1,943) Yes 55 (2.8) 28 (50.9) 27 (49.1)
No 1,888 (97.2) 453 (24.0) 1,435 (76.0)
Depression:(n=1,943) Yes 82 (4.2) 38 (46.3) 44 (53.7)
No 1,861 (95.8) 443 (23.8) 1,418 (76.2)
Osteoporosis:(n=1,942) Yes 89 (4.6) 54 (60.7) 35 (39.3)
No 1,853 (95.4) 426 (23.0) 1,427 (77.0)
Benign prostatic hyperplasia:(n=1,930) Yes 30 (1.6) 13 (43.3) 17 (56.7)
No 1,900 (98.4) 462 (24.3) 1,438 (75.7)
Obesity:(n=1,943) Yes 110 (5.7) 38 (34.5) 72 (65.5)
No 1,833 (94.3) 443 (24.2) 1,390 (75.8)
Colon cancer:(n=1,943) Yes 17 (0.9) 7 (41.2) 10 (58.8)
No 1,926 (99.1) 474 (24.6) 1,452 (75.4)
Breast cancer:(n=1,942) Yes 24 (1.2) 8 (33.3) 16 (66.7)
No 1,918 (98.8) 473 (24.7) 1,445 (75.3)
Neurological diseases (excl. dementia):(n=1,945) Yes 20 (1.0) 16 (80.0) 4 (20.0)
No 1,925 (99.0) 466 (24.2) 1,459 (75.8)
Dementia:(n=1,945) Yes 23 (1.2) 22 (95.7) 1 (4.3)
No 1,922 (98.8) 460 (23.9) 1,462 (76.1)

Increased fall risk according to the demographic, clinical, and psychosocial characteristics of the participants (numerical variables).

Characteristic (n=number of non-missing values) All participants Median (IQR) Participants with increased fall risk Median (IQR) Participants without increased fall risk Median (IQR)
Age (years)(n=1945) 61.8 80.5 54.3
(42.1, 76.5) (69.4, 87.2) (38.6, 67.8)
Systolic blood pressure (mmHg)(n=1,930) 130 130 125
(120, 140) (120, 141.5) (115, 136.2)
Diastolic blood pressure (mmHg)(n=1,930) 75 75 75
(70, 80) (70, 80) (70, 80)
Pain intensity (scale 1-10)(n=1,918) 1 3 1
(1, 3) (2, 5) (1, 2)
Self-assessment of current health (scale 1-10)(n=1,932) 8 5 8
(5, 9) (4, 7) (6, 9)
Feeling of loneliness (scale 1-10)(n=1,917) 1 2 1
(1, 3) (1, 5) (1, 2)
Dependence in daily activities (scale 1-4 in steps of 0.125)(n=1,922) 1 1.2 1
(1, 1) (1.1, 1.8) (1, 1)

Sensitivity analysis - Multivariate logistic model for fall risk without covariate dependence in daily activities, showing only interpretable coefficients: sample size n=1,474 with 382 (25.9%) with increased fall risk, AUC=0.910 (bias-corrected 0.900), pseudo R2=57.0% (bias-corrected 53.9%), calibration curve based on the out-of-bag samples with intercept -0.036 and slope 0.922, likelihood ratio test p<0.001.

Variable OR 95% CI p value
Age <0.001
  Nonlinear 0.001
Gender (female vs. male) 0.84 [0.59, 1.18] 0.312
Body mass index 0.117
  Underweight vs. normal 1.22 [0.52, 2.82] 0.642
  Overweight vs. normal 0.75 [0.50, 1.12] 0.158
  Obese vs. normal 1.23 [0.80, 1.89] 0.337
Systolic blood pressure 0.058
  Nonlinear 0.033
Diastolic blood pressure 0.575
  Nonlinear 0.606
Poor family function 1.87 [1.18, 2.96] 0.008
Increased risk of malnutrition 1.86 [1.11, 3.11] 0.018
Chronic diseases <0.001
  1 disease vs. no disease 1.59 [1.02, 2.47] 0.040
  2 diseases vs. no disease 2.29 [1.42, 3.72] 0.001
  3 or more diseases vs. no disease 3.79 [2.25, 6.46] <0.001
Pain intensity <0.001
  Nonlinear 0.572
Self-assessment of current health <0.001
  Nonlinear 0.003
Feelings of loneliness 0.596
  Nonlinear 0.310
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