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A Classification and Regression Tree for Predicting Recurrent Falling among Community-dwelling Seniors Using Home-care Services

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Abstract

Objectives: A prospective, observational study was undertaken to identify risk profiles of subjects regarding the recurrence of falling among community-dwelling seniors using home-care services.

Methods: A convenience sample of 868 community-dwelling older persons, aged 65 years or older, who use home-care services offered by public community-based centres in the province of Québec. Subjects were recruited between 2002 and 2005, assessed for fall-related risk factors, and monitored for prospective falls. Data were examined by a classification and regression tree (CART) and survival analyses.

Results: Ninety-nine participants reported two falls within six months of entry to the study. Thus, the incidence of recurrent fallers was 11.4%. The tree analysis classified the population into five groups differing in risk of recurrent falling, based on history of falls in the three months prior to the initial interview, Berg balance score, type of housing, and usual alcohol consumption in the six months preceding study entry. The relative risks varied from 0.7 to 5.1. The survival analysis showed that the length of time before becoming a recurrent faller varies among risk profiles.

Conclusion: The study permitted the construction of easily interpretable risk profiles of recurrent falling. These can guide clinicians and public health practitioners to identify high-risk individuals and to decide on the appropriate intervention and follow-up.

Résumé

Objectifs: Identifier des profils d’aînés à haut risque de devenir des chuteurs récurrents parmi la clientèle des services de soutien à domicile.

Méthode: Il s’agit d’une étude d’observation prospective conduite auprès d’un échantillon de commodité de 868 personnes de 65 ans ou plus vivant dans la communauté et inscrits aux services de soutien à domicile de la mission CLSC des centres de santé et de services sociaux de la région de Lanaudière, au Québec. Le recrutement des volontaires a été effectué entre mars 2002 et juillet 2005. L’étude est caractérisée par la mesure des facteurs de risque au domicile du participant à son entrée dans le projet ainsi que par une relance téléphonique mensuelle dont le but était de documenter la survenue des chutes subséquentes. Les données ont été examinées au moyen d’un arbre de régression et de classification et d’une analyse de survie.

Résultats: Durant les six mois de leur suivi, 99 des 868 participants ont rapporté au moins deux chutes et sont considérés comme chuteurs récurrents. Cette valeur se traduit par une incidence de récidive de 11,4 %. Les analyses statistiques ont révélé l’existence de cinq profils de risque distinctifs dont le risque relatif varie de 0,7 à 5,1. Vivre dans une résidence pour aînés, avoir des antécédents récents de chutes multiples ou des troubles de l’équilibre et consommer de l’alcool, même occasionnellement, sont les principaux facteurs associés à une probabilité accrue de devenir un chuteur récurrent et de chuter précocement.

Conclusion: Des profils de risque de chutes récurrentes à court terme ont été établis à partir d’un nombre restreint de facteurs validés par l’expérience. Ces profils facilement interprétables peuvent aider les cliniciens et les praticiens de santé publique à identifier les aînés à haut risque et à guider leurs choix vers des interventions et des suivis appropriés.

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Author information

Authors and Affiliations

  1. Service de surveillance, recherche et évaluation, Direction de santé publique et d’évaluation, Agence de la santé et des services sociaux de Lanaudière, Joliette, QC, Canada

    Bernard Simon Leclerc MSc & Élizabeth Cadieux MSc

  2. Service de prévention et de promotion, Direction de santé publique et d’évaluation, Agence de la santé et des services sociaux de Lanaudière, Joliette, QC, Canada

    Claude Bégin MSc

  3. Groupe de recherche interdisciplinaire en santé, Université de Montréal, Montréal, QC, Canada

    Lise Goulet MD, PhD & Nicole Leduc PhD

  4. The Statistics Consulting Group, Institut Philippe-Pinel de Montréal, Montréal, QC, Canada

    Jean-François Allaire MSc & Julie Meloche MSc

  5. Institut universitaire de gériatrie de Montréal, Research Centre, Montréal, QC, Canada

    Marie-Jeanne Kergoat MD, CCFP, FCFP, CSPQ

Authors
  1. Bernard Simon Leclerc MSc
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  2. Claude Bégin MSc
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  3. Élizabeth Cadieux MSc
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  4. Lise Goulet MD, PhD
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  5. Jean-François Allaire MSc
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  6. Julie Meloche MSc
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  7. Nicole Leduc PhD
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  8. Marie-Jeanne Kergoat MD, CCFP, FCFP, CSPQ
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Corresponding author

Correspondence to Bernard Simon Leclerc MSc.

Additional information

This research is part of Leclerc’s PhD thesis in Public Health and Epidemiology, realized under the supervision of Professors Lise Goulet and Nicole Leduc, respectively from the Département de médecine sociale et préventive and the Département d’administration de la santé, Faculté de médecine, Université de Montréal, Montréal, QC, Canada.

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Leclerc, B.S., Bégin, C., Cadieux, É. et al. A Classification and Regression Tree for Predicting Recurrent Falling among Community-dwelling Seniors Using Home-care Services. Can J Public Health 100, 263–267 (2009). https://doi.org/10.1007/BF03403944

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  • DOI: https://doi.org/10.1007/BF03403944

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