Falls in Chinese Older People

Abstract

Previous studies suggest that Chinese older people report markedly fewer falls than Caucasian older people, while prevalence and types of fall risk factors are similar between the two populations. To gain a better understanding of fall risk in Chinese older people, a systematic review and four studies examining socio-demographic, physical, functional and psychological fall risk factors were conducted in large cohorts of older Chinese people living in Taiwan, Hong Kong and Australia and in older Caucasian people living in Australia. In study one, the Minimal Chair Height Standing (MCHS) - a novel functional test similar to deep squatting - was found to be underpinned by strength and balance and constitute an independent falls risk factor. In study two, performance of the Timed Up & Go (TUG) test was shown to be determined by a range of sensorimotor, balance and psychological measures, and TUG test performance was correlated with concern about falls, functional disability but not falls. Study three developed the Chinese version of the Fall Efficacy Scale International (FESI( Ch)), which provides a valid and reliable measure of fall efficacy in Chinese older people. Study four showed depression was an important risk factor for falls in the Taiwanese cohort, and that this risk was independent of established sensorimotor and balance risk factors. The final study identifies the key explanatory factors that contribute to the observed difference in fall rates between older Chinese and Caucasians people using a cross-cultural, migrant study design. Fall rates were at least 50% lower in all Chinese cohorts when compared to the Australian Cohort. Negative binomial regression analyses revealed that low fall rates in Chinese cohorts resulted from higher levels of concern about falls (increased caution) and reduced exposure to risk due to more structured activity patterns. In conclusion, this thesis adds to the understanding of what factors contribute to the significantly lower falls rate found in Chinese older people. As such it provides important insights for fall risk assessments and fall prevention strategies for both Chinese and non- Chinese older people.