Study design
This is a descriptive analytic study that using cross sectional approach. Household survey was conducted during June – September 2020. West Java Provinces selected as one of Indonesian province that entering aging population (have more than 10% older people population). 31
Population and sample
Population of this study are community dwelling older adult aged 60 years old or more. The sample size calculation is based the prevalence of fall in community dwelling older adult in Indonesia by using fall prevalence 29 % in the previous year 32 and precision was considered as 95% (±0.05) counted for urban area and each area. A cluster sampling method was used to achieve the required study sample from 2 selected area out of 28 municipalities in West Java administrative area namely Bandung Regency that representing rural area and Bandung City representing urban area. From those selected municipalities, then we randomly selected 4 sub-district from each rural and urban area. From each subdistrict we randomly selected 2 villages for each subdistrict in rural area and 2 urban villages in urban area, a total of 16 urban village and village are selected. The sample size for each village was calculated proportionally and the sampling was carried out randomly in each village.
Variable and Measures
Outcome variable
Fall is become outcome on this study. Fall is assessed with following questions; “Have you fallen down in the last twelve months?” and “How many time have you fallen down?”
Risk Factor for Fall
Sociodemographic factor included age, sex, education, occupation status and residential area. Chronic medical conditions were assessed with the question “Has a doctor/paramedic/nurse/midwife ever told you that you had following diseases?” (“hypertension, diabetes or high blood sugar, heart diseases, stroke, arthritis/rheumatism, and depression”) (Yes, No). The existence of one or more chronic medical condition considering as having chronic illness.
Visual impairment refers to any degree of impairment to a person’s ability to see that affects his or her daily life33. Visual impairment was assessed subjectively with the questions “Do you have any problem with your vision? Such as blurred vision? (Yes/No) any answer will be confirmed with tumbling E chart test to confirm subjective visual impairment. Any correction with glasses will be considered as normal visual.
Hearing impairment refer to a person who is not able to hear as well as someone with normal hearing – hearing thresholds of 20 dB or better in both ears 34. This study assessed the subjective hearing impairment using the question: “Do you have any problem with your hearing function?” (Yes/No. Any subjective answer, to be confirmed by observation and whisper test. Any correction with hearing aids considered as normal hearing.
Functional capacity was measured by Barthel index of ADL (Activity Daily Living). This Barthel index measures the likelihood of being able to live at home with a degree of independence35. Ten basic activities of daily living (ADL) are captured: bowels, bladder, grooming, toilet use, feeding, transfers, walking, dressing, climbing stairs, and bathing. A dichotomous category selected as mild/severe dependent (score ≤19) and independent (score 20)35.
The physical performance measured by SPPB (Short Physical Performance Battery). SPPB is a well-known and sensitive performance test which combines the results of 3 balance tests, a gait speed test and a chair stand test into one score36,37. Hand-clocked durations are used to indicate the performance capacity for individual components which are scaled to a grade between 0 and 4 and add up to a score between 0 and 12). This performance is dichotomized in to poor and good physical performance.
Living environmental risk factor was assessed with the CDC Home Fall Prevention Checklist for Older Adults to identify home hazard that may increase the risk of falling, including room lighting, floor condition, stairs and steps, kitchen, bedroom and safety in the bathroom. Any “Yes” in one of the hazards categorized as unsafe environment. Medication
Data analysis
Data analysed using statistical software IBM SPSS statistics 22. A descriptive analytic was perform to describe the sociodemographic profile of study participants. Independent sample t-test and chi-square analysis selected to compare risk of falling among the older person living in rural and urban area. Binary multiple logistic regression analysis performed to identify the association between fall and the risk factor.
Prior to participation, all older people participated in this study voluntarily signed their informed consent to prove their voluntary contribution on this study. This study has passed the ethical clearance from institutional research bureau of Universitas Indonesia with approval number: Ket- 326/UN2.F10.D11/PPM.00.02/2020.