Methodological challenges in a study on falls in an older population of Cape Town, South Africa.

Sebastiana Z Kalula, Monica Ferreira, George H Swingler, Motasim Badri, Avan A Sayer
1. Division of Geriatric Medicine, The Albertina and Walter Sisulu Institute of Ageing in Africa, University of
Cape Town, South Africa
2. International Longevity Centre–South Africa, Faculty of Health Sciences, University of Cape Town, South Africa
3. Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town, South Africa
4. Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa, and King Saud bin
Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
5 . MRC Lifecourse Epidemiology Unit, Faculty of Medicine, University of Southampton, United Kingdom.

Abstract
Background: Falls are a major cause of disability, morbidity and mortality in older persons, but have been under researched in
developing countries. .

Objective: To describe challenges encountered in a community-based study on falls in a multi-ethnic population aged ≥65 years  in a low-income setting.

Methods: The study was conducted in four stages: A pilot study (n=105) to establish a sample size for the survey. An equipment validation study (n=118) to use for fall risk determination. A cross-sectional baseline (n=837) and a 12-month follow-up  survey (n=632) to establish prevalence and risk factors for falls.

Results: Prevalence rate of 26.4% (95% CI 23.5-29.5%) and risk factors for recurrent falls: previous falls, self-reported poor  mobility and dizziness were established. Adaptations to the gold standard prospective fall research study design were employed: 1) to gain access to the study population in three selected suburbs, 2) to perform assessments in a non-standardised setting, 3)  to address subjects’ poverty and low literacy levels, and high attrition of subjects and field workers.

Conclusion: Studies on falls in the older population of low- to middle-income countries have methodological challenges. Adaptive strategies used in the Cape Town study and the research experience reported may be instructive for investigators planning  similar studies in such settings.

Keywords: Falls, older people, community-based research, low and middle income countries, methodology, study design.