Abstract
Objectives: While the negative impact of falls in older persons has been recognized, the association between knee pains and falls remains inconclusive due to underreporting and undertreatment of knee pain. This study was conducted to evaluate the relationship between knee pain and knee pain severity with falls risk and to further determine factors which influence this potential relationship.Design: This was cross-sectional study from the Malaysian Elders Longitudinal Research (MELoR) study.Setting: Urban community dwellers in a middle-income South East Asian country.Participants: One thousand two hundred twelve of a representative sample of community dwelling older persons aged 55 years and older.Outcome measures: Falls in the preceding 12 months and knee pain were collected during a home-based computer-assisted interview. Physical and functional performance were measured using the Timed Up and Go test and the Katz and Lawton scales, respectively. Psychological status was determined using the Depression Anxiety and Stress Scale (DASS-21).Results: Of the 1,212 participants included in this analysis, knee pain was present in 402 (33.17%) individuals (124 (30.85%) mild, 210 (52.24%) moderate, 68 (16.92%) severe). The presence of knee pain was associated with increased risk of falls [odds Ratio, OR(95% confidence interval, CI): 1.81 (1.37–2.38)]. Severe knee pain was an independent predictor for falls after adjustment for functional impairment and psychological status. Mild, moderate, and severe knee pain had a specific indirect effect on falls through reducing functional impairment, which in turn increases their psychological concern.Conclusion: Future studies should explore this relationship prospectively and evaluate whether interventions which alleviate psychological concerns and improve function will reduce falls risk in those with mild to moderate knee pain.
Highlights
As the global population is aging rapidly, falls have become an increasingly prominent public health concern [1]
All three stages of knee pain severity were significantly associated with increased risk of falls compared with no knee pain (Mild: odds ratios (OR) = 1.57; 95%confidence intervals (CI) = 1.02–2.42, Moderate: OR = 1.55; 95%CI = 1.11–2.25, Severe: OR = 2.92; 95%CI = 1.72–4.97), respectively
When the severity of knee pain was considered, mild knee pain was no longer associated with increased risk of falls compared to those with no knee pain once adjusted for potential confounders
Summary
As the global population is aging rapidly, falls have become an increasingly prominent public health concern [1]. One in three older persons report at least one fall over the previous 12 months [2]. Complications resulting from falls may include severe life-threatening injuries such as subdural hematoma, hip fractures and spinal cord injuries [2]. Hospitalization and treatment costs associated with falls contribute substantially to healthcare costs and has been increasing [3, 4]. Current cost estimates usually do not include social and psychological costs, which include increased dependency, institutionalization, fear of falling, and quality of life (QoL) [5]. Common risk factors for falls include older age, female gender, previous falls, gait and balance problem, poor vision, and other chronic diseases [6]
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