Abstract
To assess the association between having suffered a fall in the month prior to interview and long-term overall survival in nursing-home residents. Retrospective cohort study conducting an overall survival follow-up of 689 representative nursing-home residents from Madrid, Spain. Residents lived in three types of facilities: public, subsidized and private and its information was collected by interviewing the residents, caregivers and/or facility physicians. Residents contributed to follow-up time from their baseline interviews until death or being censored at the end of the 5-year follow-up period. The association between suffering a fall during the month prior to interview and long-term overall survival was analyzed using Cox proportional hazards models. To adjust for potential confounders we used progressive adjusted models. We then repeated the analyses with severity of the fall (no fall, non-severe, severe) as the main independent variable. After a 2408 person-year follow-up (median 4.5 years), 372 participants had died. In fully-adjusted models, residents who had suffered any kind of fall in the previous month showed virtually the same survival rates compared to non-fallers (hazard ratio (HR) = 1.03; 95% CI = 0.75-1.40). There was a weak graded relationship between increased fall severity and survival rates for the non-severe fall group (HR = 0.92; 95% CI = 0.58-1.45) and the severe fall group (HR = 1.36; 95% CI = 0.73-2.53) compared with residents who had not suffered any kind of fall. The hazard ratios for severe falls were higher in men, residents with less comorbidity, fewer medications, and those functionally independent. We found no associations between having suffered a fall in the month prior to interview and long-term survival; neither did we find a marked association when severity of fall was accounted for in the whole population. In some subgroups, however, the results merit further scrutiny.
Highlights
Older people’s accidental falls are a priority for WHO/Europe [1] and they constitute a major public health problem
Residents who had suffered any kind of fall in the previous month showed virtually the same survival rates compared to non-fallers (hazard ratio (HR) = 1.03; 95% confidence intervals (CIs) = 0.75–1.40)
There was a weak graded relationship between increased fall severity and survival rates for the non-severe fall group (HR = 0.92; 95% CI = 0.58–1.45) and the severe fall group (HR = 1.36; 95% CI = 0.73–2.53) compared with residents who had not suffered any kind of fall
Summary
Older people’s accidental falls are a priority for WHO/Europe [1] and they constitute a major public health problem. In the European Union, older adults account for half of deaths from unintentional injuries [2], despite representing one fifth of the population [3]. In older adults from developed countries, unintentional injuries are between the fifth and the seventh most common causes of death [4, 5], and the majority of unintentional injuries are caused by falls [2, 4, 6]. Mortality due to accidental falls has recently increased in older adults [7,8,9,10], and the rapid ageing of the population makes it probable that this trend will increase in the future [7, 11]. As the interval between injury and death increases, fall mortality could be underreported due to the death being attributed to a concomitant pathology [13, 14] (pneumonia, cerebral hemorrhage, pulmonary thromboembolism, worsening of comorbidities or other complication of the fall)
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