Abstract
BackgroundFalls may occur as unpredictable events or in patterns indicative of potentially modifiable risks and predictive of adverse outcomes. Knowing the patterns, risks, and outcomes of falls trajectories may help clinicians plan appropriate preventive measures. We hypothesized that clinically distinct trajectories of falls progression, baseline predictors and their coincident clinical outcomes could be identified.MethodsWe studied 765 community-dwelling participants in the MOBILIZE Boston Study, who were aged 70 and older and followed prospectively for falls over 5 years. Baseline demographic and clinical data were collected by questionnaire and a comprehensive clinic examination. Falls, injuries, and hospitalizations were recorded prospectively on daily calendars. Group-Based Trajectory Modeling (GBTM) was used to identify trajectories.ResultsWe identified 4 distinct trajectories: No Falls (30.1%), Cluster Falls (46.1%), Increasing Falls (5.8%) and Chronic Recurring Falls (18.0%). Predictors of Cluster Falls were faster gait speed (OR 1.69 (95CI, 1.50–2.56)) and fall in the past year (OR 3.52 (95CI, 2.16–6.34)). Predictors of Increasing Falls were Diabetes Mellitus (OR 4.3 (95CI, 1.4–13.3)) and Cognitive Impairment (OR 2.82 (95CI, 1.34–5.82)). Predictors of Chronic Recurring Falls were multi-morbidity (OR 2.24 (95CI, 1.60–3.16)) and fall in the past year (OR 3.82 (95CI, 2.34–6.23)). Symptoms of depression were predictive of all falls trajectories. In the Chronic Recurring Falls trajectory group the incidence rate of Hospital visits was 121 (95% CI 63–169) per 1,000 person-years; Injurious falls 172 (95% CI 111–237) per 1,000 person-years and Fractures 41 (95% CI 9–78) per 1,000 person-years.ConclusionsFalls may occur in clusters over discrete intervals in time, or as chronically increasing or recurring events that have a relatively greater risk of adverse outcomes. Patients with multiple falls, multimorbidity, and depressive symptoms should be targeted for preventive measures.
Highlights
Falls are common among older persons [1,2] and rank among the 10 leading causes of death in the United States, resulting in more than $19 billion in health care costs annually [3]
It is possible that some people may experience falls as random, unpredictable events, while others may have patterns of falls that are indicative of potentially modifiable risks factors and are predictive of adverse outcomes
Of the 765 older adults included in this study, 276 (36.1%) were male and 489 (63.9%) female, 156 (20.4%) were nonwhite, 245 (32.0%) met the Physical Activity Scale for the Elderly (PASE) score of low intensity physical activity
Summary
Falls are common among older persons [1,2] and rank among the 10 leading causes of death in the United States, resulting in more than $19 billion in health care costs annually [3]. It is possible that some people may experience falls as random, unpredictable events, while others may have patterns of falls that are indicative of potentially modifiable risks factors and are predictive of adverse outcomes. To our knowledge there are no longitudinal studies that have observed long-term trajectories of falls and determined their predictors and outcomes. Falls may occur as unpredictable events or in patterns indicative of potentially modifiable risks and predictive of adverse outcomes. Risks, and outcomes of falls trajectories may help clinicians plan appropriate preventive measures. We hypothesized that clinically distinct trajectories of falls progression, baseline predictors and their coincident clinical outcomes could be identified
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