Chronic Health Conditions as a Risk Factor for Falls among the Community-Dwelling US Older Adults: A Zero-Inflated Regression Modeling Approach

Abstract

Falls are an important health concern among older adults due to age-related changes in the body. Having a medical history of chronic health condition may pose even higher risk of falling. Only few studies have assessed a number of chronic health conditions as risk factor for falls over a large nationally representative sample of US older adults. In this study, Behavioral Risk Factor Surveillance System (BRFSS) 2014 participants aged 65 years and older (n = 159,336) were evaluated. It was found that 29.7% (n = 44,550) of the sample experienced at least one fall and 16.3% (n = 20,444) experienced more than one fall in the past 12 months. According to the study findings, having a medical history of stroke, CKD, arthritis, depression, and diabetes independently predict the risk of first-time falling as well as the risk of recurrent falling in older adult population while controlling for other factors. On the other hand, having a medical history of the heart attack, angina, asthma, and COPD did not predict the risk of first-time falling, but did predict the risk of recurrent falling after experiencing the first fall in this population.

Prevalence and risk factors of falls among community-dwelling older people: results from three consecutive waves of the national health interview survey in Taiwan

“…Considering biological factors, our finding that older adults with unclear vision had an OR that was twice as high as older adults with clear vision aligns with that in a previous report by Lord [31]. Our finding that having any of the selected chronic conditions was associated with a higher risk of falls is compatible with previous falls and multi-morbidity studies in terms of diabetes, stroke, chronic kidney disease, asthma [32], and hypertension [33].…”

“…Besides, some older adults were reluctant to verbalize their incontinence because of embarrassment or because of its interference with sexual function. Third, a zero-inflated regression models in the previous report [32] was not adopted, because our data did not differentiate first-time fall event from recurrent fall event. Fourth, our observation period and interval of data collection are not comparable with those of other fall-related hospitalization [18].…”

“…Even though the declining prevalence of falls implies that previous community-based health promotion programs, including multifactorial fall risk awareness, were successful, older adults with multiple risk factors are often overlooked. Current fall prevention guidelines [52] do not address the potential risk of falls derived from multi-morbidity [32,33]. Thus, an approach that accounts for adults who have multimorbidity and are prescribed multiple medicines is recommended because such population has a higher risk for adverse events and drug interactions [53].…”

Prevalence of Falls and Fall‐Related Outcomes in Older Adults with Self‐Reported Vision Impairment

“…Finally, the study did not report prevalence estimates adjusted for potential confounders that have been associated with VI 23,24 and fall risk. 25,26 Several studies have also found an association between VI and FoF and have demonstrated that individuals with FoF are more likely to experience activity restriction. 17,18,27 One study found that in older adults with age-related macular degeneration (AMD), declines in vision were associated with less physical activity and that FoF mediated the relationship between vision loss and activity restriction.…”

“…In addition, this study calculated fall prevalence in individuals who reported severe VI and did not count those with milder forms of VI that are more common in the general population. Finally, the study did not report prevalence estimates adjusted for potential confounders that have been associated with VI and fall risk …”