Falling and fall risk factors in adults with haemophilia: an exploratory study

Abstract

Falls are a particular risk in persons with haemophilia (PWH) because of damaged joints, high risk of bleeding, possible impact on the musculoskeletal system and functioning and costs associated with treatment for these fall-related injuries. In addition, fall risk increases with age and PWH are increasingly entering the over 65 age group. The aim of this study was to determine the occurrence of falls during the past year and to explore which fall risk factors are present in community-dwelling PWH. Dutch speaking community-dwelling adults were included from the age of 40 years with severe or moderate haemophilia A or B, independent in their mobility and registered at the University Hospitals Leuven. They were asked to come to the haemophilia centre; otherwise a telephone survey was conducted. Demographic and social variables, medical variables, fall evaluation and clinical variables were queried. From the 89 PWH, 74 (83.1%) participated in the study. Twenty-four (32.4%) fell in the past year, and 10 of them (41.7%) more than once with an average of four falls. Living conditions, physical activity, avoidance of winter sports due to fear of falling, orthopaedic status, urinary incontinence and mobility impairments are potential fall risk factors in adult PWH. This exploratory study indicates that PWH are attentive to falling since they are at higher risk for falls and because of the serious consequences it might have. Screening and fall prevention should be stimulated in the daily practice of haemophilia care.

Balance, falls, and exercise: Beliefs and experiences in people with hemophilia: A qualitative study

“…Prior research has established that falls are commonplace in adults with hemophilia,1, 2 and advises that physical therapy and exercise are successful in fall prevention 3, 4. Limited exercise and physical activity leads to a decline in balance, increasing fall risk 5.…”

Haemophilia A and B as a cause for secondary osteoporosis and increased fracture risk

“…Others have reported an even higher prevalence (50% in the preceding 12 months compared with 10% in age-matched controls) [22]. Risk factors associated with falls are living conditions, physical activity, avoidance of winter sports, urinary incontinence and decreased mobility [21], as well as common factors reported in the general population, such as a history of a previous fall, orthopaedic status (including arthritis and decreased strength in lower extremities and reduced hip extension range), pain with daily activities, avoidance of pain-related exercise, depression and HIV infection [23]. Haemophilic arthropathy and acute musculoskeletal bleeding as a consequence of a fall, and subsequent behaviour, further increase the risk of re-falling, creating, thus, a vicious cycle [4].…”

“…Indeed, a recent study reported that about one-third of patients with severe or moderate haemophilia A or B experience at least one fall per year, 42% of which more than once (with an average of four falls) [21]. Others have reported an even higher prevalence (50% in the preceding 12 months compared with 10% in age-matched controls) [22].…”

Von Willebrand Disease in the elderly: clinical perspectives

“…An ongoing study has suggested both physical therapy and occupational therapy programs in older patients with hemophilia are feasible, and would be reasonable options for patients with VWD 115. An interesting study in hemophilia patients indicated overall a reduced risk of falls, presumably because of an increased level of caution when ambulating and avoidance of fall risks 116. More studies on the risk and management of osteoporosis and falls in elderly VWD patients are needed.…”