Falls in people living with HIV: a scoping review

Abstract

ObjectivesRecent research has indicated seemingly increased propensity for falls and accelerated bone demineralisation in people living with HIV (PLWH). We aim to map out the extent and nature of existing research relating to falls in PLWH and describe the relationship between bone demineralisation and falls in PLWH.MethodsA scoping review was done following Arksey & O’Malley’s methodological framework and recommendations from Joanna Briggs Institute. Four databases were searched until October 2019 for peer-reviewed studies available in English reporting on the definition, prevalence, assessment, risk factors and interventions for falls in PLWH as well as information on bone demineralisation linked to falls in PLWH. Narrative reviews were excluded. Two reviewers independently performed the extraction using a predesigned Excel sheet. A descriptive analysis of extracted information was done.ResultsFourteen studies on falls in older PLWH were identified, with all but one study conducted in high-income countries. Prevalence of falls in PLWH ranged from 12% to 41%. Variable assessment tools/tests were used to assess potential risk factors, but it remains to be determined which are more predictive and appropriate for use among PLWH. Considerable agreement existed for risk factors regarding use of medications while evidence regarding functional and cognitive impairments were variable. Few studies compared risk factors for falls in PLWH with those in age-matched and sex-matched seronegative population. There is currently no evidence for interventions to prevent or reduce falls risk in PLWH.ConclusionMore research is needed on falls in younger cohorts of PLWH and in sub-Saharan Africa where HIV is most prevalent and more robust clades exist. More studies need to report on data in seronegative controls to determine risk factors unique to PLWH. More intervention studies targeted at falls prevention and promotion of bone health are required. Quality clinical practice guidelines highlighting validated assessment tools and outcome measures need to be developed.

Alcohol and falls among people with HIV infection: A view from Russia and the United States

“…Among people with HIV (PWH), falls are prevalent even at younger ages with fall estimates that range between 16% and 41% in the past year (Berner et al, 2019; Erlandson et al, 2019; Kim et al, 2018; Sharma et al, 2020; Womack et al, 2019) including 16% sustaining a fall that required medical attention (Kim et al, 2018). What is known about falls in PWH is largely from high‐income countries with very limited research in lower‐middle‐income countries (Berner et al, 2019; Charumbira et al, 2020). Falls are particularly consequential for PWH given their elevated risk of low bone density (Brown et al, 2004; Erlandson et al, 2018) and fracture (Sharma et al, 2015).…”

“…Research on alcohol and falls using the same instruments in different countries would be helpful in substantiating thresholds or cut points to identify those whose drinking is associated with greater risk of falls. Rather than extrapolating study findings in higher‐income countries to those in lower‐middle‐income countries, developing appropriate fall prevention interventions requires an understanding of globally relevant determinants of falls (Charumbira et al, 2020).…”

“…Research on alcohol and falls using the same instruments in different countries would be helpful in substantiating thresholds or cut points to identify those whose drinking is associated with greater risk of falls. Rather than extrapolating study findings in higher-income countries to those in lower-middle-income countries, developing appropriate fall prevention interventions requires an understanding of globally relevant determinants of falls (Charumbira et al, 2020). This study's objective was to describe the incidence of falls in two cohorts of PWH-one in St Petersburg (Russia) and the other in Boston (the United States) and to ascertain the severity of alcohol use associated with a fall using the AUDIT-C questionnaire and a symptom-based measure, DSM-5 criteria for AUD (American Psychiatric Association, 2013).…”

Comorbidities and psychosocial factors as correlates of self-reported falls in a nationwide sample of community-dwelling people aging with HIV in Germany

“…A 41% fall rate was also found in two longitudinal studies which followed their participants for 2 years [ 8 ], with one reporting a rate of 10% of these falls being complicated by “an injury leading to medical evaluation” [ 9 ]. Studies comparing fall rates between people living with HIV (PLWH) and uninfected individuals did not show statistically significant differences between both groups [ 10 ], while fall rates were actually higher in PLWH in one study [ 11 ]. Similarly, studies showed that neither the HIV status itself nor HIV disease- or treatment-related characteristics were significantly associated with fall events [ 8 , 12 ].…”

“…Instead, risk factors for falls in this population were largely the same as the risk factors that were identified for non-infected individuals [ 13 ]. Falls in PLWH can result in serious consequences, fall-related fractures showed a prevalence of 3.8 to 8% among PLWH fallers [ 10 ], in one study every fifth faller sought medical attention because of a fall [ 6 ]. A recent study reported a strong association between falls and mortality in middle-aged adults with HIV [ 14 ].…”