Risk Factors for Falls in HIV-Infected Persons

Abstract

Background The incidence of and risk factors for falls in human immunodeficiency (HIV)-1-infected persons are unknown. Methods Fall history during the prior 12 months, medical diagnoses, and functional assessments were collected on HIV-infected persons 45 to 65 years of age receiving effective antiretroviral therapy. Fall risk was evaluated using univariate and multivariate regression analyses. Results Of 359 subjects, 250 persons (70%) reported no falls, 109 (30%) had ≥1 fall; 66 (18%) were recurrent fallers. Females, Caucasians, and smokers were more like to be recurrent fallers (p≤0.05). HIV-related characteristics including current and nadir CD4 T-cell count, estimated HIV duration, and Veterans Aging Cohort Study Index scores were not predictors of falls (all p≥0.09); didanosine recipients were more likely to be recurrent fallers (p=0.04). The odds of falling increased 1.7 for each comorbidity and 1.4 for each medication (p<0.001), and were higher in persons with cardiovascular disease, hypertension, dementia, neuropathy, arthritis, chronic pain, psychiatric disease, frailty or disability (all OR≥ 1.8; p≤0.05). Beta-blockers, antidepressants, anti-psychotics, sedatives, and opiates were independently associated with falling (all OR ≥2.7; p≤0.01). Female gender, diabetes, antidepressants, sedatives, opiates, didanosine, exhaustion, weight loss, and difficulty with balance were the most significant predictors of falls in logistic regression (all OR ≥2.5; p≤0.05). Conclusion Middle-aged HIV-infected adults have high fall risk. Multiple comorbidities, medications, and functional impairment were predictive of falls, but surrogate markers of HIV infection or an HIV-specific multimorbidity index were not. Fall risk should be assessed routinely as part the care of HIV-infected persons.

Ambulatory Function in Men with and without HIV Infection: Association with Cardiorespiratory Fitness

“…In community dwelling elderly adults each increased minute to perform the 400-meter walk is associated with a 29% increased mortality risk and 52% increased risk of mobility limitations [3]. Erlandson and colleagues recently performed the LDCW in a clinic-based cohort of 359 HIV-infected patients aged 45-65 years who received ART for at least 6 months and were 85% male [29]. Patients were not excluded based on comorbid conditions, with 18% (N 66) of the participants reporting recurrent falls in the prior year.…”

High Prevalence of Low Bone Mineral Density and Substantial Bone Loss over 4 Years Among HIV-Infected Persons in the Era of Modern Antiretroviral Therapy

“…38,39 Moreover, HIV-infected persons often have risk factors for falling, such as multimorbidity, polypharmacy, peripheral neuropathy, and frailty, which lead to the development of fragility fracture at much younger ages. [39][40][41] Our study was subject to several limitations. The SUN Study was conducted in only four U.S. cities; therefore, data presented here may not be generalizable to all HIV-infected persons in care in the United States.…”

Association Between Frailty and Components of the Frailty Phenotype With Modifiable Risk Factors and Antiretroviral Therapy

“…Even with effective ART, frailty and physical function impairments are common and have been associated with increased risk of falls, hospitalizations, and mortality [2][3][4][5][6]. In addition to the composite frailty phenotype, measurement of the single, objective component of gait speed may be equally predictive of morbidity and mortality and may be easier to implement in the clinical or research setting [7].…”