Use of structural models to elucidate the occurrence of falls among older adults according to abdominal obesity: a cross-sectional study

Abstract

INTRODUCTIONFalls are a public health problem at the global level due to the associated repercussions, such as a large number of years of disability, the need for long-term care, and high mortality rates. 1 In the Brazilian population there is a prevalence of 27% for falls among older adults, with advanced age among the risk factors with strong scientific evidence for falls. 2,3 Falls have also been associated with the presence of morbidities, 4,5 depressive symptoms, 3,6 changes in balance and reduction in muscle strength, 7-9 use of medicines, 10,11 disabilities in basic activities (BADL) and instrumental activities (IADL) of daily living, 12,13 lower levels of physical activity, 14 prolonged sedentary behavior, 15 female sex 2,3 and obesity. [16][17][18] Among these factors, obesity, which is also currently a public health problem, requires further investigation. However, the effects of body fat distribution on the occurrence of falls are not yet well established. 18 The scientific literature shows that excess fat in the central region contributes to the anterior displacement of the body's center of mass, making it difficult to stabilize in an upright posture, shifting the line of gravity that approaches the body's base of support. 19 Based on studies in older adults, it appears that falls are associated with sociodemographic, health, and behavioral characteristics. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] However, which of these factors act directly or indirectly to mediate the occurrence of falls in older adults with and without abdominal obesity remains unclear.Obesity is a common condition in the elderly population and is associated with higher morbidity and mortality, risk of institutionalization, and poorer quality of life. 20 Additionally, advanced age is one of the main factors associated with falls. 1 Thus, it is necessary to expand on the understanding of the association between obesity and falls in this population, aiming to identify individuals at greater risk and propose preventive measures. 18

Obesity and falls injuries risk: Is there a relevant connection in older adults?

“…Moreover, older adults who employ alpha-blockers, benzodiazepines and beta-blockers, as well as those with prior fractures, and who exhibit a high body mass index are more likely to fall than those who are not overweight or on medication regimens, especially in adults older than 60 years of age with abdominal obesity who have a higher prevalence of falls than those of healthy weight age matched adults. 33,34 As affirmed by Mitchell et al 5 older obese individuals have an increased risk of falls and obese fallers have a higher prevalence of pain and inactivity than fallers of a healthy weight.…”