Older Adult Falls Linked to Increased Impairments in Daily Living Activities

Claire Adam

Credit: University of Montana

Falls among older adults are associated with increased impairment in activities of daily living, according to a new study.¹

Using data from the Ginkgo Evaluation of Memory Study, which was a randomized controlled trial of adults aged 75 years or older from the US, results of the study suggest experiencing a fall was associated with a 42% increase in risk of impairment in daily activity.

“The trajectory models in conjunction with the Cox proportional hazards models provide evidence of increased risk of greater, sustained [activities of daily living] impairment after a fall,” the investigators wrote. “Certain older adults are more likely to have increased impairment post-fall.”

Approximately 36 million older adults fall each year, resulting in > 32,000 deaths.² With falls, older adults may experience a significant decline in quality of life, safety, and functioning—requiring assistance on daily living activities.¹ Older adults may depend on others or assistive devices, as well as have an increased need for formal and informal care and an increased risk of institutionalization. Needing assistance creates a burden on finances and healthcare systems.

The new study, led by Claire Adam, PhD, from the School of Public and Community Health Sciences at University of Montana, strived to quantify the link between falls and post-fall daily activity impairment, as well as to evaluate the long-term impact of falls and characteristics of individuals most likely to have impairment.

The investigators tracked the following activities of daily living: walking around the house, going on a chair or bed, eating, dressing, bathing, and toileting. Impairments in the activities of eating, bathing, dressing, toileting, going from the bed or chair, and walking were associated with an increased risk of declines in mental health. Moreover, difficulties bathing and walking was associated with an increased risk of nursing home admission, and troubles walking was associated with reduced social interaction.

Participants were asked at each 6-month study visit if they had any falls within the past 6 months. If they did fall, they were asked how many times they had fallen and whether the fall required medical attention. Participants also filled out the Ginkgo Evaluation of Memory Study Activities of Daily Life questionnaire at the screening and then every 6 months starting at the 1-year visit until the 4 -year visit.

In the cohort, 73% of participants had a fall and 27% did not. For those who fell, 75% of the falls were not medically treated.

As for activities of daily living, 17% (n = 505) of participants had impairment at baseline, which increased to 25% (725) at the end of the study. The largest percentage of participants reported having an impairment in transferring to or from a bed or chair—16% of participants had this impairment at baseline and 18% did at the end of the study.

According to the Cox proportional hazards models analyses, ≥ 1 fall in a 6-month period was significantly linked to a 42% higher risk of impairment in activities of daily living, adjusted for sex, study site, study treatment, cognition, polypharmacy, NDI, hospitalization, and number of falls (hazard ratio [HR]: 1.42; 95% CI, 1.32 – 1.52) in adjusted models. In a trajectory model, 19% of participants had increased, persistent daily activity impairment after falling.

Although the extent of impairment reduced over time, it worsened over time for 81% of participants who fell. Furthermore, participants who were female (odds ratio [OR], 1.53; 95%; CI, 1.05 – 2.22), lived in a neighborhood with higher deprivation (OR: 2.16; 95%; CI, (1.21 – 3.96), or experience polypharmacy (OR: 1.91; 95%; CI, 1.31 – 2.79) were more likely to have impairment in daily activities post-fall.

Impaired cognition was linked with an increased risk of falling. Impairments in the activities of eating, bathing, dressing, toileting, going from the bed or chair, and walking were associated with an increased risk of declines in mental health. Moreover, difficulties bathing and walking was associated with an increased risk of nursing home admission, and troubles walking was associated with reduced social interaction.

The investigators evaluated cognition at each visit with the Clinical Dementia Rating Scale to assess a participant’s mild cognitive impairment. Other covariates linked to increased falls were polypharmacy, high education, and a high neighborhood deprivation index score.

Strengths the investigators of the study pointed out was the large study population, duration length, participants with mild cognitive impairment, and the design of Ginkgo Evaluation of Memory Study to allow for more covariates to be examined. Limitations included missing data on falls, lack of mild cognitive impairment measurement during the study, and the characteristics of the participants due to exclusion.

“Falls put older adults at risk of ongoing [activities of daily living] impairment,” investigators wrote. “The magnitude and duration of [activities of daily living] impairment further highlights the importance of fall prevention, and the importance of intervention for post-fall [activities of daily living] impairment.”

^References

1. ^{Adam CE, Fitzpatrick AL, Leary CS, Ilango SD, Phelan EA, Semmens EO. The impact of falls on activities of daily living in older adults: A retrospective cohort analysis. PLoS One. 2024;19(1):e0294017. Published 2024 Jan 3. doi:10.1371/journal.pone.0294017}
2. ^{Keep on Your Feet—Preventing Older Adult Falls. Centers for Disease Control and Prevention. https://www.cdc.gov/injury/features/older-adult-falls/index.html. Accessed January 10, 2024.}