Association between multimorbidity and rate of falls: a 3-year 5-country prospective study in generally healthy and active community-dwelling adults aged 70+

Authors: HUBERTY, SARAH - University Of Zurich; FREYSTATTER, GREGOR - University Of Zurich; WIECZOREK, MAUD - University Of Zurich; DAWSON-HUGHES, BESS - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; KANIS, JOHN - University Of Sheffield Medical School; RIZZOLI, RENE - University Of Geneva; KRESSIG, R - University Of Basel; VELLAS, B - University Of Toulouse; DA SILVA, J - University Of Coimbra; ARMBRECHT, G - Humboldt University; THEILER, ROBERT - University Of Zurich; EGLI, ANDREAS - University Of Zurich; ORAV, E - Harvard University; BISCHOFF-FERRARI, HEIKE - University Of Zurich

Submitted to: Journal of the American Medical Directors Association - Post-Acute and Long Term Care Medicine
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 12/6/2022
Publication Date: 1/17/2023
Citation: Huberty, S., Freystatter, G., Wieczorek, M., Dawson-Hughes, B., Kanis, J.A., Rizzoli, R., Kressig, R., Vellas, B., Da Silva, J., Armbrecht, G., Theiler, R., Egli, A.L., Orav, E., Bischoff-Ferrari, H.A. 2023. Association between multimorbidity and rate of falls: a 3-year 5-country prospective study in generally healthy and active community-dwelling adults aged 70+. Journal of the American Medical Directors Association - Post-Acute and Long Term Care Medicine. https://doi.org/10.1016/j.jamda.2022.12.011.
DOI: https://doi.org/10.1016/j.jamda.2022.12.011

Interpretive Summary: Falling is a common and devastating problem in older adults because falls lead to hip fractures and other serious injuries. Although many risk factors for falling have been identified, little information is available on whether common chronic diseases affect fall risk in older adults. The scientists conducting this study examined the link between the number of chronic diseases at baseline and risk of falling over the next three years in a large group of older adults. The number of chronic conditions was a strong indicator of fall risk. For example, participants with 3 chronic diseases at baseline had a 21% increase in number of falls over the next 3 years, when compared with participants who had no chronic diseases at baseline. This research supports the addition of chronic disease burden to the known list of risk factors for falling among older adults. It is important to predict which older adults are at high risk for falling so that strategies to reduce fall risk can be introduced to lower that risk.

Technical Abstract: Objective: to examine the association between baseline number of chronic diseases and multimorbidity with regard to the incidence of all and injurious falls over 3 years among European community-dwelling older adults. Design: Observational analysis of DO-HEALTH, a double-blind, randomized controlled trial. Setting and participants: Multicenter trial with seven European centers: Zurich, Basel, Geneva (Switzerland), Berlin (Germany), Innsbruck (Austria), Toulouse (France), and Coimbra (Portugal), including 2157 community-dwelling adults aged 70 years and older without any major health events in the five years prior to enrollment, sufficient mobility, and good cognitive status. Methods: The main outcomes were the number of all falls and injurious falls experienced over 3 years. The number of chronic diseases and multimorbidity, defined as the presence of three or more chronic diseases, were assessed with the Sangha's Questionnaire at baseline. Results: Among the 2155 participants included in the analyses (mean age: 74.9 years, 62% were women, 52% were physically active more than 3 times/week), 569 (26.4%) had multimorbidity at baseline. Overall, each 1-unit increase in the baseline number of chronic diseases was linearly associated with a 7% increased incidence rate of all falls (Incidence Rate Ratio [IRR] =1.07, 95% CI: 1.03, 1.12, p<.001) and a 6% increased incidence rate of injurious falls (IRR=1.06, 95% CI 1.02, 1.11, p=0.003). Baseline multimorbidity was associated with a 21% increased incidence rate of all falls (IRR =1.21, 95% CI: 1.07, 1.37, p=0.002) and a 17% increased incidence rate of injurious falls (IRR=1.17, 95% CI: 1.03, 1.32, p=0.02). Conclusions: Baseline number of prevalent chronic diseases and multimorbidity in generally healthy and active community-dwelling older adults were associated with increased incidence rates of all and injurious falls over 3 years. These findings support that multimorbidity may need consideration as a risk factor for falls, even in generally healthy and active older adults.