The effect of falls and fall injuries on functioning in community-dwelling older persons

Background. Several preventive strategies have proven effective at reducing the occurrence and rate of falling. It remains to be determined, however, whether, and to what extent, falls and/or fall injuries are independent determinants of adverse functional outcomes in older persons. Methods. A probability sample of 1,103 community-dwelling persons over age 71 years was followed for 3 years. The 957 cohort members (87%) who participated in at least one follow-up interview while residing in the community were included in this study. Outcome measures included one and three year change in basic and instrumental activities of daily living (BADLs-IADLs), social activities, and physical activities, Based on daily calendars and hospital surveillance, participants were placed into one of four levels of fall status: no falls, one fall without serious injury, at least two falls without serious injury, and one or more falls with serious injury. Hierarchical linear regression models, sequentially adding six domains of covariates, were constructed to examine fall status as a risk factor for change in function. Results. One noninjurious fall (beta = -.437; p < .01), at least two noninjurious falls (beta = -.877; p < .001); and at least one injurious fall (beta = -1.254; p < .001) were each associated with decline in BADL-IADL function over 3 years after adjusting for covariates (model R-2 = .2617). Experiencing two or more noninjurious falls (beta = -.538; p < .05) was associated with decline in social activities (model R-2 = .2779) while experiencing at least one injurious fall (beta = -.580, p < .01) was associated with decline in physical activity (model R-2 = .4231). Conclusions. Falls and fall injuries appear to be independent determinants of functional decline in community-dwelling older persons. Falling is a health condition meeting all criteria for prevention: high frequency, evidence of preventability, and high burden of morbidity.