Age-stratified modifiable fall risk factors in Chinese community-dwelling older adults

Highlights

• Modifiable fall risk factors and interactions varied among age groups.

• Anxiety is a common fall risk factor for older adults of all ages.

• Fall prevention strategies can be applied by targeting at fall risk factors in corresponding age groups.

Abstract

Background

Fall incident is one of the major causes of mortality and injury in older adults. Modifiable fall risk factors are the targets for fall prevention. Since the status of some fall risk factors can change with age, insights into age-stratified fall risk factors can be beneficial for developing tailored fall prevention strategies for older adults at different ages. Therefore, the objective of this study was to identify fall risk factors in different age groups of older people.

Methods

The current study analysed data of 14,601 community-dwelling older Chinese (aged 65 years or above) recruited from the Chinese Longitudinal Healthy Longevity Survey (CLHLS, wave 2017–2018). 24 modifiable fall risk factors were selected from the CLHLS as candidate risk factors and multivariable logistic regression was used to identify significant risk factors associated with fall incidents by three age groups (65–79 years, 80–94 years, ≥95 years).

Results

Anxiety is identified across all age groups. Hearing impairment, stroke, rain/water leakage were found in both the 65–79 years and the 80–94 years old groups. Interactions between hearing and stroke and between hearing and rain /water leakage were found in these two groups, respectively. Medication use is a shared factor in both the 65–79 years and the ≥95 years old group.

Conclusion

Modifiable fall risk factors varied among age groups, suggesting that customised fall prevention strategies can be applied by targeting at fall risk factors in corresponding age groups.

Introduction

Falls are a worldwide public health problem and have become the second leading cause of unintentional injury deaths in the world (World Health Organization, 2022). According to the latest estimation of the World Health Organization, there are 684,000 fatal falls each year, the majority of which take place in older adults (World Health Organization, 2021). Meanwhile, fall incidence increases sharply with advancing age. The Global Burden of Disease Study 2019 reported that among older adults aged 60–79 years, the fall incidence was 3648.3/per 100k while for adults aged 80 or above, the value reached 11,524.4/per 100k (Vos et al., 2020). For older adults, falls can be devastating and fatal. It has been found that one out of five falls in older adults causes severe injuries such as head injuries and hip fractures, resulting in hospitalization and reduced quality of life (World Health Organization, 2007). With one-third of older adults falling each year, falls have become a leading cause of death in developed countries (Carpenter et al., 2019). Besides adverse health outcomes, injuries from falls also bring about a concerning financial burden. In China, the annual medical costs of fall injuries among older adults are over 5 billion RMB (Li & Wang, 2001). In the US, fall-related injuries (2015) resulted in an estimated medical cost of approximately $50 billion (Florence et al., 2018). Therefore, fall prevention for older adults is of great importance for both the older people and the healthcare system.

Falls in older adults are multifactorial (China Disease Prevention & Control Center, 2011). Generally, fall risk factors can be categorised into non-modifiable factors, such as age, sex and race, and modifiable ones, such as chronic diseases, lifestyle, psychological diseases and living environment (Lord et al., 2007). In developing fall-prevention strategies, modifiable factors are usually the aspects to be targeted at. Notably, the conditions of some modifiable factors (e.g., number of chronic diseases, sensory abilities and physical function) can change with age (World Health Organization, 2007). Therefore, it is plausible to think that the different fall incidences in age groups might be associated with varied conditions of modifiable factors. However, studies of age-stratified modifiable fall risk factors have not been reported. An exploration of this topic can be beneficial for developing pertinent fall prevention strategies for older people at different ages.

The aim of the current study was to identify modifiable risk factors in different age groups of older people. To address this aim, we analysed associations between 24 modifiable risk factors and fall incidents by age groups (65–79 years, 80–94 years, ≥95 years) based on a nationwide survey of community-dwelling Chinese older adults.