Age-stratified modifiable fall risk factors in Chinese community-dwelling older adults
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.
Section snippets
Study design and participants
Data were obtained from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), a nationwide survey conducted by the Center for Healthy Aging and Development Studies (CHADS) of Peking University with an aim of monitoring the health status and quality of life of older adults (mainly aged 65 years or above) across 23 provinces in China (Zeng et al., 2008). Data regarding demographic information, socioeconomic status, disease status, lifestyle and psychological characteristics were collected by
Results
Among the 14,601 participants, the mean age of the total sample was 85.4 (SD 11.6), and the unweighted male participants were 6386 (43.7%). The weighted incidence of falls and fall injuries in the past year were 22.9% and 8.4%, respectively. The incidence of falls and fall injuries demonstrated significant increase with advancing age. The weighted descriptive data are presented in Table 1. In respect of the 24 fall risk factors, most factors demonstrated significant differences among age groups
Discussion
The current study analysed associations between 24 modifiable fall risk factors and fall incident in age-stratified (i.e., 65–79 years, 80–94 years and ≥95 years old) older adults in China. Our results showed that fall risk factors varied among age groups. Specifically, anxiety is identified across all age groups, 4 risk factors were shared between two age groups, and 5 risk factors were only found in one age group.
Our findings showed that the fall incidences of community-dwelling Chinese older
CRediT authorship contribution statement
Xiaodong Chen: Conceptualization, Data curation, Formal analysis, Methodology, Software, Visualization, Writing – original draft. Lingxiao He: Conceptualization, Formal analysis, Funding acquisition, Methodology, Writing – review & editing. Kewei Shi: Formal analysis, Software, Visualization. Jinzhu Yang: Data curation, Formal analysis. Xinyuan Du: Data curation. Kanglin Shi: Software. Ya Fang: Conceptualization, Project administration, Supervision, Writing – review & editing.
Declaration of Competing Interest
None Declared.
Acknowledgements
This work was supported by the Headmaster Funding of Xiamen University (20720220061).
References (50)
- et al.
Older adult falls in emergency medicine: 2019 update
Clinics in Geriatric Medicine
(2019) - et al.
Fall-related factors and risk of hip fracture: the EPIDOS prospective study
Lancet (London, England)
(1996) - et al.
Association of using biomass fuel for cooking with depression and anxiety symptoms in older Chinese adults
Science of the Total Environment
(2022) - et al.
Risk factors for falls and fall-related injuries in adults 85 years of age and older
Archives of Gerontology and Geriatrics
(2012) - et al.
Risk factors for recurrent falls in older adults: A systematic review with meta-analysis
Maturitas
(2021) - et al.
Hearing sensitivity and the risk of incident falls and fracture in older women: The study of osteoporotic fractures
Annals of Epidemiology
(2004) - et al.
Associations of objectively measured physical activity and sedentary behaviour with fall-related outcomes in older adults: A systematic review
Annals of Physical and Rehabilitation Medicine
(2022) - et al.
Screening instruments for a population of older adults: The 10-item Kessler Psychological Distress Scale (K10) and the 7-item Generalized Anxiety Disorder Scale (GAD-7)
Psychiatry Research
(2015) - et al.
Alcohol intake and its relationship with bone mineral density, falls, and fracture risk in older men
Journal of the American Geriatrics Society
(2006) - et al.
Asian working group for sarcopenia: 2019 consensus update on sarcopenia diagnosis and treatment
Journal of the American Medical Directors Association
(2020)
Different aspects of visual impairment as risk factors for falls and fractures in older men and women
Journal of Bone and Mineral Research
Risk factors associated with injury attributable to falling among elderly population with history of stroke
Stroke; a Journal of Cerebral Circulation
Medical costs of fatal and nonfatal falls in older adults
Journal of the American Geriatrics Society
Does obesity increase the risk and severity of falls in people aged 60 years and older? A systematic review and meta-analysis of observational studies
Journal of Gerontology A Biological Science and Medical Sciences
Fall risk-increasing drugs, polypharmacy, and falls among low-income community-dwelling older adults
Innov Aging
Anxiety and depression symptoms in older adults during coronavirus disease 2019 pandemic: A community-based cross-sectional study
SAGE Open Medicine
Hearing loss and falls: A systematic review and meta-analysis
The Laryngoscope
The effect of visual and hearing impairments on functional status
Journal of the American Geriatrics Society
Epidemiology of fall and its socioeconomic risk factors in community-dwelling Korean elderly
PloS One
Increased neural response to social rejection in major depression
Depression and Anxiety
The relationship between visual function, duration and main causes of vision loss and falls in older people with low vision
Graefes Archive for Clinical and Experimental Ophthalmology
Disease burden and risk factors of falls in the elderly [in Chinese]
Chinese Journal of Epidemiology
Falls in older people: Risk factors and strategies for prevention
Cited by (4)
- †
Xiaodong Chen and Lingxiao He contribute equally as first authors.