Advertisement

Association Between Multimorbidity and Rate of Falls: A 3-Year 5-Country Prospective Study in Generally Healthy and Active Community-Dwelling Adults Aged ≥70 Years

Published:January 16, 2023DOI:https://doi.org/10.1016/j.jamda.2022.12.011

      Abstract

      Objective

      To examine the association between the 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 7 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 5 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 3 or more chronic diseases at baseline, were assessed with the Self-Administered Comorbidity Questionnaire by Sangha et al.

      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 a 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 [adjusted incidence rate ratio (aIRR) 1.07, 95% CI 1.03-1.12, P < .001] and a 6% increased incidence rate of injurious falls (aIRR 1.06, 95% CI 1.02-1.11, P = .003). Baseline multimorbidity was associated with a 21% increased incidence rate of all falls (aIRR 1.21, 95% CI 1.07-1.37, P = .002) and a 17% increased incidence rate of injurious falls (aIRR 1.17, 95% CI 1.03-1.32, P = .02).

      Conclusions and Implications

      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.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of the American Medical Directors Association
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. WHO–ageing and health.
        (2021. Available from:)
        • Atella V.
        • Piano Mortari A.
        • Kopinska J.
        • et al.
        Trends in age-related disease burden and healthcare utilization.
        Aging Cell. 2019; 18: e12861
        • van den Akker M.
        • Buntinx F.
        • Metsemakers J.F.
        • et al.
        Multimorbidity in general practice: prevalence, incidence, and determinants of co-occurring chronic and recurrent diseases.
        J Clin Epidemiol. 1998; 51: 367-375
        • Rizza A.
        • Kaplan V.
        • Senn O.
        • et al.
        Age- and gender-related prevalence of multimorbidity in primary care: The Swiss FIRE project.
        BMC Fam Pract. 2012; 13: 113
        • Barnett K.
        • Mercer S.W.
        • Norbury M.
        • et al.
        Epidemiology of multimorbidity and implications for health care, research, and medical education: A cross-sectional study.
        Lancet. 2012; 380: 37-43
        • Excoffier S.
        • Herzig L.
        • N'Goran A.A.
        • et al.
        Prevalence of multimorbidity in general practice: A cross-sectional study within the Swiss Sentinel Surveillance System (Sentinella).
        BMJ Open. 2018; 8: e019616
        • St John P.D.
        • Tyas S.L.
        • Menec V.
        • et al.
        Multimorbidity predicts functional decline in community-dwelling older adults: Prospective cohort study.
        Can Fam Physician. 2019; 65: e56-e63
        • Fortin M.
        • Lapointe L.
        • Hudon C.
        • et al.
        Multimorbidity and quality of life in primary care: A systematic review.
        Health Qual Life Outcome. 2004; 2: 51
        • Wang L.
        • Si L.
        • Cocker F.
        • et al.
        A systematic review of cost-of-illness studies of multimorbidity.
        Appl Health Econ Health Pol. 2018; 16: 15-29
        • Davies L.E.
        • Spiers G.
        • Kingston A.
        • et al.
        Adverse outcomes of polypharmacy in older people: Systematic review of reviews.
        J Am Med Dir Assoc. 2020; 21: 181-187
        • Ahmad R.
        • Mehta H.
        The ocular adverse effects of oral drugs.
        Aust Prescr. 2021; 44: 129-136
        • Khow K.S.F.
        • Visvanathan R.
        Falls in the aging population.
        Clin Geriatr Med. 2017; 33: 357-368
        • Siegrist M.
        • Freiberger E.
        • Geilhof B.
        • et al.
        Fall prevention in a primary care setting.
        Dtsch Arztebl Int. 2016; 113: 365-372
        • Tinetti M.E.
        • Kumar C.
        The patient who falls: "It's always a trade-off".
        JAMA. 2010; 303: 258-266
        • Cadore E.L.
        • Saez de Asteasu M.L.
        • Izquierdo M.
        Multicomponent exercise and the hallmarks of frailty: Considerations on cognitive impairment and acute hospitalization.
        Exp Gerontol. 2019; 122: 10-14
        • Fasano A.
        • Canning C.G.
        • Hausdorff J.M.
        • et al.
        Falls in Parkinson's disease: A complex and evolving picture.
        Mov Disord. 2017; 32: 1524-1536
        • Gassmann K.G.
        • Rupprecht R.
        • Freiberger E.
        • et al.
        Predictors for occasional and recurrent falls in community-dwelling older people.
        Z Gerontol Geriatr. 2009; 42: 3-10
        • Afrin N.
        • Honkanen R.
        • Koivumaa-Honkanen H.
        • et al.
        Multimorbidity predicts falls differentially according to the type of fall in postmenopausal women.
        Maturitas. 2016; 91: 19-24
        • Bischoff-Ferrari H.
        DO-HEALTH/Vitamin D3–Omega3–Home Exercise–Healthy Ageing and Longevity Trial (DO-HEALTH).
        (2018. Available from:)
        • Bischoff-Ferrari H.A.
        • Molino C.
        • Rival S.
        • et al.
        DO-HEALTH: Vitamin D3–Omega3–Home Exercise–Healthy Aging and Longevity Trial–design of a multinational clinical trial on healthy aging among European seniors.
        Contemp Clin Trials. 2021; 100: 106124
        • Bischoff-Ferrari H.A.
        • Vellas B.
        • Rizzoli R.
        • et al.
        Effect of vitamin D supplementation, omega-3 fatty acid supplementation, or a strength-training exercise program on clinical outcomes in older adults: The DO-HEALTH Randomized Clinical Trial.
        JAMA. 2020; 324: 1855-1868
        • Buchner D.M.
        • Hornbrook M.C.
        • Kutner N.G.
        • et al.
        Development of the common data base for the FICSIT trials.
        J Am Geriatr Soc. 1993; 41: 297-308
        • Johnston M.C.
        • Crilly M.
        • Black C.
        • et al.
        Defining and measuring multimorbidity: A systematic review of systematic reviews.
        Eur J Publ Health. 2019; 29: 182-189
        • Harrison C.
        • Britt H.
        • Miller G.
        • et al.
        Examining different measures of multimorbidity, using a large prospective cross-sectional study in Australian general practice.
        BMJ Open. 2014; 4: e004694
        • Sangha O.
        • Stucki G.
        • Liang M.H.
        • et al.
        The Self-Administered Comorbidity Questionnaire: A new method to assess comorbidity for clinical and health services research.
        Arthritis Rheum. 2003; 49: 156-163
        • Chocano-Bedoya P.O.
        • Bischoff-Ferrari H.A.
        DO-HEALTH: Vitamin D3-Omega-3-Home Exercise-Healthy Aging and Longevity Trial—Dietary Patterns in Five European Countries.
        in: Weaver C.M. Bischoff-Ferrari H. Daly R.M. Nutritional Influences on Bone Health: 10th International Symposium. Springer International Publishing, 2019
        • SOV, SO
        Wegleitung Sehtest/Gesuch Lernfahr-bzw.
        Führerausweis, 2016
        • Sheikh J.I.
        • Yesavage J.A.
        Geriatric depression scale: Recent evidence and development of a shorter version.
        Clin Gerontol. 1986; 5: 165-173
        • Yesavage J.A.
        • Brink T.L.
        • Rose T.L.
        • et al.
        Development and validation of a geriatric depression screening scale: A preliminary report.
        J Psychiatr Res. 1982; 17: 37-49
        • Guralnik J.M.
        • Simonsick E.M.
        • Ferrucci L.
        • et al.
        A short physical performance battery assessing lower extremity function: Association with self-reported disability and prediction of mortality and nursing home admission.
        J Gerontol. 1994; 49: M85-94
        • Wolf A.M.
        • Hunter D.J.
        • Colditz G.A.
        • et al.
        Reproducibility and validity of a self-administered physical activity questionnaire.
        Int J Epidemiol. 1994; 23: 991-999
        • Deandrea S.
        • Lucenteforte E.
        • Bravi F.
        • et al.
        Risk factors for falls in community-dwelling older people: A systematic review and meta-analysis.
        Epidemiology. 2010; 21: 658-668
        • Nguyen H.
        • Manolova G.
        • Daskalopoulou C.
        • et al.
        Prevalence of multimorbidity in community settings: A systematic review and meta-analysis of observational studies.
        J Comorb. 2019; 9 (2235042X19870934)
        • Marengoni A.
        • Akugizibwe R.
        • Vetrano D.L.
        • et al.
        Patterns of multimorbidity and risk of disability in community-dwelling older persons.
        Aging Clin Exp Res. 2021; 33: 457-462
        • Piotrowicz K.
        • Pac A.
        • Skalska A.
        • et al.
        Patterns of multimorbidity in 4588 older adults: Implications for a nongeriatrician specialist.
        Pol Arch Intern Med. 2021; 131: 16128
        • Lawlor D.A.
        • Patel R.
        • Ebrahim S.
        Association between falls in elderly women and chronic diseases and drug use: Cross sectional study.
        BMJ. 2003; 327: 712-717
        • Sibley K.M.
        • Voth J.
        • Munce S.E.
        • et al.
        Chronic disease and falls in community-dwelling Canadians over 65 years old: A population-based study exploring associations with number and pattern of chronic conditions.
        BMC Geriatr. 2014; 14: 22
        • Kojima G.
        Frailty as a predictor of future falls among community-dwelling older people: A systematic review and meta-analysis.
        J Am Med Dir Assoc. 2015; 16: 1027-1033
        • Manemann S.M.
        • Chamberlain A.M.
        • Boyd C.M.
        • et al.
        Fall risk and outcomes among patients hospitalized with cardiovascular disease in the community.
        Circ Cardiovasc Qual Outcomes. 2018; 11: e004199
        • Schafer I.
        • Hansen H.
        • Schon G.
        • et al.
        The influence of age, gender and socio-economic status on multimorbidity patterns in primary care. First results from the multicare cohort study.
        BMC Health Serv Res. 2012; 12: 89
        • Abad-Diez J.M.
        • Calderon-Larranaga A.
        • Poncel-Falco A.
        • et al.
        Age and gender differences in the prevalence and patterns of multimorbidity in the older population.
        BMC Geriatr. 2014; 14: 75
        • Xu B.Y.
        • Yan S.
        • Low L.L.
        • et al.
        Predictors of poor functional outcomes and mortality in patients with hip fracture: a systematic review.
        BMC Musculoskelet Disord. 2019; 20: 568
        • LeBlanc K.E.
        • Muncie Jr., H.L.
        • LeBlanc L.L.
        Hip fracture: diagnosis, treatment, and secondary prevention.
        Am Fam Physician. 2014; 89: 945-951