Impact of Social Network on the Risk and Consequences of Injurious Falls in Older Adults

Falls in older adults hospitalized in tertiary centers in Colombia. Clinical description and complications

OBJECTIVE

The incidence of falls in elderly patients in the hospital environment is three times higher than that in the community. The aim was to determine the characteristics of patients who suffered in-hospital falls and their complications.

METHODS

This was a cross-sectional study with patients older than 64 years of age, admitted between 2018 and 2020 to four clinics in Colombia who presented a fall during their stay. Clinical data, reasons for the fall, complications and use of drugs with a known risk for causing falls and with an anticholinergic load were reviewed.

RESULTS

A total of 249 patients were included. The mean age was 77.5 ± 7.4 years, and there was a predominance of males (63.9%). The patients were hospitalized mainly for community-acquired pneumonia (12.4%) and heart failure (10.4%). Falls occurred most frequently in hospitalization wards (77.1%) and emergency departments (20.9%). Falls were related to standing alone (34.4%) and on the way to the bathroom (28.9%), with 40.6% (n = 102) of falls resulting in trauma, especially to the head (27.7%); the incidence of fractures was low (3.2%). Ninety-two percent of patients had polypharmacy (≥5 drugs), 88.0% received psychotropic drugs, and 37.3% received drugs with an anticholinergic load ≥3 points.

CONCLUSIONS

Hospitalized adults over 65 years of age suffered falls, mainly in hospitalization wards and emergency departments, especially during the process of solitary ambulation. Most had received psychotropic drugs and medications with a high anticholinergic load. These results suggest that it is necessary to improve risk prevention strategies for falls in this population.

How Do Discrepancies between Subjective and Objective Health Predict the Risk of Injurious Falls? A Study of Community-Dwelling Swedish Older Adults

OBJECTIVES

Previous studies demonstrated that discrepancies between subjective and objective health measures are associated with physical and mental health-related outcomes in older adults. We investigate whether such discrepancies are also associated with risk of injurious falls in community-dwelling Swedish older adults.

DESIGN

A prospective, observational cohort study.

SETTING AND PARTICIPANTS

Using data from the Swedish National Study on Aging and Care in Kungsholmen, we followed 2222 community-dwelling older adults aged ≥60 years at baseline, across a 10-year period of data collection (2001-2011).

METHODS

A "health asymmetry" metric classified older adults into 4 categories, based on the level of agreement between their subjective and objective health scores ("health pessimist", "health optimist", "poor health realist", and "good health realist"). Time-varying Cox proportional hazard and Laplace regressions were employed to investigate if these categories were associated with the risk of injurious falls.

RESULTS

Over a 10-year follow-up, 23.5% of the sample experienced an injurious fall. Health optimists had the greatest risk of experiencing an injurious fall [hazard ratio (HR) 2.16, 95% confidence interval (CI) 1.66, 2.80], compared with good health realists. Poor health realists (HR 1.77, 95% CI 1.50, 2.11) and health pessimists (HR 1.66, 95% CI 1.21, 2.29) also had an increased risk of experiencing injurious falls, compared with good health realists. Being a health pessimist was only associated with the risk of injurious falls within the younger-old (HR 2.43, 95% CI 1.63, 3.64) and among males (HR 1.95, 95% CI 1.14, 3.33).

CONCLUSIONS AND IMPLICATIONS

Older adults with similar objective health levels may differ in terms of their injurious fall risk, depending on their subjective health. Interpreting subjective health alongside objective health is clinically pertinent when assessing injurious fall risk.

Social interaction level modulates the impact of frailty on cognitive decline: a longitudinal study

OBJECTIVES

This study evaluates whether social interaction level modifies the association between frailty and cognitive decline in older adults.

METHODS

A total of 2701 adults aged ≥65 years enrolled in the Progetto Veneto Anziani (Pro.V.A.), participated in the study. At baseline, participants were classified as having low, moderate, or high social interactions based on: cohabiting status, frequency of contacts with relatives/friends or involvement in childcare activities, and frequency of participation in social or community activities. Baseline frailty was defined as the presence of ≥3 criteria among: weight loss, weakness, slowness, low physical activity, and exhaustion. Cognitive function was assessed through the Mini-Mental State Examination (MMSE) at baseline and after 4.4 and 7 years. The association between frailty and MMSE changes over time was evaluated through linear mixed models. Interaction and subgroup analyses explored the modifying effect of social interaction level on the above association.

RESULTS

The mean age of participants was 76.1 years, and 59.1% were women. Frail individuals had a steeper annual MMSE decline than their non-frail counterparts (ß=-0.40, 95%CI: -0.59, -0.20). When stratifying participants by social interaction level, we found that the association between frailty and MMSE changes over time was stronger in those with low social interactions (ß=-0.74, 95%CI: -1.33, -0.15) while attenuated in those with moderate (ß=-0.42, 95%CI: -0.74, -0.11) or high social interaction level (ß=-0.29, 95%CI: -0.58, 0.01).

CONCLUSION

Maintaining frequent social interactions might mitigate the negative impact of frailty on older people's cognitive functions.

Falls among community-dwelling older adults in the Philippines and Viet Nam: Results from nationally representative samples

Falls are a significant public health issue globally. However, studies with nationally representative samples have yet to be done to understand falls among older adults in the Philippines and Viet Nam. Using a biopsychosocial perspective, this study investigated the prevalence of falls and their associated factors among community-dwelling older adults in these countries. Cross-sectional data were drawn from the baseline survey of the Longitudinal Study of Ageing and Health in the Philippines (2018, N = 4,606) and the Longitudinal Study of Ageing and Health in Viet Nam (2018, N = 4,378). The outcome variables were any falls in the past year. Independent variables included sociodemographic factors (age, sex, education, living in urban areas, living alone, social network size), biophysical factors (vision, chronic conditions, functional impairments, pain locations, insomnia symptoms, sleep medications, grip strength, walking speed, postural control), and psychological factors (depressive symptoms). Descriptive analysis and logistic regression analysis were used to analyze the data. The results showed that 17.7 % and 7.3 % of older Filipino and Vietnamese adults fell in the year before the study. Significant factors associated with the odds of any falls among Filipino older adults were having a higher level of education, living in urban areas, living with others, experiencing more functional impairments, reporting one or more pain locations, and having poor grip strength. In Viet Nam, having more chronic conditions, experiencing more functional impairments, and reporting two or more pain locations were found to be associated with higher odds of any falls. The population in the Philippines and Viet Nam is aging rapidly. Findings from this study are timely in identifying at-risk individuals and preparing for effective fall prevention strategies.

Testing the Reciprocal Relationship Between Social Networks and Purpose in Life Among Older Adults: Application of a Random Intercept Cross-Lagged Panel Model

Objectives: The purpose of this study is to examine if there are longitudinal reciprocal effects between social network size and purpose in life among older adults. Methods: Using data from the National Health and Aging Trends Study, the sample included 1485 male and 2058 female adults 65 years and older. We first computed t-tests to assess gender differences in social network size and purpose in life. In order to examine the reciprocal effects between social network size and purpose in life over four time points (2017, 2018, 2019, and 2020), a RI-CLPM (Model 1) was computed. In addition to the main model, two multiple group RI-CLPM analyses (Model 2 and 3) were computed to test the moderated gender effect on the relationship with models estimating unconstrained and constrained cross-lagged parameters. Results: The results of the t-tests denoted significant gender differences in social network size and purpose in life. The results indicated that Model 1 fit the data well. The carry-over effects of social networks and purpose in life and spill-over effect from wave 3 purpose in life on wave 4 social networks were significant. There were no significant differences between the constrained and unconstrained models testing for moderated gender effects. Discussion: The findings of the study highlight the significant carry-over effect of purpose in life and social network size over four years and the positive spill-over effect from purpose in life on social network size at the subsequent wave, which only appeared at the last time point.

Mild Neurocognitive Disorder, Social Engagement, and Falls Among Older Primary Care Patients

OBJECTIVES

(1) To estimate the association between social engagement (SE) and falls; (2) To examine the relation between mild neurocognitive disorder (MNCD) and falls by different levels of SE.

DESIGN

We performed a secondary data analysis using prospective cohort study design.

SETTING

Primary care.

PARTICIPANTS

A total of 425 older adult primary care patients at risk for mobility decline (N=425). As previously reported, at baseline, 42% of participants exhibit MNCD.

MAIN OUTCOME MEASURES

The outcome variable was the number of falls during 2 years of follow-up. Exposure variables at baseline included (1) MNCD identified using a cut-off of 1.5 SD below the age-adjusted mean on at least 2 measures within a cognitive performance battery and (2) SE, which was assessed using the social component of the Late-Life Function and Disability Instrument. High SE was defined as having a score ≥ median value (≥49 out of 100). All models were adjusted for age, sex, education, marital status, comorbidities, and pain status.

RESULTS

Over 2 years of follow-up, 48% of participants fell at least once. MNCD was associated with a higher rate of falls, adjusting for the covariates (Incidence Rate Ratio=1.6, 95% confidence interval: 1.1-2.3). There was no significant association between MNCD and the rate of falls among people with high SE. In participants with low SE (having a score less than 49.5 out 100), MNCD was associated with a higher rate of falls as compared with participants with no neurocognitive disorder (No-NCD).

CONCLUSIONS

Among participants with low SE, MNCD was associated with a higher rate of falls, but not among participants with high SE. The findings suggest that high SE may be protective against falls among older primary care patients with MNCD.

Social Mediators of the Association Between Depression and Falls Among Older Adults

OBJECTIVES

To investigate the role of social factors in the association between depression and falls among older adults.

METHODS

The sample included data from 3443 older adults from three waves of the Health and Retirement Study (2010-2014). A Lifestyle Questionnaire was used to measure social engagement, social network contact, and neighborhood social context. Mediating effects of social factors were estimated through causal mediation analysis. Results: Poorer social engagement and network contact were associated with greater likelihood of falls, while poorer neighborhood context was associated with greater likelihood of fall injuries. Social engagement mediated a significant portion of the effect of depression on falls (OR: 1.03, 95% CI: 1.00, 1.06), and neighborhood context mediated a portion of the effect of depression on fall injuries (OR: 1.03, 95% CI: 1.00, 1.07). Discussion: The direct and indirect impacts of social factors suggest that considering them may help improve existing fall prevention approaches.

Injurious falls before, during and after dementia diagnosis: a population-based study

BACKGROUND

the timing of incident injurious falls at different stages of dementia diagnosis is unclear.

OBJECTIVES

to identify when the occurrence of injurious falls begins to increase among individuals who are going to develop dementia, to explore the time point at which people living with dementia are at highest risk of injurious falls and to ascertain differences in fall-related factors pre- and post-dementia diagnosis.

DESIGN

this study included 2,707 participants with incident dementia and 2,707 1:1 matched (i.e. same birth year and sex) controls without dementia.

METHODS

dementia diagnosis and date of onset were identified from the National Patient Registry (NPR) and the Swedish Cause of Death Register following international criteria. Information on injurious falls and history of chronic disease was obtained from the NPR. Data were analysed using conditional Poisson regression and generalized estimating equation models.

RESULTS

compared with controls, the incidence of injurious falls among participants with dementia started to increase beginning 4 years pre-diagnosis (incidence rate ratio [IRR] 1.70, 95% confidence interval [CI] 1.30-2.22), reaching a peak (IRR 3.73, 95% CI 3.16-4.41) in the year of dementia diagnosis. Heavy drinking, physically active and cardiometabolic diseases (CMDs) were associated with incident falls among those with dementia.

CONCLUSION

people with dementia have a higher incidence of injurious falls beginning 4 years leading up to diagnosis and peaking during the year of diagnosis. Older age, female, heavy drinking, physically active and CMDs may predict injurious falls among people with dementia.

Psychological Factors Associated With Fear of Falling Avoidance Behavior in Parkinson's Disease: The Role of Depression, Anxiety, and Catastrophizing

PURPOSE

The purpose of this study was to examine the relationship between psychological factors (depression, anxiety, and catastrophizing) and fear of falling avoidance behavior (FFAB) among individuals with Parkinson's disease (PD).

METHODS

A secondary analysis of cross-sectional data from 59 individuals with PD using hierarchical multiple regression.

RESULTS

Disease severity (Movement Disorder Society - Unified PD Rating Scale) and catastrophizing (Consequences of Falling Questionnaire (CoF)) explained approximately 48.2% of the variance in the FFAB Questionnaire scores (P < .001). Catastrophizing was the only significant psychological variable (P < .001). The damage to identity subscale of the CoF was significant in the final model (P < .001).

CONCLUSIONS

Catastrophizing about the consequences of falls explained the largest portion of variability in FFAB after controlling for disease severity. Catastrophizing about the immediate consequences of falling may play a prominent role in FFAB and may be a potential treatment target for mitigating FFAB.

Trajectories of cognitive and physical performance after accidental falls in nursing home residents: A prospective study

This prospective study evaluated cognitive and physical trajectories of nursing home (NH) residents after fall occurrence and their predictors. In 167 residents aged ≥60, we considered the closest pre-fall assessment and up to the first three post-fall assessments of cognitive and physical functions performed through Mini-Mental State Examination (MMSE) and Tinetti tests. Mixture models identified three post-fall cognitive and physical trajectories: stability, slow decline, and rapid decline. At logistic regression, older age, fewer informal visits, and falls within one month from institutionalization increased the probability of experiencing a decline in MMSE and Tinetti scores. Worse pre-fall cognitive function increased the likelihood of cognitive and physical decline, while worse pre-fall Tinetti score negatively impacted only physical decline. In conclusion, the impact of falls on the cognitive and physical health of NH residents may be modulated by their pre-fall cognitive function and some modifiable factors, such as social interactions and physical function.

Association of frailty with fall events in older adults: A 12-year longitudinal study in Korea

BACKGROUND

Evidence has shown that frailty is associated with the risk of falls in older people. However, the components of frailty that have the highest association with fall events are largely unknown.

METHODS

This study analyzed panel data from the Korean Longitudinal Study of Aging. We used the Korean Frailty Instrument, which includes domains for social isolation, exhaustion and weakness estimated by grip strength, to assess frailty. Fall event data were collected during follow-up visits.

RESULTS

A total of 3122 community-dwelling adults aged 65 years or older were included at baseline in 2006 and were followed up every 2 years until 2018. The participants with frailty had a higher risk of falls than those without frailty (OR=1.31, 95% CI=1.11-1.54, P = 0.001; fully adjusted model). We found that three components of frailty, namely, social isolation, exhaustion, and weakness, were independently and significantly related to fall events in the unadjusted model. In the fully adjusted model, social isolation and exhaustion were significantly associated with fall events (OR=1.38, 95% CI=1.18-1.61, P < 0.001 and OR=1.28, 95% CI=1.10-1.51, P = 0.006, respectively), and there was no significant association between weakness and the risk of falls (OR=1.11, 95% CI=0.91-1.34, P = 0.307).

CONCLUSIONS AND IMPLICATIONS

Frailty was associated with more fall events in Korean older adults. Social isolation and exhaustion but not weakness were significantly associated with fall events. Our study suggests that interventions should be tailored to older adults with social and psychological frailty.

Factors associated with physical activity reduction in Swedish older adults during the first COVID-19 outbreak: a longitudinal population-based study

Background

Physical activity (PA) decreased during the COVID-19 pandemic, especially among older adults, potentially leading to adverse consequences for their health. However, factors associated with reductions of PA during the pandemic have not been examined in a population-based sample of older adults. Thus, the aim of this study was to explore the association of pre-pandemic physical, mental, social and lifestyle factors with reductions in PA in older adults during the first wave of COVID-19, and whether the associations differed by age and sex.

Methods

A population-based sample of 624 participants aged 65-99 years were identified from the Swedish National study on Aging and Care in Kungsholmen (SNAC-K) COVID19 Study. Information on pre-pandemic factors was collected through clinical examinations, interviews, and self-administered questionnaires in 2016-2019. Changes in light and intense PA during the first wave of the pandemic (May-September 2020) were self-reported. Data were analyzed using multiple logistic regression models, stratified by age (<70 vs. >80 years) and sex.

Results

There was an association between pre-pandemic levels of higher depressive symptom burden (Odds Ratio (OR): 2.6, 95% Confidence Interval (CI): 1.1-6.4, <70 years), and impaired balance (OR: 1.7, 95% CI: 1.0-2.8, >80 years old) with reductions in light-intensity PA. Furthermore, the presence of musculoskeletal disease (OR: 1.8, 95% CI: 1.1-2.9, <70 years; OR: 2.3, 95% CI: 1.2-4.4, men), moderate/high levels of neuroticism (OR: 1.6, 95% CI: 1.0-2.6, <70 years; OR: 2.2, 95% CI: 1.3-3.5, women), and poor levels of social support (OR: 2.2, 95% CI: 1.2-4.3, >80 years) were related to reductions in higher-intensity PA. Those who were current smokers (OR: 0.3, 95% CI: 0.1-0.8, <70 years; OR: 0.2, 95% CI: 0.06-0.7, women), or had impaired balance (OR: 0.4, 95% CI: 0.2-0.8, >80 years) were less likely to reduce their levels of higher-intensity PA.

Conclusions

For future pandemics or waves of COVID-19, development of strategies is warranted for older individuals with psychiatric- or physical illness/dysfunction, as well as those with poor social support to counteract reductions in physical activities.

Supplementary Information

The online version contains supplementary material available at 10.1186/s11556-022-00287-z.

Socioeconomic status and ADL disability of the older adults: Cumulative health effects, social outcomes and impact mechanisms

INTRODUCTION

Socioeconomic status (SES) is one of the important indicators affecting individual's social participation and resource allocation, and it also plays an important role in the health shock of individuals. Faced by the trend of aging society, more and more nations across the world began to pay attention to prevent the risk of health shock of old adults.

METHODS

Based on the data of China Health and Retirement Longitudinal Study (CHARLS) in 2013, 2015 and 2018, this study uses path analysis and ologit model to empirically estimate the effects of SES and health shock on the activities of daily living (ADL) disability of old adults.

RESULTS

As a result, first, it was found that SES has significant impact on the disability of old adults. Specifically, economic conditions (income) plays dominant role. Economic status affects the risk of individual disability mainly through life security and health behavior. Secondly, SES significantly affecting health shock, with education and economic status showing remarkable impact, and there is an apparent group inequality. Furthermore, taking high education group as reference, the probability of good sight or hearing ability of the low education group was only 49.76% and 63.29% of the high education group, respectively, while the rates of no pain and severe illness were 155.50% and 54.69% of the high education group. At last, the estimation of path effect of SES on ADL disability indicates evident group inequality, with health shock plays critical mediating role.

CONCLUSIONS

SES is an important factor influencing residents' health shock, and health shocks like cerebral thrombosis and cerebral hemorrhage will indirectly lead to the risk of individual ADL disability. Furthermore, among the multi-dimensional indicators of SES, individual income and education are predominant factors affecting health shock and ADL disability, while occupation of pre-retirement have little impact.

Subjective well-being among male veterans in later life: the enduring effects of early life adversity

OBJECTIVES

This study investigated the association between childhood and young adult adversities and later-life subjective well-being among older male veterans. We also explored whether early-life parent-child relationships and later-life social engagement served as moderators and mediators, respectively.

METHODS

Data were from the 2008 to 2012 waves of the Health and Retirement Study for male veterans (N = 2026). Subjective well-being measures included depressive symptoms, self-rated health, and life satisfaction. Linear regression with the Process macro was employed to estimate the relationships.

RESULTS

Adverse childhood experiences (ACEs) were positively associated with number of depressive symptoms and negatively related to life satisfaction. Combat exposure, a young adulthood adversity experience, was positively associated with depressive symptoms, but not with self-rated health or life satisfaction. Later-life social engagement mediated the relationship between ACEs and subjective well-being indices. Parent-child relationship quality did not moderate the association between the measures of adversity and any measure of subjective well-being.

DISCUSSION

Childhood adversity and combat exposure were related to worse later life subjective well-being. Also, later-life social engagement mediated the association of two early life adversity measures and subjective well-being. Future research should examine subjective well-being and early life adversity for female veterans and should employ more detailed information about combat exposure.

Physical activities for older adults: Are local co-operations of sports clubs and care partners an option to increase access?

Group-based physical activity brings high and long-term added value for the participants. Especially for older adults in need of care, this development is dependent on interdisciplinary thinking and the networking of local structures. Studies underline the consideration of the communication and access options that are needed to be able to promote the target group’s health through exercise programmes. Sports clubs are repeatedly mentioned as competent partners in health promotion, but in municipal practice—possibly due to very different basic structures to the system of care—they receive less attention. The project Moving Nursing Homes and Care Providers (2019–2022) is coordinated by the State Sports Federation of North Rhine-Westphalia, Germany. Local sports clubs cooperate with providers of outpatient and inpatient care to start new sports programs for older adults in need of care. As part of the scientific evaluation, the perspectives involved are equally considered and their motives and needs are analysed. For this paper, four conducted qualitative interviews with representatives of sports clubs were analysed with the focus on opportunities and barriers for local partnerships between sports clubs and care. Results show structural and personal parameters that have to be looked at from the beginning. Local networks are essential for sports clubs to get in contact with potential partners and to reflect initiated processes. Although aspects of (financial) organisation is an often named topic, sports clubs have the opinion that they have the social responsibility to influence developments in their neighbourhood for all generations positively.

Hypothetical Interventions for Falls Among Older Adults: An Application of the Parametric G-Formula

Introduction: Falls, which have a higher incidence and mortality due to accidental injuries, are a major global health challenge. The effects of lifestyle factor, health indicator, psychological condition, and functional status interventions on the risk of falls are unknown and the conventional regression model would not adjust for the confounders. This study aimed to evaluate the 4-year risk of falls on the basis of these hypothetical interventions among Chinese older adults.

Methods: Data were obtained from 9,692 aged 65 years and over older adults in the China Health and Retirement Longitudinal Study wave, from 2011 to 2015. We used the parametric g-formula to evaluate the risk of falls on the basis of independent hypothetical interventions of sleep duration, social activities, smoking status, drinking status, body mass index (BMI), systolic blood pressure (SBP), vision, depression, activities of daily living (ADL), and their different joint intervention combinations.

Results: During the follow-up of 4 years, we documented 1,569 falls. The observed risk of falls was 23.58%. The risk ratios (95% confidence intervals [CIs]) of falls under the intensive hypothetical interventions on increasing sleep duration, participating in more social activities, quit smoking and drinking, reducing BMI and SBP, better vision, alleviating depressive symptoms, and improving ADL capability were 0.93 (0.87–0.96), 0.88 (0.79–0.92), 0.98 (0.95–1.03), 0.97 (0.95–1.02), 0.92 (0.86–1.03), 0.93 (0.87–1.04), 0.86 (0.74–0.91), 0.91 (0.85–0.96), and 0.79 (0.74–0.85), respectively. The feasible and intensive joint hypothetical intervention reduced the 4-year fall risk by 22% (95% CI: 0.52–0.91) and 33% (95% CI: 0.56–0.72), respectively.

Conclusions: Hypothetical interventions for increasing sleep duration, participating in more social activities, better vision, alleviating depressive symptoms, and improving ADL capability help protect older adults from falls. Our findings suggest that a combination of lifestyle factors, health indicators, psychological conditions, and functional status may prove to be an effective strategy for preventing falls among older adults.

Falls may trigger body weight decline in nursing home residents

OBJECTIVES

The effect of falls on changes in body weight is still unknown. This study investigated the extent to which falls can modify the course of body weight in nursing home residents, and aimed to identify the factors that might modulate this effect.

METHODS

The sample included 132 residents aged ≥60 y who had experienced at least one fall after nursing home admission. Body weight was measured monthly in the 6 mo after the fall in the entire sample, and also in the 6 mo prefall in a subsample (n = 111). Sociodemographic and health data were obtained from medical records. Linear mixed models were used to estimate the average monthly changes in body weight after the fall in the total sample, and as a function of the sociodemographic and medical factors.

RESULTS

Falls modified the course of body weight in the total sample (β = -0.28, 95% confidence interval, -0.44 to -0.12, for the change in slope before and after fall) in all age classes and especially in individuals with severe cognitive impairment who received less-frequent informal visits (β = -0.55, 95% confidence interval, -0.87 to -0.22). Individuals aged ≥90 y and those with severe cognitive impairment had a steeper monthly weight decline in the 6 mo postfall, of 0.23 and 0.35 kg greater, respectively, than their younger and cognitively healthier counterparts.

CONCLUSIONS

Falls may trigger a body weight loss in nursing home residents, especially in the oldest old people and those with severe cognitive impairment who receive little support from informal caregivers. These findings highlight the importance of monitoring nutritional status of people who live in institutions after falls.

Perceived social isolation, social disconnectedness and falls: the mediating role of depression

OBJECTIVES

to estimate the association of social disconnectedness and perceived social isolation with the risk of falls and also investigate whether depression mediated this association.

METHOD

Biennial longitudinal survey data from 2006 to 2012 waves of the U.S. Health and Retirement Study of adults aged 65 and older (N = 22,153 observations) were examined. The outcome variable was number of self-reported falls over the observation period. Independent variables included social isolation (social disconnectedness, perceived social isolation) and number of depressive symptoms. Generalized Estimating Equation regressions were performed to address the research questions.

RESULTS

Regression models indicated that social disconnectedness is associated with a 5% increase in the risk of falls. Perceived social isolation (lack of perceived social support and loneliness combined) was associated with a 33% increase in falls risk. For each increase in the number of depressive symptoms, the risk of falls increased by 13%. Also, the number of depressive symptoms mediated the association between perceived social isolation and risk of falls.

CONCLUSION

Our findings were suggestive of the need to consider social isolation when designing falls prevention programs. More research is needed with research designs that address potential endogeneity bias.

The association between injurious falls and older adults' cognitive function: the role of depressive mood and physical performance

Background

The impact of falls on cognitive function is unclear. We explored whether injurious falls are associated with cognitive decline in older adults, and evaluated the role of changes in psychological and physical health as mediators of such association.

Methods

This prospective study involved 2267 community-dwelling participants in the Swedish National study on Aging and Care in Kungsholmen (≥60 years). Data on injurious falls (ie, falls requiring medical attention) during each 3-year time interval of follow-up were obtained from national registers. Assessment of cognitive function (Mini-Mental State Examination), depressive mood (Montgomery-Åsberg Depression Rating Scale), and physical performance (walking speed) were carried out every 3 or 6 years over a 12-year follow-up. The association between falls and cognition was estimated through linear mixed-effects models, and the mediating role of changes in depressive mood and physical performance was tested using mediation analysis.

Results

After adjusting for potential confounders, individuals who experienced injurious falls had a greater annual decline in Mini-Mental State Examination in the subsequent time interval (β = −1.49, 95% CI: −1.84; −1.13), than those who did not. The association increased with the occurrence of ≥2 falls (β = −2.13, 95% CI: −2.70; −1.56). Worsening of walking speed and depressive mood explained around 26% and 8%, respectively, of the association between falls and cognitive decline.

Conclusions

Injurious falls are associated with greater cognitive decline, and this association is partly mediated by worsening of physical performance and, in a lesser extent, of depressive mood. These findings suggest that physical deficits and low mood are potential therapeutic targets for mitigating the association between falls and cognitive decline.

The Role of Psychological and Social Well-being on Physical Function Trajectories in Older Adults

BACKGROUND

Psychological and social well-being are emerging as major determinants in preserving health in old age. We aimed to explore the association between these factors and the rate of decline in physical function over time in older adults.

METHODS

Data were gathered from the Swedish National study on Aging and Care in Kungsholmen (SNAC-K). The study population consisted of 1,153 non-demented, community-dwelling men and women free from multimorbidity or impairments in basic or instrumental activities of daily living at baseline. They were followed over 12 years to capture the rate of decline in physical function, which was measured by combining data on walking speed, balance, and chair stands. The association between baseline psychological and social well-being and decline in physical function was estimated through linear mixed models, after multiple adjustments including personality and depressive symptoms.

RESULTS

Higher levels of psychological (β = .007; p = .037) and social (β = .008; p = .043) well-being were significantly associated with a decreased rate of decline in physical function over the follow-up. There was a significant three-way interaction between psychological well-being*time*sex (female vs male) (β = .015; p = .047), showing that a slower decline in physical function was observed only among women and not in men. The association was strongest for individuals with high levels of both psychological and social well-being (β = .012; p = .019).

CONCLUSION

High levels of psychological and social well-being may slow down the age-related decline in physical function, which confirms the complexity of older adults' health, but also points towards new preventative strategies.

Judgment Capacity, Fear of Falling, and the Risk of Falls in Community-Dwelling Older Adults: The Progetto Veneto Anziani Longitudinal Study

Little is known of the factors that transform fear of falling (FOF) from a normal adaptive to a maladaptive response that could alter its impact on fall risk. Focusing on judgment capacity, we investigated whether it is associated with FOF and FOF-related activity restriction (AR), and whether it modifies the influence of FOF on fall risk. Data came from 2625 community-dwelling older adults enrolled in the Progetto Veneto Anziani. Baseline FOF and AR were assessed through personal interviews, and judgment capacity-high, moderate, or poor-through situational tests. At follow-up after 4.4 years, self-reported falls during the previous year were recorded. The associations between judgment and FOF/AR, and between FOF and the risk of at least one fall or recurrent falls (two or more falls), stratified by judgment capacity, were evaluated using multinomial logistic regressions. Compared with high-judgment participants, lower judgment participants were 20% more likely to report FOF; moderate judgment participants were 54% more likely and poor judgment participants twice as likely to report AR. After adjusting for potential confounders, including physical activity and physical performance, FOF increased the reporting of at least one fall only in the poor judgment group. The association between FOF and recurrent falls was stronger in individuals with poor (odds ratio [OR] = 3.66, 95% confidence interval [CI]: 2.10-6.36) than with moderate (OR = 2.81, 95% CI: 2.22-3.55) or high (OR = 1.65, 95% CI: 1.48-1.83) judgment. Poor judgment capacity increases the probability of FOF and AR in older adults, and may exacerbate the effect of FOF in increasing fall risk.