Original article
Falls Among Adults Aging With Disability

https://doi.org/10.1016/j.apmr.2014.09.034Get rights and content

Abstract

Objective

To investigate the prevalence of and risk factors for falling among individuals aging with multiple sclerosis (MS), muscular dystrophy (MD), postpolio syndrome (PPS), and spinal cord injury (SCI).

Design

Cross-sectional survey data from 2009 to 2010 were analyzed. We used forward logistic regression models to examine whether risk factors such as age, sex, mobility level, years since diagnosis, vision, balance, weakness, number of comorbid conditions, and physical activity could distinguish participants who reported falling from those who did not.

Setting

Surveys were mailed to community-dwelling individuals who had 1 of 4 diagnoses (MS, MD, PPS, or SCI). The survey response rate was 91%.

Participants

A convenience sample of community-dwelling individuals (N=1862; age, 18–94y) with MS, MD, PPS, or SCI in the United States.

Interventions

Not applicable.

Main Outcome Measure

Self-reported fall within the last 6 months.

Results

Fall prevalence for people with MS (54%), MD (70%), PPS (55%), and SCI (40%). Across all 4 groups, fall rates peaked in middle age (45–64y) and among people with moderate mobility limitations. Seven risk factors differentiated participants who fell from those who did not: mobility level, imbalance, age, curvilinear age (age2), number of comorbid conditions, duration of diagnosis, and sex. The models differed across diagnostic groups.

Conclusions

People aging with long-term physical disabilities experience unique challenges that affect their risk of falls. A better understanding of the frequency, severity, and risk factors of falls across diagnostic groups is needed to design and implement customized, effective fall prevention and management programs for these individuals.

Section snippets

Participants

Participants for present analyses came from the first time point of a longitudinal survey on aging with physical disability being conducted at the University of Washington's Rehabilitation Research and Training Center on Aging with a Physical Disability. Participants were recruited through existing participant databases (47%), through online and print advertisements distributed by national disability organizations (40%), and from other sources (13%). Of the 2202 respondents, 2041 were eligible

Sociodemographic characteristics of participants

Sociodemographic variables of participants are presented in table 2. In all but the SCI group, survey respondents were predominately women (MS, 83%; MD, 58%; PPS, 75%; SCI, 33%) and non-Hispanic white (MS, 94%; MD, 96%; PPS, 94%; SCI, 85%). Only 14% of the respondents had a high school–level education or less; however, those with SCI had the largest proportion with low education (20%). Twenty-four percent of the respondents had a household annual income of <$25,000, with participants with SCI

Discussion

To our knowledge, this study represents the first attempt to compare the prevalence of falls across these 4 diagnostic groups of individuals with long-term physical disabilities. The study participants aging with MS, MD, PPS, and SCI had a higher prevalence of falls than did other community-dwelling older adults. The prevalence of falling was highest for those with MD (70%), followed by individuals with PPS (55%), MS (54%), and SCI (40%). These fall rates are similar to those previously

Conclusions

Preventing falls, especially in individuals aging with physical disabilities, is of significant importance to patients, caregivers, health care providers, and policymakers. A better understanding of the frequency, severity, and correlates of falls in various diagnostic and age groups is an important first step toward designing and implementing effective fall prevention programs for these individuals.

Supplier

  • a.

    Stata, version 6.0; StataCorp, 4905 Lakeway Dr, College Station, TX 77845.

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      The most frequent situations when falls occurred were driving on uneven surfaces or during transfers (Nelson et al., 2010; Wannapakhe et al., 2015; Jorgensen et al., 2016; Forslund et al., 2017). Studies revealed that patients with an iSCI who are ambulatory or with mild and moderate mobility limitations experience significantly more falls than patients who use a wheelchair for mobility (Matsuda et al., 2015; Wannapakhe et al., 2015; Jorgensen et al., 2016). Studies report a fall incidence of their observed cohorts between 34% and 82% (Brotherton et al., 2007a; Wirz et al., 2010b; Phonthee et al., 2013a, b; Wannapakhe et al., 2014; Srisim et al., 2015; Jorgensen et al., 2016, 2017).

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    Supported by the Department of Education, National Institute on Disability and Rehabilitation Research (grant no. H133B080024). However, the contents do not necessarily represent the policy of the Department of Education, and you should not assume endorsement by the federal government.

    Disclosures: none.

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