Falls in the Oldest Old: Role of Gender, Living Situation, and Assistive Devices

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INTRODUCTION: Falls can have serious health consequences, especially in the oldest old (individuals 90+ years), for whom falls often result in injury or even death. Few studies have examined falls in the oldest old. We aim to assess fall prevalence, fall rate, and rate change over time according to gender, living situation, and assistive device use. METHODS: Participants are from the 90+ Study, a longitudinal study of individuals 90 years and older with evaluations every 6 months. Participants, or their informants, were asked how many times they have fallen in the past year (first visit) or since their last visit (follow-up visits). We calculated unadjusted baseline fall prevalence. Using generalized linear mixed regression models, we estimated adjusted baseline fall rate and adjusted change in rate over time by gender, living situation, and assistive device. RESULTS: In 1,672 participants (mean age 93 years, range 90-110 years), unadjusted baseline prevalence of 1+ falls was 47.8% in women and 47.9% in men. Estimated adjusted baseline fall rate was 0.66 falls per person-year in women and 0.71 falls per person-year in men. In women, fall rate did not change significantly over time, whereas in men, fall rate increased by an average of 6% per year. Both men and women in nursing homes had a higher fall rate compared with those in the community. In nursing homes, fall rate remained stable over time in men and decreased over time in women. Fall rate was higher in both men and women using assistive devices. However, walkers were associated with a decrease in fall rate over time in women and in participants in nursing homes. Canes were unexpectedly associated with an increase in fall rate over time. CONCLUSION: Individuals 90 years and older had a high prevalence of falls overall. The higher and increasing rate of falls over time in men compared to women suggests that efforts should be made to increase the uptake of fall prevention strategies specifically in men in the oldest age categories. The increasing fall rate in participants using canes suggests that referral to a health care provider trained in gait analysis prior to assistive device prescription could assist with fall prevention efforts in the oldest old.

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