A recent cross-sectional study of 871 male retirement home residents in Taiwan found that depression and urinary incontinence were associated with an increased risk of recurrent falls.

Dr. Cheng-Hao Hung and colleagues, of the National Yang Ming University, in Taipei, Taiwan published their paper entitled, “Recurrent Falls and Its Risk Factors among Older Men Living in the Veterans Retirement Communities: A Cross-Sectional Study,” in the journal Archives of Gerontology and Geriatrics in February of 2017.

The authors sought to determine the prevalence and risk factors of recurrent falls in elderly male veterans home residents.

Falls occur in over 20% of community-dwelling older adults in Taiwan, with women more likely to fall than men.

Falls are also the number one cause of injury and death from injury among elderly Americans, with an estimated 29 million falls per year taking place in the US. “Older adult falls are increasing and, sadly, often herald the end of independence,” noted US Centers for Disease Control and Prevention Director Dr. Tom Frieden.

The guidelines from the American and British Geriatric Societies recommend screening for falls to improve intervention efforts and reduce risk in individuals who have experienced multiple falls within the past year.

According to Dr. Hung and colleagues, many studies have evaluated the risk factors for falls; however, “little was known regarding to [sic] the risk factors for recurrent falls.”

Study design

The authors conducted a cross-sectional analysis of 871 elderly male veterans home residents (mean age 85.5 years) from the Longitudinal Older Veterans (LOVE) Study. Participants were all generally physically fit and cognitively normal at baseline, and were given a questionnaire to determine sociodemographics and medical history, including past falls. Women, persons under the age of 65, and those who were cognitively impaired or bed-ridden were excluded from this study.

Falls included in this study were defined as those that happened accidentally, not in association with a stroke or other incapacitating medical event or significant environmental hazard, and were stratified by number in the past year (none, one, or more than one). A battery of geriatric assessments was performed to evaluate cognition, mood, capability in performing everyday tasks, and nutrition. Vision and hearing acuity, as well as urinary and stool incontinence were also determined for each participant.

Recurrent falls, depression, and urinary incontinence

Of the 871 participants, 222 (25.5%) experienced a fall within the previous year, with 91 (10.4%) participants experiencing multiple falls. Diabetes mellitus and chronic kidney disease were both associated with an increased risk of falls. Higher levels of comorbidity, reduced ability to perform everyday tasks, depression, and poor nutrition were also associated with more falls. In addition, participants who experienced more falls were more likely to be taking more than 4 medications concurrently, and to have urinary or stool incontinence. The study did not find any association between number of falls and age, height, body weight, or BMI.

After performing a multivariate logistic regression analysis on the data, the authors found that depression and urinary incontinence were independently associated with the number of falls experienced by the participants. Depression was associated with about a 25% increased risk (OR = 1.256, 95% CI 1.094–1.441, P=0.001) for a single fall, and nearly a 50% increased risk for recurrent falls (OR = 1.480, 95% CI 1.269–1.727, P<0.001). Urinary incontinence was associated with recurrent falls (OR = 2.369, 95% CI 1.449–3.817, P<.001) but not single falls.

“Urinary incontinence may contribute to the number of falls among elderly male by increasing voiding frequency, therefore the opportunity to have fall accidents [sic],” the authors state. Dr. Hung and colleagues also discuss the possibility that falls may cause musculoskeletal damage, which could contribute to urinary incontinence. Psychomotor retardation associated with depression may influence fall frequency through impaired judgement and coordination. Although, the authors note that the cross-sectional nature of this study means that only correlations can be drawn, and not a causal relationship.

The authors highlight several important limitations to the current study. Specifically, they note that obtaining fall prevalence data through a questionnaire allows for the possibility of recall bias in the participants. “The exclusion criteria may make our results underestimate the impact of cognitive impairment on falls since those who can’t complete MMSE usually suffer from severe cognitive impairment. By excluding those subjects with ADL <20, who is [sic] bed-ridden and unlikely to suffer from falls due to complete lack of activity, we may overestimate the prevalence rate of fall,” the researchers state.

According to the authors, this study highlights depression and urinary incontinence as risk factors for recurrent falls in elderly men living in retirement communities and the findings may warrant further prospective studies.

Published: April 25, 2017