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

摘要

? 2022 AMDA – The Society for Post-Acute and Long-Term Care MedicineObjective: 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.