Risk Factors for Falls in Community-Dwelling Older Adults with Heart Failure

Abstract

Community-dwelling older adults with heat failure (HF) appear to have a greater risk of falling related to their symptoms, comorbid diseases, and/or adverse effect of HF management. The complexity of HF conditions and the growing number of HF patients pose new challenges for developing innovative fall prevention programs. To be successful, it is essential first to examine the independent effect of HF on falls, and to describe fall risk factors in the HF population. However, little is known about the effect of HF on falls in the U.S. population, and known risk factors have not been fully examined specific to HF patients. This study had two aims. Aim 1 examined the independent effect of HF on the likelihood of falling among community-dwelling older adults. Aim 2 explored functional impairment (i.e., physical, cognitive, sensory, and urinary impairment) in explaining falls among community-dwelling older adults with HF. This retrospective cohort study used data from Health and Retirement Study (HRS), a nationally-representative longitudinal study. The sample for Aim 1 included 17,712 community-dwelling older adults aged 65 or older, who participated in at least two consecutive HRS interview waves between 1998 and 2014. Among them, the sample for Aim 2 included 1,693 community-dwelling older adults with self-reported HF. This study found that HF patients had a 14% higher likelihood of falling than those without HF, after controlling for socio-demographics, physical and psychological symptoms, health behaviors, functional factors, psychiatric medication use, and environmental factors (OR = 1.14, 95% CI: 1.04, 1.26). This study of the sample of HF patients found that while a decline in sensory function was least associated with falls, three functional domains (declines in physical, cognitive, or urinary function) were associated with an approximately two-fold higher likelihood of falling, after controlling for socio-demographic factors (i.e., age, sex, race/ethnicity, and spouse/partner status). This study provides empirical evidence for developing fall prevention interventions specific to community-dwelling older adults with HF. Future prospective studies are needed to extend this research to elucidate the causal mechanism among HF, functional factors and falls. Also, future work is needed to understand the indirect effect of behavioral/environmental factors, and/or person-environment interactions, which have not been fully tested on falls in HF patients. In order to develop and test fall prevention interventions for this population, more attention needs to be paid to HF patients’ fall experiences in outpatient, primary or home care settings and their need for support from caregivers, health providers, and the social community.