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Chronic Diseases Significantly Associated with Increased Risk of Falls in Elderly Women

Older women have an increased risk of falling that is associated with the simultaneous occurrence of one or more chronic diseases, researchers report.

"The risk of falling rose with the number of drugs taken and the number of chronic diseases each woman had, but the association was stronger for multiple pathology than for polypharmacy," writes Debbie A Lawlor, senior lecturer in epidemiology, University of Bristol, United Kingdom, and colleagues. They conducted a cross sectional survey of 4050 women, aged from 60 to 79 years, who had participated in the British women's heart and health study, and were seen in general practices in 23 towns in the United Kingdom. The investigators collected data on the clinical diagnoses, medications used, and the number of falls that occurred within the previous 12 months in the patient population.

Overall, 686 of the women had fallen at least once during the previous 12 months (prevalence of 16.9%). The prevalence of frequent falls was 7.0% and the prevalence of falls requiring medical attention was 6.8%.

Compared with those who had not fallen, the women who had at least 1 fall were older; more likely to have coronary heart disease, any circulatory disease, chronic obstructive pulmonary disease, depression, eye disease, or arthritis; were more likely to be taking hypnotics and anxiolytics, antidepressants, any central nervous system drug, any analgesic, or any cardiovascular disease drug; and had a higher mean body mass index (p<0.001 for all characteristics).

In a fully adjusted population attributable analysis, the risk of having had at least 1 fall in the previous year was 6.2% each for coronary heart disease and circulatory disease, 8.0% for chronic obstructive pulmonary disease, 9.4% for depression and 17.4% for arthritis. The odds ratio for a fall for each additional chronic disease when adjusted for the number of drugs taken was 1.39. The odds ratio for each additional drug taken when adjusted for the number of chronic diseases was 1.05. An increased odds of falling was independently associated with only 2 classes of drugs, hypnotics and anxiolytics as well as antidepressants.

Overall, the fully adjusted, population attributable risk of falling associated with having at least 1 chronic disease was 32.2% while the risk of falling associated with the use of psychotropic drugs was between 2% and 5%. The authors note that "factors commonly supposed to be associated with falls, such as postural hypotension, alcohol consumption, and reduced physiological reserve were not associated with falls in this study." In this population, the researchers conclude, "chronic diseases and multiple pathology, rather than polypharmacy, may be the most important predictors of falling."

BMJ 2003;327:712-5.

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