From First Slip to Second Setback: Intracranial Injury Risk after Recurrent Falls in Older Adults: A Retrospective Cohort Study-Advances in Geriatric Medicine and Research-CSCIED科技核心评价数据库-手机版

From First Slip to Second Setback: Intracranial Injury Risk after Recurrent Falls in Older Adults: A Retrospective Cohort Study

From First Slip to Second Setback: Intracranial Injury Risk after Recurrent Falls in Older Adults: A Retrospective Cohort Study

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DOI	10.20900/agmr20250012
刊名	Advances in Geriatric Medicine and Research AGMR
年，卷(期)	2025, 7(2)
作者	Asmaa Namoos*,Nicholas Thomson Thomson,Tarek Zaho,Amanda Rudderman,Michel Aboutanos,
作者单位	The Injury and Violence Prevention Program, Departments of Surgery, Virginia Commonwealth University, Richmond, VA 23284, USA ;
摘要	Background: Recurrent falls in older adults are a major public health concern, often resulting in severe injuries such as Intracranial Injuries (ICIs). These injuries increase the risk of cognitive decline, disability, and early mortality. While medications like antihypertensives and antidepressants are essential for managing chronic conditions, they may also contribute to fall-related injury risk. Methods: This retrospective cohort study analyzed data from 3760 adults aged 65 to 89 years at the Virginia Commonwealth University Health System (VCUHS) in 2023. Patients were categorized into two cohorts: those with initial falls (n = 2710) and those with recurrent falls (n = 1050). Demographic variables, medication use, and fall-related ICI outcomes were examined. Incidence, prevalence, and measures of association were calculated. Cox regression models assessed the impact of demographic and clinical predictors on ICI risk. Results: The risk of ICI was 10.4% higher in patients with recurrent falls compared to those with initial falls (HR = 1.104, 95% CI: 0.833–1.463, p = 0.0493). Males were significantly more likely to sustain ICIs (HR = 1.369, 95% CI: 1.054–1.779, p = 0.0186), as were older adults with each additional year of age (HR = 1.021, 95% CI: 1.001–1.041, p = 0.0347). Antihypertensive use nearly doubled the risk of ICI (HR = 1.958, 95% CI: 1.379–2.781, p = 0.0002), and antidepressant use was associated with a 47.1% increase (HR = 1.471, 95% CI: 1.1–1.968, p = 0.0093). Race was not a significant predictor of ICI risk in adjusted models. Conclusions: Recurrent falls were associated with a higher likelihood of ICIs among older adults, particularly in males, those of advanced age, and individuals prescribed antihypertensive or antidepressant medications. These results point to the importance of identifying patients at increased vulnerability and tailoring fall-related care and medication reviews accordingly to help reduce injury severity in this population.
Abstract	Background: Recurrent falls in older adults are a major public health concern, often resulting in severe injuries such as Intracranial Injuries (ICIs). These injuries increase the risk of cognitive decline, disability, and early mortality. While medications like antihypertensives and antidepressants are essential for managing chronic conditions, they may also contribute to fall-related injury risk. Methods: This retrospective cohort study analyzed data from 3760 adults aged 65 to 89 years at the Virginia Commonwealth University Health System (VCUHS) in 2023. Patients were categorized into two cohorts: those with initial falls (n = 2710) and those with recurrent falls (n = 1050). Demographic variables, medication use, and fall-related ICI outcomes were examined. Incidence, prevalence, and measures of association were calculated. Cox regression models assessed the impact of demographic and clinical predictors on ICI risk. Results: The risk of ICI was 10.4% higher in patients with recurrent falls compared to those with initial falls (HR = 1.104, 95% CI: 0.833–1.463, p = 0.0493). Males were significantly more likely to sustain ICIs (HR = 1.369, 95% CI: 1.054–1.779, p = 0.0186), as were older adults with each additional year of age (HR = 1.021, 95% CI: 1.001–1.041, p = 0.0347). Antihypertensive use nearly doubled the risk of ICI (HR = 1.958, 95% CI: 1.379–2.781, p = 0.0002), and antidepressant use was associated with a 47.1% increase (HR = 1.471, 95% CI: 1.1–1.968, p = 0.0093). Race was not a significant predictor of ICI risk in adjusted models. Conclusions: Recurrent falls were associated with a higher likelihood of ICIs among older adults, particularly in males, those of advanced age, and individuals prescribed antihypertensive or antidepressant medications. These results point to the importance of identifying patients at increased vulnerability and tailoring fall-related care and medication reviews accordingly to help reduce injury severity in this population.
关键词	falls; older adults; recurrent falls; intracranial injuries (ICIs); fall prevention; risk factors
KeyWord	falls; older adults; recurrent falls; intracranial injuries (ICIs); fall prevention; risk factors
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相关文献

1.CDC. Older Adult Fall Prevention. 2024. Facts About Falls. Available from: https://www.cdc.gov/falls/data-research/facts-stats/index.html. Accessed on 30 Jun 2024.

2.The Falls Management Program: A Quality Improvement Initiative for Nursing Facilities Chapter 2. Fall Response
[Internet]. 2010. Available from: https://www.ahrq.gov/patient-safety/settings/long-term-care/resource/injuries/fallspx/man2.html. Accessed on 27 Oct 2024.

3.Rodrigues F, Monteiro AM, Forte P, Morouço P. Effects of muscle strength, agility, and fear of falling on risk of falling in older adults. Int J Environ Res Public Health. 2023;20(6):4945.

4.Berg RL, Cassells JS. Falls in older persons: Risk factors and prevention. In: The Second Fifty Years: Promoting Health and Preventing Disability
[Internet]. 2nd ed. Washington (DC, US): National Academies Press; 1992. p. 263–90.

5.Jo KH, Park J, Ryu SY. The effects of mental health on recurrent falls among elderly adults, based on Korean Community Health Survey data. Epidemiol Health. 2020;42:e2020005.

6.Gill TM, Williams CS. Likelihood of sustaining an injury in the setting of multiple falls. J Am Geriatr Soc. 2018;67(1):119.

7.Falls in Older Adults Are Serious—PMC
[Internet]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7093636/. Accessed on 4 Sep 2024.

8.Choi NG, Marti CN, Choi BY, Kunik MM. Recurrent falls over three years among older adults age 70+: Associations with physical and mental health statues, exercise, and hospital stay. J Appl Gerontol. 2023;42(5):1089.

9.Appeadu MK, Bordoni B. Falls and Fall Prevention in Older Adults. In: StatPearls
[Internet]. Treasure Island (FL, US): StatPearls Publishing; 2024. Available from: http://www.ncbi.nlm.nih.gov/books/NBK560761/. Accessed on 30 Jun 2024.

10.Poelgeest EP van, Pronk AC, Rhebergen D, Velde N van der. Depression, antidepressants and fall risk: Therapeutic dilemmas—a clinical review. Eur Geriatr Med. 2021;12(3):585.

11.Iaboni A, Flint AJ. The complex interplay of depression and falls in older adults: A clinical review. Am J Geriatr Psychiatry. 2013;21(5):484.

12.National Institute on Aging. Falls and Fractures in Older Adults: Causes and Prevention
[Internet]. 2022 Available from: https://www.nia.nih.gov/health/falls-and-falls-prevention/falls-and-fractures-older-adults-causes-and-prevention. Accessed on 13 Nov 2024.

13.Vaishya R, Vaish A. Falls in older adults are serious. Indian J Orthop. 2020;54(1):69–74.

14.Majnarić LT, Bosnić Z, Guljaš S, Vučić D, Kurevija T, Volarić M, et al. Low psychological resilience in older individuals: An association with increased inflammation, oxidative stress and the presence of chronic medical conditions. Int J Mol Sci. 2021;22(16):8970.

15.Southerland LT, Stephens JA, Robinson S, Falk J, Phieffer L, Rosenthal JA, et al. Head trauma from falling increases subsequent emergency department visits more than other fall-related injuries in older adults. J Am Geriatr Soc. 2016;64(4):870.

16.Thompson HJ, McCormick WC, Kagan SH. Traumatic brain injury in older adults: Epidemiology, outcomes, and future implications. J Am Geriatr Soc. 2006;54(10):1590–5.

17.Falls and Traumatic Brain Injury
[Internet]. Available from: https://www.physio-pedia.com/Falls_and_Traumatic_Brain_Injury. Accessed on 27 Oct 2024.

18.Lord SR, Sherrington C, Menz HB, Close JCT. Falls in older people: Risk factors and strategies for prevention
[Internet]. 2nd ed. Cambridge (UK): Cambridge University Press; 2007 Available from: https://www.cambridge.org/core/books/falls-in-older-people/6D88D1A20407C20842D6536CA3AFA8EB. Accessed on 28 Oct 2024.

19.TriNetX
[Internet]. 2013 Available from: https://live.trinetx.com/tnx/study/202800/analytics/new. Accessed on 18 Jul 2024.

20.World Health Organization. ICD-10: International Statistical Classification of Diseases and Related Health Problems: Tenth Revision
[Internet]. World Health Organization; 2004. Available from: https://iris.who.int/handle/10665/42980. Accessed on 10 Sep 2024.

21.TriNetX. TriNetX Help Center. How Are Incidence Proportion, Incidence Rate, and Prevalence Calculated?
[Internet]. 2021. Available from: https://support.trinetx.com/hc/en-us/articles/1260801259830-How-are-incidence-proportion-incidence-rate-and-prevalence-calculated. Accessed on 10 Sep 2024.

22.Smee DJ, Anson JM, Waddington GS, Berry HL. Association between physical functionality and falls risk in community-living older adults. Curr Gerontol Geriatr Res. 2012;2012:864516.

23.Dionyssiotis Y. Analyzing the problem of falls among older people. Int J Gen Med. 2012;5:805.

24.Jehu DA, Davis JC, Liu-Ambrose T. Risk factors for recurrent falls in older adults: A study protocol for a systematic review with meta-analysis. BMJ Open. 2020;10(5):e033602.

25.Jefferis BJ, Merom D, Sartini C, Wannamethee SG, Ash S, Lennon LT, et al. Physical activity and falls in older men: The critical role of mobility limitations. Med Sci Sports Exerc. 2015;47(10):2119.

26.Lang TF. The bone-muscle relationship in men and women. J Osteoporos. 2011;2011:702735.

27.American Indian/Alaska Native Health
[Internet]. 2020. Available from: https://minorityhealth.hhs.gov/american-indianalaska-native-health. Accessed on 11 Nov 2024.

28.Perez FP, Perez CA, Chumbiauca MN. Insights into the social determinants of health in older adults. J Biomed Sci Eng. 2022;15(11):261–8.

29.National Institute on Aging. Older Adults and Balance Problems
[Internet]. 2022. Available from: https://www.nia.nih.gov/health/falls-and-falls-prevention/older-adults-and-balance-problems. Accessed on 13 Nov 2024.

30.Tinetti ME, Han L, Lee DSH, McAvay GJ, Peduzzi P, Gross CP, et al. Antihypertensive medications and serious fall injuries in a nationally representative sample of older adults. JAMA Intern Med. 2014;174(4):588–95.

31.Badila E. 2024 ESC guidelines for the management of elevated blood pressure and hypertension—How practical is it for clinical practice? Int J Cardiol Cardiovasc Risk Prev. 2024;23:200341.

32.Gangavati A, Hajjar I, Quach L, Jones RN, Kiely DK, Gagnon P, et al. Hypertension, orthostatic hypotension, and the risk of falls in a community-dwelling elderly population: The Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly of Boston Study. J Am Geriatr Soc. 2011;59(3):383–9.

33.Antihypertensive Medications and Serious Fall Injuries in a Nationally Representative Sample of Older Adults—PubMed
[Internet]. Available from: https://pubmed.ncbi.nlm.nih.gov/24567036/. Accessed on 13 May 2025.

34.Masoli JAH, Delgado J, Pilling L, Strain D, Melzer D. Blood pressure in frail older adults: associations with cardiovascular outcomes and all-cause mortality. Age Ageing. 2020;49(5):807–13.

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Asmaa Namoos*,Nicholas Thomson Thomson,Tarek Zaho,Amanda Rudderman,Michel Aboutanos. From First Slip to Second Setback: Intracranial Injury Risk after Recurrent Falls in Older Adults: A Retrospective Cohort Study [J]. Advances in Geriatric Medicine and Research. 2025; 7; (2). - .

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