Falls are known to be a leading cause of functional decline among older adults, though little is known about the relationship between pre-fall functional ability and post-fall trajectory. In other words, it is unclear how pre-fall functional status might be clinically useful information in post-fall treatment and recovery. A longitudinal study presented in JAMA Internal Medicine found that the pre-fall health and functional trajectory of individuals who experienced a fall was significantly associated with the recovery trajectory after the fall.
For the study, researchers recruited 754 community-dwelling adults age 70 or better, living in the New Haven (Connecticut) area. Participants were without functional disability at the beginning of the study, without cognitive impairment, and were all English-speaking. (Participants were also members of the same health plan, which limits the generalizability of the study to participants without health care or whose health plans provide different standards of care.) Every 18 months for a period of up to 14 years, researchers administered in-home assessments with participants that included demographic characteristics, chronic conditions, cognitive and mood status, and gait speed. These assessments were complemented by monthly interviews that assessed functional difficulty (as measured by difficulties with activities of daily living) and hospitalization, including falls-related hospital visits. For participants who experienced a fall, medical records and Medicare claims data were also assessed.
Within the study sample, 130 participants had a fall that led to an injury. The researchers grouped participants who fell based on their pre-fall trajectories (e.g., no development of disability, progressive disability, severe disability) and their post-fall trajectories (rapid recovery, gradual recovery, little recovery, or no recovery). Among participants whose falls led to a hip fracture or other serious injury, pre-fall functional trajectory strongly predicted the trajectory post-fall: gradual recovery was significantly less likely to occur among participants with progressive or severe functional disabilities pre-fall, and rapid recovery only occurred among participants whose pre-fall trajectories included either mild or no functional disability.
The authors state that these findings might be used to guide further research on the treatment of falls. For example, researchers might explore whether participants whose pre-fall trajectories indicate a high likelihood of recovery should be administered more aggressive physical therapies, while other post-fall therapies might focus on palliative care and assistive services.
Gill TM, Murphy TE, Gahbauer EA, et al. The course of disability before and after a serious fall injury. JAMA Internal Medicine. (2013). DOI: 10.1001/jamainternmed.2013.9063