Chonnam Med J.  2019 May;55(2):104-108. 10.4068/cmj.2019.55.2.104.

Association of Falls and Fear of Falling with Mortality in Korean Adults: The Dong-gu Study

Affiliations
  • 1Department of Public Health, Graduate School Chonnam National University Medical School, Gwangju, Korea.
  • 2Department of Preventive Medicine, Chonnam National University Medical School, Gwangju, Korea. mhshinx@paran.com
  • 3Department of Preventive Medicine & Institute of Wonkwang Medical Science, Wonkwang University College of Medicine, Iksan, Korea.
  • 4Department of Preventive Medicine, Chungnam National University Medical School, Daejeon, Korea.
  • 5Cardiocerebrovascular Center, Mokpo Jung-Ang Hospital, Mokpo, Korea.
  • 6Department of Preventive Medicine, Chosun University Medical School, Gwangju, Korea.

Abstract

This study evaluated the association between falls and the fear of falling (FOF) with the risk of all-cause mortality in Korean adults. The study enrolled 4,386 subjects aged 50 years and over who participated in the Dong-gu Study. Falls in the past year were categorized as yes or no. Injurious falls were defined as falls that resulted in fractures, head injuries, sprains or strains, bruising or bleeding, or other unspecified injuries. FOF was classified as low or high. The associations of falls and fall-related characteristics with mortality were assessed using Cox proportional hazards models. The average follow-up was 7.8 years. During this period, 255 men and 146 women died. In a fully adjusted model, falls in the past year were not associated with an increased risk of all-cause mortality (hazard ratio [HR] 1.16, 95% confidence interval [CI] 0.85-1.58), but a history of injurious falls was associated with an increased risk of mortality (HR 1.36, 95% CI 1.04-1.79). Compared with subjects without a FOF, subjects who were moderately or very afraid of falling had a higher mortality rate (HR 1.26, 95% CI 0.97-1.63). In conclusion, injurious falls and a high FOF increased the risk of all-cause mortality in Koreans. This study suggests that injurious falls and FOF can predict mortality in the general population.

Keyword

Accidental Falls; Cohort Studies; Risk; Cause of Death

MeSH Terms

Accidental Falls*
Adult*
Cause of Death
Cohort Studies
Craniocerebral Trauma
Female
Follow-Up Studies
Hemorrhage
Humans
Male
Mortality*
Proportional Hazards Models
Sprains and Strains

Figure

  • FIG. 1 Hazard ratio according to fear of falling (FOF) and history of injurious falls. Error bars showed 95% confidence intervals.


Reference

1. Tinetti ME. Clinical practice. Preventing falls in elderly persons. N Engl J Med. 2003; 348:42–49.
2. Choi EJ, Kim SA, Kim NR, Rhee JA, Yun YW, Shin MH. Risk factors for falls in older Korean adults: the 2011 Community Health Survey. J Korean Med Sci. 2014; 29:1482–1487.
Article
3. Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med. 1988; 319:1701–1707.
Article
4. Rubenstein LZ. Falls in older people: epidemiology, risk factors and strategies for prevention. Age Ageing. 2006; 35:Suppl 2. ii37–ii41.
Article
5. Pohl P, Nordin E, Lundquist A, Bergström U, Lundin-Olsson L. Community-dwelling older people with an injurious fall are likely to sustain new injurious falls within 5 years--a prospective long-term follow-up study. BMC Geriatr. 2014; 14:120.
Article
6. Dierking L, Markides K, Al Snih S, Kristen Peek M. Fear of falling in older Mexican Americans: a longitudinal study of incidence and predictive factors. J Am Geriatr Soc. 2016; 64:2560–2565.
Article
7. Tomita Y, Arima K, Tsujimoto R, Kawashiri SY, Nishimura T, Mizukami S, et al. Prevalence of fear of falling and associated factors among Japanese community-dwelling older adults. Medicine (Baltimore). 2018; 97:e9721.
Article
8. Goh HT, Nadarajah M, Hamzah NB, Varadan P, Tan MP. Falls and fear of falling after stroke: a case-control study. PM R. 2016; 8:1173–1180.
Article
9. Albert CM, Chae CU, Rexrode KM, Manson JE, Kawachi I. Phobic anxiety and risk of coronary heart disease and sudden cardiac death among women. Circulation. 2005; 111:480–487.
Article
10. Oh E, Hong GS, Lee S, Han S. Fear of falling and its predictors among community-living older adults in Korea. Aging Ment Health. 2017; 21:369–378.
Article
11. Boyd R, Stevens JA. Falls and fear of falling: burden, beliefs and behaviours. Age Ageing. 2009; 38:423–428.
Article
12. Chang HT, Chen HC, Chou P. Fear of falling and mortality among community-dwelling older adults in the Shih-Pai study in Taiwan: a longitudinal follow-up study. Geriatr Gerontol Int. 2017; 17:2216–2223.
Article
13. Becker C, Gebhard F, Fleischer S, Hack A, Kinzl L, Nikolaus T, Muche R. Prediction of mortality, mobility and admission to long-term care after hip fractures. Unfallchirurg. 2003; 106:32–38.
14. Dunn JE, Rudberg MA, Furner SE, Cassel CK. Mortality, disability, and falls in older persons: the role of underlying disease and disability. Am J Public Health. 1992; 82:395–400.
Article
15. Kweon SS, Shin MH, Jeong SK, Nam HS, Lee YH, Park KS, et al. Cohort profile: the Namwon study and the Dong-gu study. Int J Epidemiol. 2014; 43:558–567.
Article
16. van Haastregt JC, Zijlstra GA, van Rossum E, van Eijk JT, Kempen GI. Feelings of anxiety and symptoms of depression in community-living older persons who avoid activity for fear of falling. Am J Geriatr Psychiatry. 2008; 16:186–193.
Article
17. Mykletun A, Bjerkeset O, Øverland S, Prince M, Dewey M, Stewart R. Levels of anxiety and depression as predictors of mortality: the HUNT study. Br J Psychiatry. 2009; 195:118–125.
Article
18. Meier SM, Mattheisen M, Mors O, Mortensen PB, Laursen TM, Penninx BW. Increased mortality among people with anxiety disorders: total population study. Br J Psychiatry. 2016; 209:216–221.
Article
19. Zijlstra GA, van Haastregt JC, van Eijk JT, van Rossum E, Stalenhoef PA, Kempen GI. Prevalence and correlates of fear of falling, and associated avoidance of activity in the general population of community-living older people. Age Ageing. 2007; 36:304–309.
Article
20. Choi K, Jeon GS, Cho SI. Prospective study on the impact of fear of falling on functional decline among community dwelling elderly women. Int J Environ Res Public Health. 2017; 14:E469.
Article
21. Kim S, So WY. Prevalence and correlates of fear of falling in Korean community-dwelling elderly subjects. Exp Gerontol. 2013; 48:1323–1328.
Article
22. Adkin AL, Frank JS, Jog MS. Fear of falling and postural control in Parkinson's disease. Mov Disord. 2003; 18:496–502.
Article
23. Pluijm SM, Smit JH, Tromp EA, Stel VS, Deeg DJ, Bouter LM, et al. A risk profile for identifying community-dwelling elderly with a high risk of recurrent falling: results of a 3-year prospective study. Osteoporos Int. 2006; 17:417–425.
Article
24. Friedman SM, Munoz B, West SK, Rubin GS, Fried LP. Falls and fear of falling: which comes first? A longitudinal prediction model suggests strategies for primary and secondary prevention. J Am Geriatr Soc. 2002; 50:1329–1335.
Article
25. Pua YH, Ong PH, Clark RA, Matcher DB, Lim EC. Falls efficacy, postural balance, and risk for falls in older adults with falls-related emergency department visits: prospective cohort study. BMC Geriatr. 2017; 17:291.
Article
26. Saeed Mirza S, Ikram MA, Hofman A, Tiemeier H. Anxiety does not predict mortality. A population-based study. World Psychiatry. 2015; 14:103–104.
Article
Full Text Links
  • CMJ
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr