Individuals with little or no disability prior to serious fall injury recovered faster than individuals with severe disability who had a serious fall injury, according to recent study results.
In an ongoing longitudinal study, 754 community community-living persons aged 70 years or older, who were initially nondisabled in their basic activities of daily living, completed home-based assessments at baseline and at 18-month intervals for 144 months, as well as monthly telephone interviews. Researchers identified functional trajectories — based on 13 basic instrumental and mobility activities assessed during monthly interviews in the year before and the year after the serious fall injury, including hip fractures and other fall-related injuries leading to hospitalization — as the main outcome measure.
Of the 130 participants who sustained serious fall injury, study results showed 62 participants had a hip fracture and 68 had another fall-related injury leading to hospitalization. Of the five distinct trajectories identified before serious fall injury, 12.3% of participants had no disability, 26.2% had mild disability, 26.2% had moderate disability, 17.7% had progressive disability and 17.7% had severe disability. After the fall, 9.2% of participants experienced a rapid recovery, 26.9% had gradual recovery, 20% had little recovery and 43.8% had no recovery.
For all falls, researchers observed rapid recovery only for participants who had no disability or mild disability before the fall. As the pre-fall functional trajectory worsened from no disability to severe disability, the probability of no recovery increased, with the probability of gradual recovery highest for participants who had mild disability.
Study results showed only about one-third of participants with moderate disability had a substantive recovery and no recovery was observed among participants who had severe disability before the fall. Post-fall trajectories were consistently worse after hip fracture than after another serious fall injury.
“Our findings can be used by physicians to advise their patients about the likely course of recovery after a serious fall injury,” the researchers concluded. “The strong association between the pre-fall and post-fall functional trajectories suggests that the likelihood of recovery after a serious fall injury will be greatly constrained by the pre-fall trajectory, especially for hip fracture.”
For more information:
Gill TM. JAMA Intern Med. 2013;doi:10.1001/jamainternmed.2013.9063.
Disclosure: The researchers report no relevant financial disclosures.