Trajectories of chronic disease burden, depressive symptoms, and functional limitations related to falls in middle-aged and older adults: a matched longitudinal study
TL;DR
A first fall report may provide a useful trigger for comprehensive assessment and sustained functional support in both cohorts, and dichotomous analyses showed higher odds of multimorbidity, depression, and ADL disability in the fall group.
Abstract
Background Falls are often treated as isolated events, but the physiological, psychological, and functional trajectories surrounding a first fall remain poorly understood. We examined chronic disease burden, depressive symptoms, and activities of daily living (ADL) limitations before and after first fall reports in England and the United States. Methods We conducted a matched longitudinal analysis of adults aged ≥50 years in the English Longitudinal Study of Ageing (ELSA) and the Health and Retirement Study (HRS). Participants who first reported a fall during follow-up were matched 1:1 to participants without reported falls using coarsened exact matching (CEM). Matching used baseline age, birth year, sex, and education. Repeated outcomes comprised an eight-condition count, the eight-item Center for Epidemiologic Studies Depression (CES-D) scale, and a six-item ADL count. Time zero was the first fall-report wave or matched pseudo-index wave. Outcome-specific piecewise mixed-effects models incorporated quadratic time terms selected using likelihood-ratio tests and information criteria. Results Matched samples included 3,582 ELSA and 4,178 HRS participants. At time zero, adjusted fall-group minus non-fall-group differences were 0.10, 0.30, and 0.12 in ELSA. The corresponding differences in HRS were 0.20, 0.35, and 0.28. These values represent chronic condition, depressive symptom, and ADL limitation counts, respectively. At +8 years, the corresponding differences were 0.19, 0.33, and 0.30 in ELSA. In HRS, they were 0.40, 0.43, and 0.95. Nonlinear specifications improved fit for all outcomes in both cohorts. Dichotomous analyses also showed higher odds of multimorbidity, depression, and ADL disability in the fall group. Conclusion A first fall report marked a period of accumulating physiological, psychological, and functional vulnerability in both cohorts. Because time zero was a survey report wave rather than the exact fall date, these event-aligned associations do not isolate acute causal effects. Nevertheless, a first fall report may provide a useful trigger for comprehensive assessment and sustained functional support.