Sharp increase in falls in women during midlife, according to Trinity research

Falls are not just a problem of advanced age, according to researchers in Trinity College Dublin, who have identified a sharp increase in falls after the age of 40, particularly in women.

The research, which drew on data from TILDA (the Irish Longitudinal Study on Ageing) as well as data from similar studies in Australia, Great Britain and the Netherlands, found that for women the prevalence of falls increases from the age of 40 on — 9% in 40-44 year olds, 19% in 45-49 year olds, 21% in 50-54 year olds, 27% in 55-59 year olds and 30% in 60-64 year olds.

The findings indicate that middle-age may be a critical life stage for interventions designed to prevent falls, according to the authors. The study incorporated the data from 19,207 men and women aged between 40 and 64 years.  It has been recently published in the international journal PLOS ONE.

With one in three older adults falling at least once per year, rising to one in two adults over 80 years, falls are a major health challenge. Serious health consequences include fractures, head injuries, reduced social participation, increased risk of nursing home admittance, decline in independence and subsequently increased need for care. Health experts estimate that the costs for falls in Ireland are projected to be over €1 billion by 2020.

Dr Geeske Peeters, Atlantic Fellow for Equity in Brain Health at the Global Brain Health Institute at Trinity, lead author on the paper commented: “Researchers and doctors have always assumed that falls are a problem that only affects people above the age of 65. This study shows that the prevalence of falls is already quite high from the age of 50. In fact, our research shows that there is a sharp increase in the prevalence of falls in women during midlife. This occurs at a time that we also see an increase in the prevalence of common risk factors for falls, such as balance problems, diabetes and arthritis.”

Recommended strategies for the prevention of falls in older adults are insufficiently effective, according to the authors. Previous research shows that, in theory, exercise may reduce the rate of falls by up to 32% and assessment and treatment of risk factors may reduce the rate of falls by up to 24%. However, hospital injury records show that the number of injuries from falls which require medical care continue to rise.

Dr Peeters continued: “Current prevention strategies basically wait until people have developed risk factors and then try to make them go away. It may be better and more effective to prevent the risk factors, or to detect them at an early stage to reduce their consequences, particularly falls. We are now working with our research colleagues in the Netherlands, Australia and the UK to investigate whether there is scope to start prevention strategies before the age of 65 years.”

Professor Rose Anne Kenny, senior author on the paper and director of TILDA and of the Falls Unit at St James Hospital, commented: “This work emphasises the importance of early prevention strategies.  While falls can cause serious injury and result in disability, they also create fear of further falls. This is a well known phenomenon and from TILDA research we know it is present in one in four people over 50. People who have a fear of falling or have had a fall are most at risk of falls and should be targeted for strength and balance programmes and medication reviews – both strategies significantly reduce falls.”

The timing of the increases in falls coincides with the onset of the menopause, decline in balance performance, and increase in the presence of vertigo and fainting, all of which will benefit from the above falls prevention strategies.

Dr Peeters concluded: “A better understanding of the factors that drive this increase in fall risk in middle age may be the key to effective prevention interventions earlier in life with potential benefits into older age. Further research should help us design the most appropriate strategies to prevent falls at this critical juncture in a person’s life.”

A digital copy of the paper, ‘Should prevention of falls start earlier? Co-ordinated analyses of harmonised data on falls in middle-aged adults across four population-based cohort studies’, is available here:  http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0201989