Diabetes and Risk of Hospitalized Fall Injury Among Older Adults
- Rebecca K. Yau, MPH1,2⇑,
- Elsa S. Strotmeyer, PHD3,
- Helaine E. Resnick, PHD4,5,6,
- Deborah E. Sellmeyer, MD7,
- Kenneth R. Feingold, MD8,
- Jane A. Cauley, DRPH3,
- Eric Vittinghoff, PHD9,
- Nathalie De Rekeneire, MD10,
- Tamara B. Harris, MD11,
- Michael C. Nevitt, PHD9,
- Steven R. Cummings, MD12,
- Ronald I. Shorr, MD13,14 and
- Ann V. Schwartz, PHD9
- 1Centers for Disease Control and Prevention/Council of State and Territorial Epidemiologists Applied Epidemiology Fellowship Program, Atlanta, Georgia
- 2Injury Prevention Research Center, University of North Carolina, Chapel Hill, North Carolina
- 3Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
- 4Department of Geriatrics, University of Maryland School of Medicine, Baltimore, Maryland
- 5Gerontology Research, Education and Training Center, Baltimore, Maryland
- 6Resnick, Chodorow and Associates, Silver Spring, Maryland
- 7Division of Endocrinology, Johns Hopkins School of Medicine, Baltimore, Maryland
- 8Division of Endocrinology, Department of Medicine, University of California, San Francisco, San Francisco, California
- 9Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
- 10Geriatrics Section, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
- 11Laboratory of Epidemiology, Demography, and Biometry, National Institute of Aging, Bethesda, Maryland
- 12California Pacific Medical Center Research Institute, San Francisco, California
- 13Geriatric Research, Education and Clinical Center, North Florida/South Georgia Veterans Health System, Gainesville, Florida
- 14Department of Aging and Geriatrics, University of Florida, Gainesville, Florida
- Corresponding author: Rebecca K. Yau, .
OBJECTIVE To determine whether older adults with diabetes are at increased risk of an injurious fall requiring hospitalization.
RESEARCH DESIGN AND METHODS The longitudinal Health, Aging, and Body Composition Study included 3,075 adults aged 70–79 years at baseline. Hospitalizations that included ICD-9-Clinical Modification codes for a fall and an injury were identified. The effect of diabetes with and without insulin use on the rate of first fall-related injury hospitalization was assessed using proportional hazards models.
RESULTS At baseline, 719 participants had diabetes, and 117 of them were using insulin. Of the 293 participants who were hospitalized for a fall-related injury, 71 had diabetes, and 16 were using insulin. Diabetes was associated with a higher rate of injurious fall requiring hospitalization (hazard ratio [HR] 1.48 [95% CI 1.12–1.95]) in models adjusted for age, race, sex, BMI, and education. In those participants using insulin, compared with participants without diabetes, the HR was 3.00 (1.78–5.07). Additional adjustment for potential intermediaries, such as fainting in the past year, standing balance score, cystatin C level, and number of prescription medications, accounted for some of the increased risk associated with diabetes (1.41 [1.05–1.88]) and insulin-treated diabetes (2.24 [1.24–4.03]). Among participants with diabetes, a history of falling, poor standing balance score, and A1C level ≥8% were risk factors for an injurious fall requiring hospitalization.
CONCLUSIONS Older adults with diabetes, in particular those using insulin, are at greater risk of an injurious fall requiring hospitalization than those without diabetes. Among those with diabetes, poor glycemic control may increase the risk of an injurious fall.
- Received February 20, 2013.
- Accepted July 31, 2013.
- © 2013 by the American Diabetes Association.
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