title: Patterns, predictors, and outcomes of falls trajectories in older adults: the MOBILIZE Boston Study with 5 years of follow-up.
abstract: BACKGROUND
  Falls may occur as unpredictable events or in patterns indicative of potentially modifiable risks and predictive of adverse outcomes. Knowing the patterns, risks, and outcomes of falls trajectories may help clinicians plan appropriate preventive measures. We hypothesized that clinically distinct trajectories of falls progression, baseline predictors and their coincident clinical outcomes could be identified.
  
  
  METHODS
  We studied 765 community-dwelling participants in the MOBILIZE Boston Study, who were aged 70 and older and followed prospectively for falls over 5 years. Baseline demographic and clinical data were collected by questionnaire and a comprehensive clinic examination. Falls, injuries, and hospitalizations were recorded prospectively on daily calendars. Group-Based Trajectory Modeling (GBTM) was used to identify trajectories.
  
  
  RESULTS
  We identified 4 distinct trajectories: No Falls (30.1%), Cluster Falls (46.1%), Increasing Falls (5.8%) and Chronic Recurring Falls (18.0%). Predictors of Cluster Falls were faster gait speed (OR 1.69 (95CI, 1.50-2.56)) and fall in the past year (OR 3.52 (95CI, 2.16-6.34)). Predictors of Increasing Falls were Diabetes Mellitus (OR 4.3 (95CI, 1.4-13.3)) and Cognitive Impairment (OR 2.82 (95CI, 1.34-5.82)). Predictors of Chronic Recurring Falls were multi-morbidity (OR 2.24 (95CI, 1.60-3.16)) and fall in the past year (OR 3.82 (95CI, 2.34-6.23)). Symptoms of depression were predictive of all falls trajectories. In the Chronic Recurring Falls trajectory group the incidence rate of Hospital visits was 121 (95% CI 63-169) per 1,000 person-years; Injurious falls 172 (95% CI 111-237) per 1,000 person-years and Fractures 41 (95% CI 9-78) per 1,000 person-years.
  
  
  CONCLUSIONS
  Falls may occur in clusters over discrete intervals in time, or as chronically increasing or recurring events that have a relatively greater risk of adverse outcomes. Patients with multiple falls, multimorbidity, and depressive symptoms should be targeted for preventive measures.
authors.affiliation: Harvard Medical School, Boston, Massachusetts, United States of America; Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America; Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, United States of America; Department of Geriatric Medicine, University Hospital Center of Limoges, University of Limoges; EA 6310 HAVAE (Disability, Activity, Aging, Autonomy and Environment), Limoges, France.
authors.forename: Achille E
authors.initials: AE
authors.lastname: Tchalla
authors.affiliation: Harvard Medical School, Boston, Massachusetts, United States of America; Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America; Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, United States of America.
authors.forename: Alyssa B
authors.initials: AB
authors.lastname: Dufour
authors.affiliation: Harvard Medical School, Boston, Massachusetts, United States of America; Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America; Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, United States of America.
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Travison
authors.affiliation: Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, United States of America.
authors.forename: Daniel
authors.initials: D
authors.lastname: Habtemariam
authors.affiliation: Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, United States of America.
authors.forename: Ikechukwu
authors.initials: I
authors.lastname: Iloputaife
authors.affiliation: Harvard Medical School, Boston, Massachusetts, United States of America; Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America; Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, United States of America.
authors.forename: Brad
authors.initials: B
authors.lastname: Manor
authors.affiliation: Harvard Medical School, Boston, Massachusetts, United States of America; Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America; Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, United States of America.
authors.forename: Lewis A
authors.initials: LA
authors.lastname: Lipsitz
mesh_terms: D000058:Accidental Falls; D000368:Aged; D000369:Aged, 80 and over; D003863:Depression / Q000453:epidemiology* / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D005684:Gait; D006801:Humans; D008297:Male; D026741:Physical Therapy Modalities; D004856:Postural Balance; D012307:Risk Factors