OBJECTIVES To identify sex‐specific associations between risk factors and injurious falls over the short (<4 years) and long (4–10 years) term. DESIGN Longitudinal cohort study between 2001 and 2011. SETTING Swedish National Study on Aging and Care, Kungsholmen, Sweden. PARTICIPANTS Community‐dwelling adults aged 60 and older (N = 3,112). MEASUREMENTS An injurious fall was defined as a fall that required inpatient or outpatient care. Information was collected on participant and exposure characteristics using structured interviews, clinical examinations, and physical function tests at baseline. RESULTS The multivariate model showed that, in the short term, living alone (hazard ratio (HR)=1.83, 95% confidence interval (CI)=1.13–2.96), dependency in instrumental activities of daily living (IADLs) (HR=2.59, 95% CI=1.73–3.87), and previous falls (HR=1.71, 95% CI=1.08–2.72) were independently associated with injurious falls in women. Low systolic blood pressure (HR=1.96, 95% CI=1.04–3.71), impaired chair stands (HR=3.00, 95% CI=1.52–5.93), and previous falls (HR=2.81, 95% CI=1.32–5.97) were associated with injurious falls in men. Long‐term risk factors were underweight (HR=2.03, 95% CI=1.40–2.95), cognitive impairment (HR=1.49, 95% CI=1.08–2.06), fall‐risk increasing drugs (HR=1.67, 95% CI=1.27–2.20 for ≥2 drugs), and IADL dependency (HR=1.58, 95% CI=1.32–5.97) for women and smoking (HR=1.71, 95% CI=1.03–2.84), heart disease (HR=2.20, 95% CI=1.5–3.24), impaired balance (HR=1.68, 95% CI=1.08–2.62), and a previous fall (HR=3.61, 95% CI=1.98–6.61) for men. CONCLUSION Men and women have different fall risk profiles, and these differences should be considered when developing preventive strategies. Some risk factors were more strongly predictive of injurious falls over shorter than longer periods and vice versa, suggesting that it may be possible to identify older men and women at short‐ and long‐term risk of injurious falls. J Am Geriatr Soc 67:246–253, 2019.

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BackgroundAlthough falls in older adults are related to multiple risk factors, these factors have commonly been studied individually. We aimed to identify risk profiles for injurious falls in older adults by detecting clusters of established risk factors and quantifying their impact on fall risk.MethodsParticipants were 2,566 people, aged 60 years and older, from the population-based Swedish National Study on Aging and Care in Kungsholmen. Injurious falls was defined as hospitalization for or receipt of outpatient care because a fall. Cluster analysis was used to identify aggregation of possible risk factors including chronic diseases, fall-risk increasing drugs (FRIDs), physical and cognitive impairments, and lifestyle-related factors. Associations between the clusters and injurious falls over 3, 5, and 10 years were estimated using flexible parametric survival models.ResultsFive clusters were identified including: a “healthy”, a “well-functioning with multimorbidity”, a “well-functioning, with multimorbidity and high FRID consumption”, a “physically and cognitively impaired”, and a “disabled” cluster. The risk of injurious falls for all groups was significantly higher than for the first cluster of healthy individuals in the reference category. Hazard ratios (95% confidence intervals) ranged from 1.71 (1.02–2.66) for the second cluster to 12.67 (7.38–21.75) for the last cluster over 3 years of follow-up. The highest risk was observed in the last two clusters with high burden of physical and cognitive impairments.ConclusionRisk factors for injurious fall tend to aggregate, representing different levels of risk for falls. Our findings can be useful to tailor and prioritize clinical and public health interventions.