Falls among Middle-Aged Women in the Women's Interagency HIV Study

Abstract

Objective To determine the frequency and risk factors for falls among middle-aged HIV+ and HIV− women in the Women's Interagency HIV Study (WIHS). Methods We quantified self-report of any and multiple (≥2 falls) in the prior 6 months among 1,412 HIV+ and 650 HIV− women with mean age 48 years. Logistic regression was used to evaluate associations of demographics, behavioral factors, comorbid conditions, and medications with odds of any fall (vs. none) and multiple falls (vs. ≤1 fall). Results At least one fall was reported in 263 HIV+ (19%) vs. 119 HIV− (18%) women, and ≥2 falls reported in 133 HIV+ (9%) vs. 65 HIV− (10%) women. HIV infection was not associated with falls in multivariate analyses. Factors independently associated with any fall included age (aOR 1.71, 95% CI:1.17-2.49 age 50-59 vs. <39y; aOR 2.26, 95% CI:1.38-3.71 age ≥60 vs. <39), current marijuana use (aOR 2.19, 95% CI:1.53-3.13) depressive symptoms (aOR 1.57, 95% CI:1.21-2.05 for CES-D ≥16), subjective cognitive complaints (aOR 2.19, 95% CI:1.56-3.08), neuropathy (aOR 1.59, 95% CI:1.19-2.13), obesity (aOR 1.39, 95% CI:1.08-1.80), number of CNS active agents (aOR 2.98, 95% CI:1.90-4.68 for ≥3 agents vs. 0) and WIHS site. Factors associated with ≥2 falls included age, marijuana use, number of CNS active agents, subjective cognitive complaints, depressive symptoms, neuropathy, and study site. Conclusions Falls were associated with factors affecting cognition, but not HIV status in this large cohort of women. Longitudinal studies are needed to determine the incidence and consequences of falls by HIV status as women age.

The Fat of the Matter: Obesity and Visceral Adiposity in Treated HIV Infection

“…Obesity has also been associated with fall risk in HIV-infected women[94]. The exact mechanisms underlying these relationships are incompletely understood, but may be related to adipocytokine imbalances[95] and/or chronic inflammation and immune activation[96, 97].…”

Frailty is strongly associated with increased risk of recurrent falls among older HIV-infected adults

“…Among middle-aged and older HIV-infected individuals, including those with well-suppressed infection, frailty and impairments in physical function are common [5-8], and one study found that the prevalence of falls among middle-aged HIV-infected adults with a mean age of 52 years paralleled that of HIV-uninfected adults 65 years or older [9]. While the number of older HIV-infected adults in the United States continues to rise due to enhanced survival and life expectancy, research into risk factors for falls in HIV-infected individuals remains limited [10-12]. Only one study to-date has considered the association between frailty and falls; frailty was found to be strongly associated with recurrent (2 or more) falls in the prior 12 months in a cross-sectional analysis of 359 HIV-infected men and women 45-65 years of age, with exhaustion being the frailty component with the strongest association [9].…”

Physiotherapists’ Awareness of Risk of Bone Demineralisation and Falls in People Living with HIV and their Perceptions about Fall Risk Management: A Qualitative Study

“…No comparable studies were identified on awareness of falls in PLWH and physiotherapists (85%) seem to be more aware of falls in other at-risk populations, such as stroke survivors [18] and geriatrics. [17] Three cross-sectional studies [30][31][32] in highincome countries reported falls prevalence ranging from 18.6% -40.7% in middle-aged to older PLWH. In LMIC, falls may be prevalent in younger cohorts of PLWH due to the different sociodemographic profile of PLWH or more virulent strains of Clade C HIV; [33] one recent South African study [34] attesting to this possibility.…”