Falls requiring medical attention among veterans with multiple sclerosis: A cohort study

Abstract

Abstract-The purpose of this study was to estimate the relative risk of an injurious fall requiring medical attention in veterans with multiple sclerosis (MS) compared with veterans without MS after controlling for sex, age, and healthcare use. The sample included 195,417 veterans treated at Veterans Health Administration (VHA) facilities in the Northwest United States in fiscal year 2008. We obtained information regarding MS diagnosis, injurious falls (operationalized as International Classification of Diseases-9th Revision-Clinical Modification codes E880-E888), and demographic and healthcare use data from the VHA Consumer Health Information Performance Set database. Using logistic regression, we determined the adjusted odds ratio (OR) of an injurious fall to be three times higher in female veterans with MS than in female veterans without MS (OR = 3.0, 95% confidence interval [CI] = 1.6-5.5). The adjusted OR of an injurious fall for men with MS was also higher than for men without MS, but this difference was not statistically significant (OR = 1.2, 95% CI = 0.8-2.1). We recommend further studies evaluating the medical, social, and economic consequences of injurious falls, as well as interventions to prevent injurious falls, to improve the independence and quality of life of veterans and others living with MS.

Medications Are Associated with Falls in People with Multiple Sclerosis

“…The proportions of fallers and injurious fallers found in this study, 58% and 44%, respectively, for the entire sample are consistent with other studies of falls in people with MS. [1][2][3][4]7,11,[22][23][24][25] However, the US sample fell more (72% fallers) than has been found in previous studies and more than the Australian sample, despite on average being less disabled and younger than the Australian sample. The reasons for this difference are uncertain but may be related to younger age, which has been found to be associated with increased fall risk in MS, 26 or to other unmeasured differences in the samples or in health-care delivery between countries.…”

“…[1][2][3][4][5] More than 50% of people with MS fall in a 3-to 6-month period, and approximately 30% to 50% fall multiple times. [4][5][6] Falls in people with MS are associated with injuries 3,7,8 and adversely affect quality of life. 9 Fall risk in MS is generally attributed to impairments in the wide range of functions affected by the disease, including balance, cognition, vision, muscle strength and tone, coordination, and sensation.…”

Multiple Sclerosis and Risk of Infection-Related Hospitalization and Death in US Veterans

“…1 The Department of Veterans Affairs (VA) health-care system treats approximately 16,000 veterans with MS each year. 2 MS is a chronic disease that results in an annual cost burden of $8500 to $54,000 per patient in the United States, much of it from complications secondary to MS. 3,4 Two recent studies have demonstrated an increased risk of infection-related hospitalizations and infectionrelated mortality in patients with MS compared with those without MS in Sweden and the United Kingdom. 5,6 The objective of this study was to examine the risk of hospitalization and death due to infections in patients with and without MS in a cohort of US veterans.…”

Whom to Target for Falls-Prevention Trials

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Multiple sclerosis (MS) is a chronic neurologic disease that may cause impairments in cognition, muscle strength, muscle tone, sensation, coordination, balance, and gait, all of which are associated with an increased risk of falls.1-7 A number of studies also demonstrate that people with MS fall frequently 1,3,5,6,[8][9][10][11][12] and fall significantly more often than healthy people of the same age and gender.11,13 Over 50% of people with MS fall in a 3-to 6-month period, and around 30% to 50% fall multiple times. 3,[5][6][7]9,10 People with MS also often sustain fallrelated injuries.

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“…1-7 A number of studies also demonstrate that people with MS fall frequently 1,3,5,6,[8][9][10][11][12] and fall significantly more often than healthy people of the same age and gender.…”