Low blood pressure levels for fall injuries in older adults: the Health, Aging and Body Composition Study

Abstract

Fall injuries cause morbidity and mortality in older adults. We assessed if low blood pressure (BP) is associated with fall injuries, including sensitivity analyses stratified by antihypertensive medications, in community-dwelling adults from the Health, Aging and Body Composition Study (N = 1819; age 76.6 ± 2.9 years; 53% women; 37% black). Incident fall injuries (N = 570 in 3.8 ± 2.4 years) were the first Medicare claims event from clinic visit (7/00-6/01) to 12/31/08 with an ICD-9 fall code and non-fracture injury code, or fracture code with/without a fall code. Participants without fall injuries (N = 1249) were censored over 6.9 ± 2.1 years. Cox regression models for fall injuries with clinically relevant systolic BP (SBP; ≤ 120, ≤ 130, ≤ 140, > 150 mmHg) and diastolic BP (DBP; ≤ 60, ≤ 70, ≤ 80, > 90 mmHg) were adjusted for demographics, body mass index, lifestyle factors, comorbidity, and number and type of medications. Participants with versus without fall injuries had lower DBP (70.5 ± 11.2 vs. 71.8 ± 10.7 mmHg) and used more medications (3.8 ± 2.9 vs. 3.3 ± 2.7); all P < 0.01. In adjusted Cox regression, fall injury risk was increased for DBP ≤ 60 mmHg (HR = 1.25; 95% CI 1.02-1.53) and borderline for DBP ≤ 70 mmHg (HR = 1.16; 95% CI 0.98-1.37), but was attenuated by adjustment for number of medications (HR = 1.22; 95% CI 0.99-1.49 and HR = 1.12; 95% CI 0.95-1.32, respectively). Stratifying by antihypertensive medication, DBP ≤ 60 mmHg increased fall injury risk only among those without use (HR = 1.39; 95% CI 1.02-1.90). SBP was not associated with fall injury risk. Number of medications or underlying poor health may account for associations of low DBP and fall injuries.

Knee Osteoarthritis and the Risk of Medically Treated Injurious Falls Among Older Adults: A Community‐Based US Cohort Study

“…In the adjudication of our diagnoses code algorithm as previously detailed , a subset of Medicare fall injuries were compared to the self‐reported fall injuries with medical records. The injuries adjudicated were included due to potential uncertainty of particular diagnoses codes to classify a primary injurious fall; these included concurrent stroke code, fall code with uncertain injury, fracture code that was not in the first or second positions (i.e., not listed as the first or second reason for visit/hospitalization billing), and vertebral column/rib fracture without a fall code.…”

Persistent polypharmacy and fall injury risk: the Health, Aging and Body Composition Study

“…This study included 3075 participants (48.4% male, 41.6% black) aged 70–79 years at baseline (1997/1998) [ 20 ]. They were recruited from a random sample of Medicare beneficiaries in Memphis, Tennessee (TN), and Pittsburgh, Pennsylvania (PA), and all age-eligible black community residents in these areas [ 21 ]. Participants were excluded if they: 1) reported difficulty with walking one-quarter of a mile or climbing 10 steps without resting, or difficulty with performing mobility-related activities of daily living; 2) had life-threatening cancers and received active treatment in the past 3 years; or 3) had plans of leaving the area within 3 years [ 21 ].…”

“…They were recruited from a random sample of Medicare beneficiaries in Memphis, Tennessee (TN), and Pittsburgh, Pennsylvania (PA), and all age-eligible black community residents in these areas [ 21 ]. Participants were excluded if they: 1) reported difficulty with walking one-quarter of a mile or climbing 10 steps without resting, or difficulty with performing mobility-related activities of daily living; 2) had life-threatening cancers and received active treatment in the past 3 years; or 3) had plans of leaving the area within 3 years [ 21 ]. The institutional review boards at the participating institutions approved the study protocol, and written informed consent was obtained before testing and data collection [ 21 ].…”

“…Participants were excluded if they: 1) reported difficulty with walking one-quarter of a mile or climbing 10 steps without resting, or difficulty with performing mobility-related activities of daily living; 2) had life-threatening cancers and received active treatment in the past 3 years; or 3) had plans of leaving the area within 3 years [ 21 ]. The institutional review boards at the participating institutions approved the study protocol, and written informed consent was obtained before testing and data collection [ 21 ]. The exclusion criteria for this analysis included 1) missing a 2000/01 clinic visit ( N = 671) since Medicare data was only linked for those participants; 2) lacking linked Medicare FFS Parts A and B claim data ( N = 28); 3) not having FFS coverage at 1997/98 baseline clinic visit ( N = 456) or within 6 months after the baseline visit ( N = 20); and 4) having fall injury ( N = 90) or ending FFS coverage ( N = 46) before 1998/99 clinic visit when persistent polypharmacy was measured (Fig.…”

“…The primary outcome was incident treated fall injury from the 1998/99 clinic visit to 12/31/08, identified using Fee-for-Service (FFS) Part A and Part B Medicare claim datasets which included inpatient, outpatient, physician/supplier, and carrier (claims from non-institutional providers) files [ 21 ]. The Medicare claims allowed fall injury events treated in inpatient and outpatient settings (e.g.…”