Accidental falls, health-related quality of life and life satisfaction: A prospective study of the general elderly population

Abstract

As the physical consequences of accidental falls in the elderly are well-researched, the long-term associations between falls and quality of life and related concepts are less known. The aim of this study was to prospectively examine the long-term relations between falls and health-related quality of life (HRQoL) and life satisfaction (LS) over six years in the general elderly population.

One thousand three hundred and twenty-one subjects (aged 60–93 years), from the general population in the south of Sweden, were included in a baseline assessment and a follow-up after six years. HRQoL was measured with the SF-12 and LS with the life satisfaction index A (LSI-A). The differences in mean scores between fallers at baseline (n = 113) and non-fallers were statistical analyzed. Furthermore, the prediction of falls on the outcomes was analyzed using a multivariate linear regression model adjusted for multiple confounding factors.

Fallers scored significant lower in HRQoL and LS at baseline and after six years, compared to non-fallers, especially in the SF-12 physical component (p = <0.001). In the linear regression analysis, one or more falls at the baseline predicted a significant reduction in the SF-12 physical component at the follow-up assessment (B-Coefficient −1.8, 95% CI −3.4 to −0.2). In conclusion, falls predict a long-term reduction in the physical component of HRQoL in the general elderly population. Over six years, fallers had a notable chronic lowered score in both HRQoL and LS, compared to non-fallers. This long-term depression of elderly fallers in these aspects may be more extent than previous assumed.

Introduction

Accidental falls in the elderly continue to be a major health problem, despite extensive research and preventive efforts (Anonymous, 2001, Hausdorff et al., 2001, Kannus et al., 2005). Unintentional injury is one of the foremost causes of death and ill-health in the western world, and in Sweden, fall-related mortality has risen since the mid-1990s (Björkenstam and Johansson, 2011, Sjogren and Bjornstig, 1989). Besides physical injuries, the consequences of falls in the elderly are broad with additional psychological and social consequences (Akyol, 2007, Gillespie et al., 2012, von Heideken Wagert et al., 2009). Falls can also affect the family and relatives and are a contributing factor for nursing home admissions (Anonymous, 2011, Tinetti, 2003, Tinetti and Williams, 1997). Falls in the elderly and their physical consequences have been well-researched: A fracture is estimated to occur in about 1–5% of the falls among the elderly residing in the community (Nevitt et al., 1991, Tinetti et al., 1994). Additionally, about 30–50% results in minor soft tissue injuries that do not receive medical attention (Nevitt et al., 1991). Although a majority of falls results in no severe physical injury, the psychological and functional consequences can be severe (Rubenstein, Josephson, & Robbins, 1994). A fall can cause fear of falling, where anxiety, loss of self-confidence and activity avoidance result in self-imposed functional limitations (Cumming et al., 2000, Oliver et al., 2004, Scheffer et al., 2008, Suzuki et al., 2002). This concept was introduced by Murphy and Isaacs’ description of a post-fall syndrome in 1982 (Murphy & Isaacs, 1982).

As the concept fear of falling is established in the literature, the concept of health-related quality of life (HRQoL) have increasingly gained recognition as an important tool for evaluating effects on medical treatment (Lin, Wolf, Hwang, Gong, & Chen, 2007). Improved quality of life can be seen as one of the most desirable outcomes of all health polices (Farquhar, 1995). In a large study of the elderly, fear of falling was identified as a major factor related to reduced HRQoL (Chang, Chi, Yang, & Chou, 2010). Fear of falling is even suggested to be the main impact on reduced HRQoL after a fall, rather than the actual fall or its sequelae (Iglesias, Manca, & Torgerson, 2009).

Although lacking a clear definition, the broad concept of quality of life is frequently used to describe ‘the good life’ within several disciplines with a range of various aspects (Berg, 2008). HRQoL refers to how health impacts an individual's ability to function and the perceived well-being in physical, mental and social domains of life. As many studies have focused on the physical consequences of falls, there is an explicit need for comprehensive studies of societal impact of falls in the elderly focusing on HRQoL and similar instruments (Hartholt et al., 2011). These measurement can be useful in evaluating the elderly with potential chronic multimorbidity, where perceived health and well-being can be more adequate apposed medically defined diagnoses and status. A literature review from 2012, assessing the scientific knowledge related to quality of life and falls in the elderly, revealed gaps in knowledge, unclear definition of the concept and a predominance of descriptive studies (Nicolussi et al., 2012).

Although overlapping the term quality of life, the concept of life satisfaction (LS) can be defined as a ‘cognitive judgmental global evaluation of one's life’, or ‘not just an absence of disease or disability but also includes the satisfaction of social and psychological needs’ (Diener, 1984, Enkvist et al., 2011). In comparison, HRQoL can be seen as measuring present health and health past month, while LS is more of a global instrument measuring life satisfaction in a life perspective (Ekström, 2009). Although LS is widely used measuring well-being in later life, no other study have, to our knowledge, analyzed the association between falls and LS in the general elderly population (Berg, 2008).

The aim of this study was to prospective examine the long-term relations between falls and HRQoL and LS over six years in the general elderly population.