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Risk Factors for Falls in Older Disabled Women With Diabetes: The Women's Health and Aging Study

¹ Section of Internal Medicine, Gerontology, and Geriatrics, Department of Clinical and Experimental Medicine, University of Ferrara, Italy.
² Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.
³ Department of Medicine, The University of Michigan, Ann Arbor.
⁴ School of Medicine and School of Public Health, The Johns Hopkins University, Baltimore, Maryland.
⁵ Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland.

Address correspondence to Stefano Volpato, MD, MPH, Department of Clinical and Experimental Medicine, University of Ferrara, Via Savonarola, 9, 44100, Ferrara, Italy. E-mail: vlt{at}unife.it

Background. The aim of this study was to determine whether older disabled women with diabetes have an increased risk of falls compared to women without diabetes and to identify fall risk factors among this high-risk subgroup of patients.

Methods. Data are from the Women's Health and Aging Study I (n = 1002, age 65 years), a prospective, population-based cohort study of the one third most disabled women in the Baltimore (MD) urban community-dwelling population. Participants were followed semiannually for 3 years. Falls were ascertained at each interview. Diabetes was ascertained by means of a standardized algorithm using multiple sources of information.

Results. Baseline prevalence of diabetes was 15.5%. Of the 878 women who participated in at least one follow-up visit and were able to walk at baseline, 64.9% fell at least once during the study and 29.6% experienced two or more falls during a follow-up interval. After adjustment for traditional risk factors, women with diabetes had a higher probability of any fall (odds ratio [OR] 1.38; 95% confidence interval [CI], 1.04–1.81) and of falling two or more times during a follow-up interval (OR 1.69; CI, 1.18–2.43), compared with women without diabetes. Among diabetic women, presence of widespread musculoskeletal pain (OR 5.58; CI, 1.89–16.5), insulin therapy (OR 2.02; CI, 1.10–3.71), overweight (OR 3.50; CI, 1.21–10.1), and poor lower-extremity performance (OR 7.76; CI, 1.03–58.8) were independently associated with increased likelihood of recurrent falls, after adjusting for major risk factors. There were synergistic effects of diabetes and lower-extremity pain and also diabetes and body mass index levels on the risk of falling (p for interactions <.05).

Conclusion. Even among disabled older women diabetes is associated with an increased risk of falling, independent of established fall risk factors. In this specific group of older women, pain, high body mass index, and poor lower-extremity performance are powerful predictors of falling.