Life-space mobility declines associated with incident falls and fractures

Objectives: To determine the effect of falls and fractures on life-space mobility in a cohort of community-dwelling older adults. Design: Prospective, observational study with a baseline in-home assessment and 6-month telephone follow-up interviews over 4 years. Setting: Central Alabama. Participants: Community-dwelling adults aged 65 and older recruited from a random sample of Medicare beneficiaries stratified according to sex, race, and urban versus rural residence (N = 970). Measurements: Sociodemographic factors, medical history, depressive symptoms (Geriatric Depression Scale), cognitive function (Mini-Mental State Examination), mobility-related symptoms, transportation difficulty, and healthcare use were assessed during a baseline in-home interview of participants. Life-space mobility and falls or injuries (including fractures) were assessed at the baseline interview and at 6-month intervals in follow-up telephone calls. Results: Four hundred fifty-four (47%) participants reported at least one fall during the 4-year follow-up. The life-space score fell 3.2 points from the beginning to the end of the 6-month interval during which a fall occurred, adjusting for other known predictors of decline in life-space mobility. The decrease in interval life-space score was progressively greater for a fall and an injury (-4.7 points), a fall and a fracture (-14.2 points), and a fall and a hip fracture (-23.6 points). Conclusion: Falls, whether associated with an injury or not, were independently associated with a decrease in life-space mobility in the ensuing 6 months. Further studies are needed to determine reasons for life-space mobility decline in community-dwelling older adults with incident falls without any injuries.