The findings of this study underscore the significant impact of falls among the older adult population, highlighting critical demographic disparities and the prevalence of comorbidities. The data obtained from the TriNetX network at Virginia Commonwealth University Health System (VCUHS) provided a comprehensive overview of the incidence and prevalence of falls among individuals aged 65 and older over a five-year period.
The demographic analysis reveals that falls are most frequent among those aged 65–69, with an incidence of 26.78% and a prevalence of 46.18%. Rates generally decrease with age. Research consistently shows that the risk of falls escalates with age, especially among individuals aged 85 and older, who are notably prone to falling 6.
Males exhibit higher fall rates (incidence: 26.25%, prevalence: 44.54%) compared to females (incidence: 22.19%, prevalence: 42.21%). Literature indicates that women are more likely to experience falls than men, possibly due to higher rates of osteoporosis and sarcopenia contributing to frailty and balance issues24(p3) 25,26.
Among ethnic groups, American Indian or Alaska Native individuals show the highest fall incidence (50%) and rate (5.11 per 1,000 person-days), highlighting significant racial disparities. Hispanic or Latino individuals have an incidence of 22.22% and the highest rate (4.66 per 1,000 person-days), underscoring the need for targeted interventions. Studies reveal that African American and Hispanic older adult populations experience higher rates of fall-related injuries compared to their White counterparts, emphasizing significant disparities in fall risks among ethnic groups27 12.
The incidence and prevalence of falls among patients with various comorbidities, including cancer, diabetes mellitus, hypertension (HTN), and high weight/obesity. Our results indicate that among patients who experienced falls, those with hypertension had the highest incidence proportion (56.67%) and prevalence (75.75%), as well as an elevated incidence rate per person-day. Hypertension, in particular, is associated with the highest incidence and prevalence of falls, potentially due to the effects of antihypertensive medications causing dizziness and balance problems14,18.
Our study found that cancer patients had an incidence proportion of 23.71%, a prevalence of 43.11%, and an incidence rate of 0.26 fall cases per person-day. These results highlight a significant burden of fall-related incidents among cancer patients.
Similar studies support our findings. Stone et al. reported that falls are common among cancer patients, with a prevalence and incidence rate that closely align with our data28. They noted that cancer treatments, increased frailty, and decreased mobility contribute significantly to falling risk among these patients29. Additionally, Capone et al. found comparable incidence rates, underscoring the widespread nature of this issue in cancer populations30.
The high prevalence rate observed in our study might be due to factors such as cancer treatment side effects, increased frailty, and decreased mobility among patients. The significant incidence proportion indicates a substantial number of new fall cases, underscoring the need for robust prevention strategies.
Our findings, validated by existing literature, emphasize the critical need for ongoing research and effective healthcare policies to reduce fall incidence among cancer patients, ultimately improving their safety and quality of life.
In addition to our findings on cancer patients, our study also revealed significant data for patients with diabetes mellitus. Specifically, the incidence proportion for diabetes patients was 21.21%, with a prevalence of 38.33%, and an incidence rate of 0.22 fall cases per person-day. These findings underscore a substantial burden of fall-related incidents within the diabetic patient population.
Supporting studies show similar trends. Yang et al., conducted a systematic review and found that older adults with diabetes have a significantly higher risk of falls, with an annual incidence of up to 39% in older adults diabetic individuals. This higher incidence is likely due to complications from diabetes such as neuropathy, poor glycemic control, and increased frailty, which impair balance and increase fall risk31. Similarly, Tinetti and Speechley observed that the risk of falls is significantly elevated in diabetic individuals, highlighting the need for targeted prevention strategies32.
The high prevalence rate in our study may be attributed to the same factors, including poor glycemic control, neuropathy, and other comorbid conditions. These complications can impair balance and mobility, thereby increasing the risk of falls33. The significant incidence proportion indicates a substantial number of new fall cases, emphasizing the urgent need for effective fall prevention strategies specifically tailored for diabetic patients.
Also, we examined patients with high weight/obesity, finding an incidence proportion of 16.11%, a prevalence of 29.88%, and an incidence rate of 0.16 cases per person-day. Supporting studies align with our findings. Mitchell et al. reported that obesity increases fall risk due to factors such as decreased mobility and joint instability, reinforcing the need for targeted fall prevention strategies in obese populations34.
These findings highlight the significant impact of comorbid conditions on the risk of falls, emphasizing the need for targeted interventions to manage these comorbidities and reduce fall risk among older adult patients.
Strength
This study has several notable strengths. Utilizing a large and diverse dataset from the TriNetX network at Virginia Commonwealth University Health System (VCUHS) allows for robust analysis with significant sample size, enhancing statistical power and reliability. The use of standardized ICD-10 codes for data extraction ensures consistency and accuracy in identifying diagnoses and comorbidities, minimizing misclassification risk and improving validity. Covering a five-year period, the study provides a longitudinal perspective on the incidence and prevalence of falls among the older adults, allowing for trend observation over time. Additionally, detailed stratification by age, gender, race, and ethnicity identifies high-risk groups, supporting targeted interventions and policies to reduce fall risk and improve outcomes for older adults’ individuals.
Limitation
This retrospective study faces multiple limitations that may affect the interpretation of its findings. Firstly, the reliance on electronic health records (EHRs) could introduce biases related to incomplete or inaccurate data entries and variations in documentation practices across different providers. Additionally, the use of ICD-10 codes for data extraction might not fully capture the clinical context, possibly leading to misclassification errors. Due to its retrospective design, the study is unable to establish causal relationships.
Another significant limitation is the geographic and institutional restriction of the data to the Virginia Commonwealth University Health System (VCUHS), which may limit the generalizability of the results to other settings. The study also did not account for variables such as the severity of comorbidities and socio-economic factors, which could influence the outcomes, thereby limiting the comprehensiveness of the analysis.
Importantly, the time period of data extraction did not explicitly account for the impact of the COVID-19 pandemic. The years 2020 and 2021 saw a notable decrease in reported falls, likely due to increased reluctance to leave home and the presence of more caregivers at home to assist the elderly. This trend might significantly skew the data, representing a critical limitation for this study period.