Diabetes Mellitus is Associated with an Increased Risk of Falls in Elderly Residents of a Long-term Care Facility

Background: Diabetes mellitus is common among elderly persons, with several potential complications that could contribute to falls. However, diabetes mellitus is not widely recognized as an important risk factor for falls among elderly persons. Accordingly, the purpose of the current study was to determine whether diabetes is an independent risk factor for falls in elderly residents of a long-term care facility.

Methods: Ours was a prospective cohort study of 139 elderly (88 +/- 7 years, range 70-105 years), Caucasian (97%) residents (women, 84%) of a long-term care facility. Inclusion criteria were age > or = 60 years, ability to rise from a seated position, informed consent obtained from participant or guardian. Multiple domains were assessed for the association with falls including: clinical diagnoses; medication use; orthostatic changes in blood pressure, gait, or balance; cognitive/mental status; general well being; activities of daily living; affect/behavior; range of motion and/or ambulation; and communication. Diabetes mellitus was determined by use of hypoglycemic agents. Time to first fall was determined by review of daily New York State mandated "Incident and Accident" reports.

Results: Over the follow-up period (mean 299 days), 49 participants (35%) experienced a fall. The fall incidence rate for the participants with and without diabetes mellitus was 78% and 30%, respectively (p <.001). The significant unadjusted hazard ratios of fall risk factors included diabetes mellitus, Berg Balance Scale score <45, number of medications, angiotensin-converting enzyme (ACE) inhibitors, hypertension, use of assistive device, inability to independently move a wheelchair, and use of antidepressants, with the latter two factors being protective. In multivariate analysis, only diabetes (adjusted hazard ratio 4.03; 95% confidence interval, 1.96-8.28) and gait and balance (adjusted hazard ratio 5.26; 95% confidence interval, 1.26-22.02) were significantly and independently associated with an increased risk of falls.

Conclusions: Our results suggest that diabetes mellitus is an independent fall risk factor among elderly nursing home residents.