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Changes in Fall Rates From Before to During the COVID-19 Pandemic: Findings From the Prospective AMBROSIA Study
C Barrett Bowling1,2, Rong X Wei3, Lei Qian3
1Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham Veterans Affairs Medical Center (VAMC), Durham, North Carolina, USA.
Insights
During COVID-19, fall rates in older adults increased during initial reopening phases but decreased during shelter-in-place periods. Healthcare providers should monitor fall risks as community mobility resumes.
Area of Science:
- Gerontology
- Epidemiology
- Public Health
Background:
- The COVID-19 pandemic prompted social distancing policies, altering community movement patterns.
- The impact of these policies on fall rates among older adults remains under-described.
Purpose of the Study:
- To investigate fall rates in adults aged 65 and older during different phases of the COVID-19 pandemic.
- To compare pandemic-era fall rates with pre-pandemic data.
Main Methods:
- Prospective cohort study of 250 adults aged 65+ (AMBULA TORY Blood Pressure in Older Adults [AMBROSIA] cohort).
- Monthly falls calendars collected from August 2019 to March 2021.
- Data grouped to compare fall 2020 reopening and winter 2020 shelter-in-place periods with the prior year.
Main Results:
- A total of 421 falls were reported by 44% of participants (rate: 15.1 per 100 calendar months).
- Fall rates were higher during the August-October 2020 reopening phase compared to the previous year (rate ratio: 1.8).
- Fall rates were lower during the November 2020-January 2021 shelter-in-place period (rate ratio: 0.5).
Conclusions:
- Fall rates in older adults fluctuated with pandemic-related policy changes and mobility.
- Increased community mobility post-shelter-in-place may pose a renewed fall risk.
- Healthcare providers need to remain vigilant regarding fall prevention in older adults as pandemic conditions evolve.
Background:
Coronavirus disease 2019 (COVID-19) social distancing policies resulted in reductions in community movement, however, fall rates during this time have not been described.
Methods:
This prospective study included adults ≥65 years old participating in the Ambulatory Blood Pressure in Older Adults (AMBROSIA) cohort and who completed ≥1 monthly falls calendar (August 2019-March 2021; n = 250). Months were grouped to correspond to the fall 2020 phased reopening (August-October) and the shelter-in-place policy during the winter 2020 surge (November-January) in Los Angeles, California and compared to the same months, 1 year earlier (ie, before the pandemic).
Results:
Participants had a mean (standard deviation [SD]) age of 75.2 (6.1) years, 49.6% were White, and 53.2% were women. We obtained 2 795 falls calendars during follow-up. Overall, 110 (44.0%) participants reported a total of 421 falls (rate 15.1 per 100 calendar months). The highest monthly fall rate during the pandemic was 22.9 (95% confidence interval [CI] 16.4-31.1) per 100 calendar-months in August 2020. The lowest fall rate during the pandemic was 8.6 (95% CI 3.5-17.8) per 100 calendar-months in February 2021. During the pandemic, fall rates in August, September, and October 2020 were higher than the previous year (rate ratio 1.8 [95% CI 1.1-2.9]), and fall rates in November and December 2020 and January 2021 were lower than the previous year (rate ratio 0.5 [95% CI 0.4-0.8]).
Conclusion:
As the pandemic continues and older adults resume community mobility after a shelter-in-place period, providers should pay attention to the risk of falls.
