Adverse childhood experiences are associated with falling among middle-aged and older adults, US 2023 BRFSS data

Adverse childhood experiences (ACEs) have detrimental health effects later in life. Our objective was to assess the association between ACEs and falls among middle-aged and older adults in the United States.

We used data from 38 437 participants aged 45 to 80 years from the 2023 Behavioral Risk Factor Surveillance System. The outcome was falling during the past 12 months. Adverse childhood experiences included questions about events before age 18, and 2 main domains of abuse (5 questions) and household dysfunction (6 questions), with a total score of 0 to 11, dichotomized as ≥2 ACEs versus 0-1. We assessed the association between ACEs and falling and explored whether risk factors for falling mediate the association between ACEs and falling.

Among middle-aged adults (45-64 years), 22.3% had fallen, and 46.4% had ≥2 ACEs. Among older adults (≥65), 27.7% had fallen, and 31.7% had ≥2 ACEs. In multivariate analyses, participants with ≥2 ACEs have increased odds of falling compared to those with 0-1 ACEs among middle-aged (odds ratio [OR] = 1.34) and older adult participants (OR = 1.28). Even one individual ACE question, such as living with anyone who served in prison (among 45-64; OR = 1.43) or being sexually touched (among ≥65; OR = 1.45), has an independent association with falling. People with depression, functional difficulties, multimorbidity, and difficulty remembering exhibited higher proportions (%) for mediation.

Adverse childhood experiences are an additional risk factor for falling among middle-aged and older adults in the United States. Clinicians and public health practitioners should also consider ACEs when exploring determinants for falling across the life course.