Risk of Accidental Falls Among Informal Caregivers

Informal caregiving has increased over recent decades. Caregivers may face an increased risk of accidental falls because of care tasks or their consequences, such as fatigue. However, this association has not been investigated. Therefore, we aimed to examine whether giving personal care to someone at home increases fall risk.

Using longitudinal repeated measures for adults aged over 50 years in 17 European countries, with biennial data collection in 2004-2017 (N = 51,132), we compared periods of caregiving to non-caregiving for falls (outcome) using fixed-effects logistic models, estimating odds ratios (OR) with 95% confidence intervals (95% CI) while controlling for measured time-varying variables as well as unmeasured time-invariant confounders. To shed light on mechanisms, we tested effect modification by sociodemographic characteristics, and examined whether fatigue, sleep problems, lower concentration, and changes in behaviour mediate the association.

Compared with the period of not giving care, the period of providing care was associated with higher fall risk (OR 1.19 [95% CI 1.05-1.35]). This association differed by baseline household income (below or above median). In higher-income households, there was no statistically significant difference in fall risk between the period giving and not giving care (OR 1.07 [95% CI 0.90, 1.26]). In contrast, in lower-income households, the caregiving period was associated with higher fall risk (OR 1.36 [95% CI 1.14-1.63]), which was equivalent to 29% (95% CI 12-46) increased probability of falls in caregiving periods. Fatigue, sleep problems, lower concentration, and behavioural changes jointly mediated 12% of the effect; thus, most of the effect of caregiving on falls is a direct effect.

There was an increased fall risk among caregivers who provide personal care at home in lower-income households. Fatigue and other consequences of caregiving mediated only small effects. Other factors, such as lack of equipment and living space, may relate to mechanisms.