Fall Risk Factors in Older Patients with Sickle Cell Disease (SCD): A Narrative Review

Background: Sickle cell disease (SCD) is a hematologic disorder that affects approximately 100,000 Black individuals in the United States. Although extensive literature describes fall risk factors in adults 65 years and older, evidence regarding fall risk in older adults with SCD remains limited and largely anecdotal. Risk factors for falls in adults aged 50 years and older with SCD overlap with those observed in the general geriatric population aged 65 years and older. Objective: The objective of this study was to describe factors associated with increased fall risk in older patients with SCD. Data Sources: A literature search of PubMed and MEDLINE was performed using the following search terms: "sickle cell disease", "falls", "risk factors", "older adults", "management," and "prevention," as well as combinations of these terms. Data Synthesis: Fifteen studies were identified. Reduced physical functioning, dizziness/imbalance, cognitive impairment, visual deficits, vitamin D deficiency, osteoporosis, polypharmacy, and silent cerebral ischemia (SCI) were identified as risk factors for SCD-related falls. Discussion: Fall risk factors, prevention, and management strategies in patients are understudied and complex. Fall-prevention strategies used for older adults are also important for patients with SCD. Conclusion: Falls in older adults with SCD appear to reflect a convergence of neuromusculoskeletal complications, sensory deficits, cognitive vulnerability, and medication-related effects; however, the evidence base remains limited, and SCD-specific guidance is lacking. Clinicians should evaluate older adults with SCD for the aforementioned fall risk factors.