Fall Rates and Risk Factors for Individuals With Type 2 Diabetes Mellitus

PURPOSE AND BACKGROUND: Primarily, we aimed to examine self-reported fall rates in a sample of individuals with Type 2 diabetes mellitus (T2DM). Secondly, we sought to explore differences in fall risk factors between self-reported fallers and nonfallers. Finally, we compared fall risk factors that contributed to fall likelihood. Falls and T2DM are two rapidly growing epidemics. To build successful interventions to address fall rates in this unique population, substantial research is needed designed to identify underlying factors contributing to fall rates for individuals with T2DM.

METHOD: For this cross-sectional research design study, participants were recruited from a primary care safety net facility. Participants had to be a patient at the facility, have a diagnosis of T2DM, be at least age 18, and have at least a sixth-grade English reading level. Participants completed background demographics and health questionnaires. They then completed multiple self-report measures used to determine a comprehensive health status picture. Assessments related to fall risk factors included health history (neuropathy, visual impairments), a recent falls history, the International Physical Activity Questionnaire short form to assess sedentary behavior using the sitting hours per week question, the Hospital Anxiety and Depression Scale (HADS) to assess anxiety and depression, the Falls Efficacy Scale–International (FES–I) to assess fear of falling (FoF), and a current medication count. A trained research assistant or occupational therapist was present to answer any questions and clarify questions as needed during the assessment period. Descriptive analysis (means and standard deviations) was used for demographic data. Self-reported fallers and nonfallers were compared using χ² and independent t tests. Multivariate linear regression was used to determine the likelihood of specific fall risk factors contributing to self-reported fall rates.

RESULTS: Of the 92 participants, the average age was 58.5, 52% identified as women, and 30% identified as Hispanic/Latino and 80% as White; 39% self-reported a recent fall. We found significant differences between self-reported fallers and nonfallers in scores on the HADS Anxiety subscale (8.86 ± 4.55 vs. 6.27 ± 2.90, p = .004), HADS Depression subscale (6.86 ± 4.10 vs. 4.66 ± 2.75, p = .006), and FES–I (34.25 ± 12.88 vs. 24.00 ± 7.45, p < .001) and in number of medications used (10.53 ± 5.67 vs. 7.49 ± 4.17, p =.004). The two greatest contributors to increased likelihood of falls were higher FoF as indicated by FES–I scores (B = 1.12, 95% confidence interval [CI] [1.06, 1.19]) and number of medications used (B = 1.16, 95% CI [1.02, 1.32]).

CONCLUSION: Participants with T2DM had a self-reported fall rate 9% higher than the 30% annual fall rate for adults over age 65. Our results offer some specific predictive fall risk factors for this sample of people with T2DM. However, we recognize that falls are a complex and multifactorial problem. Through analysis of individual needs and holistic understanding of the person and population, occupational therapy practitioners may help mitigate fall risk for this growing population. To design substantial interventions to diminish fall risk factors, occupational therapists likely need to first understand which fall risk factors should be acted on. Such interventions should address FoF and number of medications used.

IMPACT STATEMENT: Diabetes and falls are two growing epidemics. Occupational therapy practitioners can implement interventions that may reduce fall risk factors for individuals with T2DM.

References

Delbaere, K., Close, J. C., Heim, J., Sachdev, P. S., Brodaty, H., Slavin, M. J., . . . Lord, S. R. (2010). A multifactorial approach to understanding fall risk in older people. Journal of the American Geriatrics Society, 58, 1679–1685. https://doi.org/10.1111/j.1532-5415.2010.03017.x

Delbaere, K., Close, J. C., Mikolaizak, A. S., Sachdev, P. S., Brodaty, H., & Lord, S. R. (2010). The Falls Efficacy Scale International (FES–I): A comprehensive longitudinal validation study. Age and Ageing, 39, 210–216. https://doi.org/10.1093/ageing/afp225

Rubenstein, L. Z. (2006). Falls in older people: Epidemiology, risk factors and strategies for prevention. Age and Ageing, 35(Suppl. 2), ii37–ii41. https://doi.org/10.1093/ageing/afl084

Yardley, L., Beyer, N., Hauer, K., Kempen, G., Piot-Ziegler, C., & Todd, C. (2005). Development and initial validation of the Falls Efficacy Scale–International (FES–I). Age and Ageing, 34, 614–619. https://doi.org/10.1093/ageing/afi196