Falls prevention begins at 40, experts say, as new research challenges the assumption that falls are a problem of old age only.
Researchers studied the prevalence of self-reported falls among more than 19,000 men and women aged 40-64 in Australia, Ireland, Great Britain and the Netherlands, using longitudinal survey data.
Writing in the journal PLOS ONE this month, they warned: “While the prevalence of falls is lower in middle-aged adults than in older adults, the current findings show that the prevalence is not low.”
Women more at risk of falls
Falls in middle-age were more common among women than men (27% versus 15%) and the prevalence rose sharply over the mid-life period. The rate of falls in women was 9% at 40-44 years old, 19% at 45-49 years old, 21% at 50-54 years old, 27% at 55-59 years old and 30% at 60-64 years old.
The study concluded: “The sharp increase in prevalence of falls in middle-age, particularly among women, supports the notion that falls are not just a problem of old age, and that middle-age may be a critical life stage for preventative interventions.”
Overall, Australia had the highest falls rate, although the Australian cohort was older and included women only (10,556 women from the Australian Longitudinal Study on Women’s Health).
The authors suggested that the greater increase in prevalence of falls among women than men may be explained by the concurrent stronger increase in prevalence of risk factors such as arthritis, cardiovascular disease and post-menopause.
Lead study author, Dr Geeske Peeters (PhD) of the Global Brain Health Institute at Trinity College Dublin, told doctorportal the findings highlighted a need to intervene in mid-life to reduce falls risks.
“It is obvious that falls require attention not only after the age of 65 but also before the age of 65,” she said.
Balance and strength training needed earlier for falls prevention
“We know that balance and strength training is important in older adults,” she said. “As balance starts to decline from age 40, and poor mobility seems to be an important predictor of falls, it is reasonable to expect that balance training may also be beneficial in middle-aged adults.”
An earlier study by Dr Peeters and colleagues identified several factors that increased the risk of falls in middle-aged Australian women, including obesity, impaired vision, depression, joint stiffness, fatigue and osteoporosis. Hormone replacement therapy (HRT) was found to be protective.
However, the study failed to identify a clear trend with age in the number and types of significant predictors, with the authors reporting a “complex interplay of risk factors”.
Professor Susan Davis, director of the Women’s Health Research Program at Monash University noted previous research showed middle-aged and older women were at greater risk of falls if they were more physically active.
“Perhaps the kind of physical activity they do does not always take into account the need for multi-modal activity, such as balance exercises in addition to walking,” she said.
Menopause also a risk factor
She explained how menopause could also influence falls risk.
“Menopause is associated with increased tendinopathy, which the physiotherapists report all the time,” she said. “So there is possibly a hormonal effect on soft tissue that affects musculoskeletal integrity, and therefore the potential to fall.”
“Women also gain central fat at midlife and increase total body fat even if they do not increase total body weight; more fat with less muscle adds to less musculoskeletal integrity.”
Professor Davis said the study’s finding of a protective effect of HRT on falls risk may reflect a “healthy user” bias. In other words, women might be less likely to use HRT if they have impaired vision, poor physical functioning or other illness causing tiredness.
HRT might also have an independent protective effect by reducing the incidence of bone loss and lowered mood, she said.
The study authors said their findings were potentially limited by recall bias, and by slight differences in the measurement of falls between cohorts.