Association of average cumulative sensory impairment with falls and hip fractures in older adults: Evidence from a longitudinal study

BACKGROUND: Sensory impairment is prevalent among older adults and a recognized risk factor for falls and fractures. However, prior studies treated sensory impairment as a static, point-in-time exposure, overlooking its progressive nature. This study investigated the association between the long-term, cumulative burden of sensory impairment and risks of falls and hip fractures in older adults. METHODS: This longitudinal investigation included 3391 participants aged ≥60 years from the China Health and Retirement Longitudinal Study (CHARLS). Average cumulative sensory impairment scores (dual, visual, and auditory) were calculated across four waves (2011-2018) using the area under the curve. Incident falls and hip fractures were assessed through self-report during follow-up (2013-2020). Cox proportional hazards models and restricted cubic spline analyses evaluated associations. RESULTS: During follow-up, 1576 falls and 189 hip fractures occurred. In fully adjusted models, compared with the lowest quartile (Q1), participants in the highest quartile (Q4) of average cumulative dual sensory impairment exhibited a 36% higher fall risk (HR = 1.36, 95% CI: 1.18-1.58) and a 116% higher hip fracture risk (HR = 2.16, 95% CI: 1.36-3.45). Significant linear trends were evident for both outcomes (P for trend <0.01). Similar graded associations were found for visual and auditory impairment separately. Restricted cubic spline analyses confirmed monotonic, linear dose-response relationships. CONCLUSION: The long-term burden of sensory impairment is independently and dose-dependently associated with increased risks of falls and hip fractures. These findings highlight the importance of dynamic sensory monitoring and integrating sensory health management into prevention strategies. CLINICAL TRIAL NUMBER: not applicable.