The “Domino Effect”: Functional Decline and Increased Social Care Requirements Following a Fall

OBJECTIVES: Falls represent an important inflection point in later life, increasing the risk of future adverse outcomes. This study aims to examine the association between an index fall, that is, a fall in a participant with no recent history of falls, and subsequent change in functional status, requirements for social care, and falls-related health care utilization. DESIGN: Longitudinal analysis of population-representative data. SETTING AND PARTICIPANTS: Participants (n = 2454) aged ≥65 years from waves 1 to 3 of The Irish Longitudinal Study on Aging. METHODS: Index falls were those reported at wave 2 in participants with no falls reported at wave 1. Falls/fractures, functional status (activities of daily living), and social care (home care, home help, and meals on wheels) were assessed by self-report. Regression models assessed the independent relationship between index falls and outcomes of interest. RESULTS: Twenty percent of participants (n = 493) reported an index fall. In participants who were functionally independent at baseline, an index fall was associated with functional impairment at 2-year follow-up (odds ratio [OR], 1.71; 95% CI, 1.19-2.47; P = .004). Almost 12% with index falls developed functional impairment. In those not requiring home care at baseline, an index fall was independently associated with an almost 3-fold higher likelihood of requiring home care (OR, 2.87; 95% CI, 1.38-5.97; P = .005) and a higher number of monthly home care hours (β = 0.76; 95% CI, 0.18-1.34; P = .010) at 2-year follow-up. Almost 12% with index falls required "new" social supports. An index fall was independently associated with future falls-related emergency department presentations (OR, 1.69; 95% CI, 1.14-2.49; P = .008), future fractures (OR, 1.52; 95% CI, 1.08-2.15; P = .018), but not more general practitioner visits during follow-up. CONCLUSIONS AND IMPLICATIONS: This study demonstrates that even a single fall can signal a significant shift in the health and functional trajectories of community-dwelling older people, reinforcing the need for proactive and coordinated prevention strategies.