We identified demographic, health and lifestyle factors associated with falls in adults aged 50–64 years from Australia, The Netherlands, Great Britain and Ireland. Nearly all factors were associated with falls, but there were differences between countries and between men and women. Existing falls prevention programs may also benefit middle-aged adults.
Between ages 40–44 and 60–64 years, the annual prevalence of falls triples suggesting that middle age may be a critical life stage for preventive interventions. We aimed to identify demographic, health and lifestyle factors associated with falls in adults aged 50–64 years.
Harmonised data were used from four population-based cohort studies based in Australia (Australian Longitudinal Study on Women’s Health, n = 10,641, 51–58 years in 2004), Ireland (The Irish Longitudinal Study on Ageing, n = 4663, 40–64 years in 2010), the Netherlands (Longitudinal Ageing Study Amsterdam, n = 862, 55–64 years in 2012–13) and Great Britain (MRC National Survey of Health and Development, n = 2987, 53 years in 1999). Cross-sectional and prospective associations of 42 potential risk factors with self-reported falls in the past year were examined separately by cohort and gender using logistic regression. In the absence of differences between cohorts, estimates were pooled using meta-analysis.
In cross-sectional models, nearly all risk factors were associated with fall risk in at least one cohort. Poor mobility (pooled OR = 1.71, CI = 1.34–2.07) and urinary incontinence (OR range = 1.53–2.09) were consistently associated with falls in all cohorts. Findings from prospective models were consistent. Statistically significant interactions with cohort and sex were found for some of the risk factors.
Risk factors known to be associated with falls in older adults were also associated with falls in middle age. Compared with findings from previous studies of older adults, there is a suggestion that specific risk factors, for example musculoskeletal conditions, may be more important in middle age. These findings suggest that available preventive interventions for falls in older adults may also benefit middle-aged adults, but tailoring by age, sex and country is required.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Price includes VAT (USA)
Tax calculation will be finalised during checkout.
Collerton J, Kingston A, Bond J, Davies K, Eccles MP, Jagger C, Kirkwood TB, Newton JL (2012) The personal and health service impact of falls in 85 year olds: cross-sectional findings from the Newcastle 85+ cohort study. PLoS One 7(3):e33078. https://doi.org/10.1371/journal.pone.0033078
Stel VS, Smit JH, Pluijm SM, Lips P (2004) Consequences of falling in older men and women and risk factors for health service use and functional decline. Age Ageing 33(1):58–65
Peeters GM, Jones M, Byles J, Dobson AJ (2015) Long-term consequences of noninjurious and injurious falls on well-being in older women. J Gerontol A Biol Sci Med Sci 70(12):1519–1525. https://doi.org/10.1093/gerona/glv102
Peeters G, van Schoor NM, Cooper R, Tooth L, Kenny RA (2018) Should prevention of falls start earlier? Co-ordinated analyses of harmonised data on falls in middle-aged adults across four population-based cohort studies. PLoS One 13(8):e0201989. https://doi.org/10.1371/journal.pone.0201989
Preventing Falls and Harm From Falls in Older People - Best Practice Guidelines for Australian Community Care 2009 (2009). Australian commission on safety and quality in health care. Commonwealth of Australia
National Steering Group on the Prevention of Falls in Older People and the Prevention and Management of osteoporosis throughout life (2008) Strategy to prevent falls and fractures in Ireland’s ageing population. Health Service Executive, Dublin
Atkins R (2010) 2010 AGS/BGS clinical practice guideline: prevention of falls in older persons. American Geriatrics Society
Nederlandse Vereniging voor Klinische Geriatrie (2017) Preventie van valincidenten bij ouderen. Richtlijn Database, Federatie van de Medisch Specialisten. https://www.richtlijnendatabase.nl/richtlijn/preventie_van_valincidenten_bij_ouderen/startpagina_-_preventie_van_valincidenten.html. Accessed 16 Aug 2018 2018
Deandrea S, Lucenteforte E, Bravi F, Foschi R, La Vecchia C, Negri E (2010) Risk factors for falls in community-dwelling older people: a systematic review and meta-analysis. Epidemiology 21(5):658–668. https://doi.org/10.1097/EDE.0b013e3181e89905
Ambrose AF, Paul G, Hausdorff JM (2013) Risk factors for falls among older adults: a review of the literature. Maturitas 75(1):51–61. https://doi.org/10.1016/j.maturitas.2013.02.009
Reinders I, van Schoor NM, Deeg DJH, Huisman M, Visser M (2017) Trends in lifestyle among three cohorts of adults aged 55–64 years in 1992/1993, 2002/2003 and 2012/2013. Eur J Public Health. https://doi.org/10.1093/eurpub/ckx173
Lv J, Liu Q, Ren Y, Gong T, Wang S, Li L (2011) Socio-demographic association of multiple modifiable lifestyle risk factors and their clustering in a representative urban population of adults: a cross-sectional study in Hangzhou, China. Int J Behav Nutr Phys Act 8:40. https://doi.org/10.1186/1479-5868-8-40
House JS, Lantz PM, Herd P (2005) Continuity and change in the social stratification of aging and health over the life course: evidence from a nationally representative longitudinal study from 1986 to 2001/2002 (Americans’ Changing Lives Study). J Gerontol B Psychol Sci Soc Sci 60(Spec No 2):15–26
Mishra GD, Ball K, Dobson AJ, Byles JE (2004) Do socioeconomic gradients in women’s health widen over time and with age? Soc Sci Med 58(9):1585–1595. https://doi.org/10.1016/S0277-9536(03)00368-X
White AM, Tooth LR, Peeters GMEE (2018) Fall risk factors in mid-age women: the Australian longitudinal study on women’s health. Am J Prev Med 54(1):51–63. https://doi.org/10.1016/j.amepre.2017.10.009
Kool B, Ameratunga S, Robinson E (2012) Association between prescription medications and falls at home among young and middle-aged adults. Inj Prev 18(3):200–203. https://doi.org/10.1136/injuryprev-2011-040202
Thornley S, Kool B, Marshall RJ, Ameratunga S (2014) Alcohol intake, marijuana use, and sleep deprivation on the risk of falls occurring at home among young and middle-aged adults: a case-crossover study. N Z Med J 127(1406):32–38
Malmivaara A, Heliovaara M, Knekt P, Reunanen A, Aromaa A (1993) Risk factors for injurious falls leading to hospitalization or death in a cohort of 19,500 adults. Am J Epidemiol 138(6):384–394
Franse CB, Rietjens JA, Burdorf A, van Grieken A, Korfage IJ, van der Heide A, Mattace Raso F, van Beeck E, Raat H (2017) A prospective study on the variation in falling and fall risk among community-dwelling older citizens in 12 European countries. BMJ Open 7(6):e015827. https://doi.org/10.1136/bmjopen-2017-015827
Lee C, Dobson AJ, Brown WJ, Bryson L, Byles J, Warner-Smith P, Young AF (2005) Cohort profile: the Australian longitudinal study on women’s health. Int J Epidemiol 34(5):987–991. https://doi.org/10.1093/ije/dyi098
Dobson AJ, Hockey R, Brown WJ, Byles JE, Loxton DJ, McLaughlin D, Tooth LR, Mishra GD (2015) Cohort profile update: Australian longitudinal study on women’s health. Int J Epidemiol 44(5):1547, 1547a-1547f. https://doi.org/10.1093/ije/dyv110
Huisman M, Poppelaars J, van der Horst M, Beekman AT, Brug J, van Tilburg TG, Deeg DJ (2011) Cohort profile: the longitudinal aging study Amsterdam. Int J Epidemiol 40(4):868–876. https://doi.org/10.1093/ije/dyq219
Kuh D, Pierce M, Adams J, Deanfield J, Ekelund U, Friberg P, Ghosh AK, Harwood N, Hughes A, Macfarlane PW, Mishra G, Pellerin D, Wong A, Stephen AM, Richards M, Hardy R (2011) Cohort profile: updating the cohort profile for the MRC national survey of health and development: a new clinic-based data collection for ageing research. Int J Epidemiol 40(1):e1–e9. https://doi.org/10.1093/ije/dyq231
Wadsworth M, Kuh D, Richards M, Hardy R (2006) Cohort profile: the 1946 national birth cohort (MRC national survey of health and development). Int J Epidemiol 35(1):49–54. https://doi.org/10.1093/ije/dyi201
Kearney PM, Cronin H, O’Regan C, Kamiya Y, Savva GM, Whelan B, Kenny R (2011) Cohort profile: the Irish longitudinal study on ageing. Int J Epidemiol 40(4):877–884. https://doi.org/10.1093/ije/dyr116
Deandrea S, Bravi F, Turati F, Lucenteforte E, La Vecchia C, Negri E (2013) Risk factors for falls in older people in nursing homes and hospitals. A systematic review and meta-analysis. Arch Gerontol Geriatr 56(3):407–415. https://doi.org/10.1016/j.archger.2012.12.006
de Boer A, Geuskens GA, Bultmann U, Boot CRL, Wind H, Koppes LLJ, Frings-Dresen MHW (2018) Employment status transitions in employees with and without chronic disease in the Netherlands. Int J Publ Health 63(6):713–722. https://doi.org/10.1007/s00038-018-1120-8
Demou E, Bhaskar A, Xu T, Mackay DF, Hunt K (2017) Health, lifestyle and employment beyond state-pension age. BMC Public Health 17(1):971. https://doi.org/10.1186/s12889-017-4957-5
van Rijn RM, Robroek SJ, Brouwer S, Burdorf A (2014) Influence of poor health on exit from paid employment: a systematic review. Occup Environ Med 71(4):295–301. https://doi.org/10.1136/oemed-2013-101591
Ganz DA, Bao Y, Shekelle PG, Rubenstein LZ (2007) Will my patient fall? JAMA 297(1):77–86. https://doi.org/10.1001/jama.297.1.77
Muir SW, Gopaul K, Montero Odasso MM (2012) The role of cognitive impairment in fall risk among older adults: a systematic review and meta-analysis. Age Ageing 41(3):299–308. https://doi.org/10.1093/ageing/afs012
Kearney FC, Harwood RH, Gladman JR, Lincoln N, Masud T (2013) The relationship between executive function and falls and gait abnormalities in older adults: a systematic review. Dement Geriatr Cogn Disord 36(1–2):20–35. https://doi.org/10.1159/000350031
van Schoor NM, Smit JH, Pluijm SM, Jonker C, Lips P (2002) Different cognitive functions in relation to falls among older persons. Immediate memory as an independent risk factor for falls. J Clin Epidemiol 55(9):855–862
Anstey KJ, von Sanden C, Luszcz MA (2006) An 8-year prospective study of the relationship between cognitive performance and falling in very old adults. J Am Geriatr Soc 54(8):1169–1176
Lord SR, Smith ST, Menant JC (2010) Vision and falls in older people: risk factors and intervention strategies. Clin Geriatr Med 26(4):569–581. https://doi.org/10.1016/j.cger.2010.06.002
Saftari LN, Kwon OS (2018) Ageing vision and falls: a review. J Physiol Anthropol 37(1):11. https://doi.org/10.1186/s40101-018-0170-1
Kulmala J, Viljanen A, Sipila S, Pajala S, Parssinen O, Kauppinen M, Koskenvuo M, Kaprio J, Rantanen T (2009) Poor vision accompanied with other sensory impairments as a predictor of falls in older women. Age Ageing 38(2):162–167. https://doi.org/10.1093/ageing/afn228
Wilson SJ, Garner JC, Loprinzi PD (2016) The influence of multiple sensory impairments on functional balance and difficulty with falls among U.S. adults. Prev Med 87:41–46. https://doi.org/10.1016/j.ypmed.2016.02.023
Tiedemann AC, Sherrington C, Lord SR (2007) Physical and psychological factors associated with stair negotiation performance in older people. J Gerontol A Biol Sci Med Sci 62(11):1259–1265
Menant JC, St George RJ, Fitzpatrick RC, Lord SR (2010) Impaired depth perception and restricted pitch head movement increase obstacle contacts when dual-tasking in older people. J Gerontol A Biol Sci Med Sci 65(7):751–757. https://doi.org/10.1093/gerona/glq015
Cawthon PM, Harrison SL, Barrett-Connor E, Fink HA, Cauley JA, Lewis CE, Orwoll ES, Cummings SR (2006) Alcohol intake and its relationship with bone mineral density, falls, and fracture risk in older men. J Am Geriatr Soc 54(11):1649–1657. https://doi.org/10.1111/j.1532-5415.2006.00912.x
Mukamal KJ, Mittleman MA, Longstreth WT Jr, Newman AB, Fried LP, Siscovick DS (2004) Self-reported alcohol consumption and falls in older adults: cross-sectional and longitudinal analyses of the cardiovascular health study. J Am Geriatr Soc 52(7):1174–1179. https://doi.org/10.1111/j.1532-5415.2004.52318.x
Peeters GM, van Schoor NM, Pluijm SM, Deeg DJ, Lips P (2010) Is there a U-shaped association between physical activity and falling in older persons? Osteoporos Int 21(7):1189–1195. https://doi.org/10.1007/s00198-009-1053-4
Andre H, Moniz-Pereira V, Carnide F, Machado ML, Veloso A Does the prevalence of falls decrease with higher physical activity levels in the elderly? In: Congress of the European college of sports science (ECSS), Antalya, Turkey, 23–26 June 2010
Pahor M, Guralnik JM, Ambrosius WT, Blair S, Bonds DE, Church TS, Espeland MA, Fielding RA, Gill TM, Groessl EJ, King AC, Kritchevsky SB, Manini TM, McDermott MM, Miller ME, Newman AB, Rejeski WJ, Sink KM, Williamson JD (2014) Effect of structured physical activity on prevention of major mobility disability in older adults: the LIFE study randomized clinical trial. JAMA 311(23):2387–2396. https://doi.org/10.1001/jama.2014.5616
Pluijm SM, Smit JH, Tromp EA, Stel VS, Deeg DJ, Bouter LM, Lips P (2006) A risk profile for identifying community-dwelling elderly with a high risk of recurrent falling: results of a 3-year prospective study. Osteoporos Int 17(3):417–425. https://doi.org/10.1007/s00198-005-0002-0
Some of the research on which this article is based was conducted as part of the Australian Longitudinal Study on Women’s Health by The University of Newcastle and The University of Queensland. We are grateful to the women who provided the survey data and to the Australian Government Department of Health for funding. The NSHD is funded by the UK Medical Research Council. We are grateful to NSHD study members for their continuing support. NSHD data used in this publication are available to bona fide researchers upon request to the NSHD Data Sharing Committee via a standard application procedure. Further details can be found at http://www.nshd.mrc.ac.uk/data doi: https://doi.org/10.5522/NSHD/Q101; doi: https://doi.org/10.5522/NSHD/Q102. The Longitudinal Ageing Study Amsterdam is supported by a grant from the Netherlands Ministry of Health Welfare and Sports, Directorate of Long-Term Care. The data collection [in 2012–2013 and 2013-2014] was financially supported by the Netherlands Organization for Scientific Research (NWO) in the framework of the project “New Cohorts of young old in the 21st century” (file number 480-10-014). The Irish Longitudinal Study on Ageing (TILDA) is funded by the Irish Government, the Atlantic Philanthropies and Irish Life PLC. We are grateful to all of the TILDA respondents for participating in the study. Researchers interested in using TILDA data may access the data for free from the following sites:
Irish Social Science Data Archive at University College Dublin http://www.ucd.ie/issda/data/tilda/;
Interuniversity Consortium for Political and Social Research (ICPSR) at the University of Michigan http://www.icpsr.umich.edu/icpsrweb/ICPSR/studies/34315.
GP was supported by a Global Brain Health Institute Fellowship. RC was supported by the UK Medical Research Council (programme code: MC_UU_12019/4).
Conflicts of interest
The funders had no role in the study design, data collection, data analysis, data interpretation, writing of the report or the decision to submit the article for publication.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
About this article
Cite this article
Peeters, G., Cooper, R., Tooth, L. et al. A comprehensive assessment of risk factors for falls in middle-aged adults: co-ordinated analyses of cohort studies in four countries. Osteoporos Int 30, 2099–2117 (2019). https://doi.org/10.1007/s00198-019-05034-2
- Accidental falls
- Population health