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Fall Patterns Predict Mortality After Hip Fracture in Older Adults, Independent of Age, Sex, and Comorbidities

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Abstract

Falls are the most frequent cause of hip fracture. We aimed to investigate whether specific fall patterns have predictive value for mortality after hip fracture. In this cohort study, data of individuals presented to the Severance Hospital, Seoul, Korea, between 2005 and 2019 due to fragility hip fracture (n = 1986) were analyzed. Fall patterns were defined as causes, activities leading to falls, and a combination of both, based on electronic medical records using pre-specified classification from a prior study on video-captured falls. Mean age of study subjects were 77 years (71% women) and 211 patients (10.6%) died during follow-up (median 544 days). Indoor falls at home had a higher mortality than outdoor falls (11.9 vs. 8.0%, p = 0.009). Among 16 fall patterns, incorrect weight shift while sitting down (adjusted hazard ratio [aHR] 4.03) or getting up (aHR 2.01), collapse during low-risk activity (aHR 2.39), and slipping while walking (aHR 2.90, p < 0.01 for all) were associated with increased mortality compared to outdoor falls, after adjustment for age, sex, and Charlson comorbidity index (CCI), constituting a high-risk pattern. High-risk fall patterns were associated with a higher risk of mortality (aHR 2.56, p < 0.001) than low-risk patterns (aHR 1.37, p = 0.080) and outdoor falls (referent; log rank p < 0.001), which improved mortality prediction when added to a base model including age, sex, and CCI (integrative area under receiver-operating characteristics curve 0.675 to 0.698, p < 0.001). Specific fall patterns were associated with higher mortality in older adults with hip fracture, independent of age, sex, and comorbidities.

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Data Availability

The data analyzed in this study is available upon reasonable request to corresponding author (NH).

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Acknowledgements

We thank Doori Cho, the members of the SENTINEL team for assistance in the data gathering process (Sung-Kil Lim Research Award 2019, 4-2018-1215).

Funding

This research was supported by the grants of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), the Ministry of Health & Welfare, Republic of Korea (Grant Number: HI19C0189), and Severance Hospital Research fund for Clinical Excellence (SHRC C-2019-0032, C-2020-0035).

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Authors and Affiliations

  1. Department of Internal Medicine, Endocrine Research Institute, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea

    Seung Won Burm, Namki Hong, Seung Hyun Lee, Minheui Yu & Yumie Rhee

  2. Department of Emergency Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea

    Ji Hoon Kim

  3. Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea

    Kwan Kyu Park

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Contributions

SWB and NH conceptualized and designed the study. SWB performed data cleaning and initial data analysis. SWB and NH performed statistical analyses. SWB wrote the initial draft of the manuscript. NH is a guarantor of data quality and analysis. All authors critically revised the manuscript and approved the final manuscript.

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Correspondence to Namki Hong.

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Conflict of interest

Seung Won Burm, Namki Hong, Seung Hyun Lee, Minheui Yu, Ji Hoon Kim, Kwan Kyu Park, and Yumie Rhee declare no conflicts of interest for this study.

Human and Animal Rights and Informed Consent

This study was approved by the institutional review board of Severance Hospital, Seoul, Korea (4-2020-1228) with the waiver of informed consent for medical record review. All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments.

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Burm, S.W., Hong, N., Lee, S.H. et al. Fall Patterns Predict Mortality After Hip Fracture in Older Adults, Independent of Age, Sex, and Comorbidities. Calcif Tissue Int 109, 372–382 (2021). https://doi.org/10.1007/s00223-021-00846-z

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