Falling up to six months before an operation is common—and not just for elderly patients.
Surprisingly, the frequency of falls among middle-aged people is slightly higher than those who are 65 or older, according to a study of 15,000 adults.
“We may need to reconsider which patients are most at risk of falling.”
Additionally, the findings link preoperative falls to a lower quality of life and the inability to carry out daily tasks, such as using the bathroom independently. The findings suggest a patient’s history of falling may be a powerful pre-surgical tool in assessing overall health.
The observational study, published in the journal Anesthesiology, shows that 26 percent of participants fell down in the six months preceding elective surgery, and more than half of these falls caused injuries. The findings are particularly concerning, researchers say, because prior studies have linked pre-surgical falls to surgical complications and worse overall outcomes.
“A history of falls is likely to be a marker of patient vulnerability and poor health,” says senior author Michael S. Avidan, professor of anesthesiology at Washington University in St. Louis School of Medicine.
“Our study suggests that a history of falls may help to detect aspects of poor health that are not usually found in the process of obtaining a patient’s medical history and conducting a physical examination.
“This is probably because a history of falls provides insight into a patient’s health that is not related to specific conditions such as diabetes and heart disease.”
Patients in the study underwent a variety of operations—such as cataract surgery and knee replacement—during an 18-month period that ended in August 2015.
Falls and baseline health
Preoperative falls may indicate baseline health better than some other currently used measures, says first author and medical student Vanessa L. Kronzer. “Falls before surgery have not been rigorously studied, but our results point to the need for further exploration.”
Most surprising was the frequency of falls among middle-aged patients, ages 45 to 64. This group saw the highest proportion of patients who fell—28 percent. Of these, 13 percent fell more than once.
By comparison, for patients ages 65 and older, 26 percent of patients fell, with 11 percent falling more than once. For patients 44 and younger, 24 percent fell and 12 percent fell recurrently.
“As you can see, those numbers are not very different, and that’s exactly the point,” Kronzer says. “We were expecting to see a large increase in the percentage of falls from young adulthood to middle age to older age, but that didn’t happen. Instead, the percentage of people who fell was similar across all ages. This finding suggests we may need to reconsider which patients are most at risk of falling.”
Middle-aged patients also experienced the highest proportion of severe fall-related injuries.
“This is the time of life when physical decline starts to occur; however, the individual may not be aware of it yet,” Kronzer says. “Falling may indicate that physical decline is beginning, giving physicians valuable insight that ultimately may lead to positive post-surgical outcomes.”
Researchers also examined contributing factors and found that falling was most common among patients with conditions such as osteoarthritis, rheumatoid arthritis, incontinence, impaired mobility, dizziness, and poor perceived health.
Depression was associated with an increased likelihood of falling in patients aged 50 and older. Among patients aged 44 and younger, osteoarthritis was associated with higher odds of falling. Middle-aged women who suffered from incontinence also had a higher risk of falling.
“One of the next steps will be to study whether a history of falls can predict post-operative outcomes,” Kronzer says.
The National Institutes of Health and grants from the Barnes-Jewish Hospital Foundation, the Washington University Institute of Clinical and Translational Sciences, and the Washington University Department of Anesthesiology supported the work.
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