Aging
How do discrepancies between subjective and objective health predict the risk of injurious falls in older Swedish adults? Bill Calvey* Bill Calvey Anna-Karin Welmer Amaia Calderon Larrañaga Joanna McHugh Power Rebecca Maguire
Objectives
Previous studies demonstrated that discrepancies between subjective and objective health measures are associated with physical and mental health-related outcomes in older adults. However, the extent to which they relate to risk of injurious falls remains unclear. We investigate whether such discrepancies are associated with risk of injurious falls in community-dwelling Swedish older adults.
Method
A prospective, observational cohort study, using data from the Swedish National Study on Aging and Care in Kungsholmen followed a sample of 2,222 older adults, aged 60+ years at baseline (2001 – 2011). A ‘health asymmetry’ metric classified older adults into four categories, based on the level of agreement between their subjective and objective health scores (‘health pessimist’, ‘health optimist’, ‘poor health realist’ and ‘good health realist’). Time-varying Cox proportional hazard and Laplace regressions were used to investigate whether these health asymmetry categories were associated with risk of injurious falls, i.e. falls leading to inpatient or outpatient care.
Results
Over a ten-year follow-up, 23.5% of the sample experienced an injurious fall. Health optimists had the greatest risk of experiencing an injurious fall (HR: 2.16, 95% CI: 1.66, 2.80), when compared to good health realists. Poor health realists (HR: 1.77, 95% CI: 1.50, 2.11) and health pessimists (HR: 1.66, 95% CI: 1.21, 2.29) also had increased risk of experiencing injurious falls, compared to good health realists. Being health pessimist was only associated with the risk of injurious falls within the younger cohort (HR=2.43, 95% CI=1.63, 3.64), and among males (HR=1.95, 95% CI=1.14, 3.33).
Conclusions
Older adults with similar objective health levels may differ in terms of their injurious fall risk, depending on their subjective health. Interpreting subjective health alongside objective health is clinically pertinent, when assessing injurious fall risk.