Although a serious fall injury is often a devastating event, little is known about the course of disability (i.e. functional trajectories) prior to a serious fall injury or the relationship between these trajectories and those that follow the fall.
To identify distinct sets of functional trajectories in the year immediately before and after a serious fall injury, to evaluate the relationship between the pre-fall and post-fall trajectories, and to determine whether these results differed based on the type of injury.
Design, Setting, and Participants
Prospective cohort study conducted in greater New Haven, Connecticut, from March 1998 to June 2012 of 754 community-living persons aged 70 or older who were initially nondisabled in their basic activities of daily living. Of the 130 participants who subsequently sustained a serious fall injury, 62 had a hip fracture and 68 had another fall-related injury leading to hospitalization.
Main Outcome Measures
Functional trajectories, based on 13 basic, instrumental and mobility activities that were assessed during monthly interviews, were identified in the year before and after the serious fall injury, respectively.
Before the fall, five distinct trajectories were identified: no disability (n=16, 12.3%), mild disability (n=34, 26.2%), moderate disability (n=34, 26.2%), progressive disability (n=23, 17.7%), and severe disability (n=23, 17.7%). After the fall, four distinct trajectories were identified: rapid recovery (n=12, 9.2%), gradual recovery (n=35, 26.9%), little recovery (n=26, 20.0%), and no recovery (n=57, 43.8%). For both hip fractures and other serious fall injuries, the probabilities of the post-fall trajectories were greatly influenced by the pre-fall trajectories, such that rapid recovery was observed only among persons who had no disability or mild disability, and a substantive recovery, defined as rapid or gradual, was highly unlikely among those who had progressive or severe disability. The post-fall trajectories were consistently worse for hip fractures than for the other serious injuries.
Conclusions and Relevance
The functional trajectories before and after a serious fall injury are quite varied, but highly interconnected, suggesting that the likelihood of recovery is greatly constrained by the pre-fall trajectory.