Rethinking the relationship between ambulatory activity and falls in long-term care: risk versus reward

Abstract

Background: Ambulatory older residents in long-term care (LTC) have the highest risk of falling. However, the relationship between ambulatory activity (steps per day) and fall risk in LTC is unclear. This study examined whether baseline daily step count, functional capacity and cognitive function predicted falls in LTC residents, and whether functional capacity modified the relationship between step count and fall risk. Methods: Two hundred seventy-six LTC residents from New Zealand-based Staying UpRight randomized controlled trial were included (age: 84±7 years; 61% female). Baseline daily step count was derived from a lumbar-based accelerometer (3589±2379 steps). Fall rates were calculated from facilities’ falls reports (6±18 falls). Residents were categorized as Moderate (n=71) or Low functional capacity (n=205) based on Short Physical Performance Battery scores. The Montreal Cognitive Assessment assessed cognition (15±6). Quasi-Poisson generalized linear models explored associations between steps, cognition, and functional capacity with fall rates, including interactions between capacity and steps. The relative risk of falling and fall-related injuries was estimated between activity levels. Results: Key results showed a significant interaction (P=.036), indicating that only the Moderate functional capacity group had a positive association between steps and fall rates. The Moderate group had a ∼23%-24% and ∼6% higher relative risk of falls and fall-related injuries, respectively, with higher activity, while the Low group showed a lower risk of falls (∼2.7%-3.9%) and falls-related injuries (2%-4%). Cognitive function was not associated with falls. Conclusions: Findings suggest that higher exposure to ambulatory activity is related to greater falls risk but not falls-related injuries only among residents with moderate functional capacity. This stratification should be considered when shaping falls prevention policies.