The Bermuda Triangle of falls. Meeting all three increases falls by 4.3 times and fractures by 2.5 times!

📖 Literature Information and Abstract Translation

The 'Bermuda Triangle' of orthostatic hypotension, cognitive impairment and reduced mobility: prospective associations with falls and fractures in The Irish Longitudinal Study on Ageing

[Background/Objective] Orthostatic hypotension (OH), cognitive impairment (CI), and mobility impairment (MI) often co-occur in older adults who fall. In this study, we examined the clustering of these three geriatric syndromes in a large cohort of community-dwelling individuals aged 65 and older, and investigated their relationship with future falls and fractures over an 8-year follow-up.

[Methods] OH was defined as a drop in systolic blood pressure of 20 mmHg or more (from sitting to standing) and/or reporting orthostatic instability. CI was defined as a Mini Mental State Examination score ≤ 24 and/or self-reported fair/poor memory. Logistic regression models, including three-way interactions, were used to evaluate longitudinal associations with future falls (explained and unexplained) and fractures.

[Results] Nearly 10% of participants (88/2,108) had all three Bermuda syndromes. One-fifth of participants experienced unexplained falls during follow-up, and 1/10 experienced fractures. As the number of Bermuda syndromes increased, a graded relationship was observed with the incidence of unexplained falls and fractures. In fully adjusted models, the cluster of OH, CI, and MI was most strongly associated with unexplained falls (odds ratio (OR) 4.33 (2.59-7.24); P < 0.001) and fractures (OR 2.51 (1.26-4.98); P = 0.045). Other clusters significantly associated with unexplained falls were OH, CI and MI, MI and OH, and CI and OH. Other clusters were not associated with fractures.

[Discussion] The 'Bermuda Triangle' of OH, CI, and MI was independently associated with future unexplained falls and fractures in community-dwelling older adults. This simple risk identification scheme could be an ideal target for multifaceted fall prevention strategies for community-dwelling older adults.

🌱 So What?: What did I find interesting?

When I talk to patients after discharge, many say this.
I have vaguely felt that falling and fracturing a bone are like a continuous path, yet they are somehow different in nature.
And after reading this paper, that vague feeling has taken on a clear outline.

Looking at the results figure, falls had a linear relationship where they increased as the Bermuda triangle was filled, but fractures showed a non-linear relationship where the risk of fracture spiked only when all three points of the triangle were met.
Doesn't this suggest the following?

In other words, when all three points of the Bermuda triangle are met, one may be prone to falls accompanied by 'massive impact force'.
Among the patients I am currently in charge of, there are several who meet all the criteria of this Bermuda triangle, and I certainly think that if they were to fall, it would be with a large impact force and with few protective responses.
The Bermuda Triangle of falls... it is a 'Devil's Functional Zone'.

⬇︎ Related note & 𝕏 post✨

○●━━━━━━━━━━━・・・‥ ‥ ‥ ‥
High-quality Rehabilitation Medicine & English Paper Reading 'ARI'
From here♪
↓↓↓

‥ ‥ ‥ ‥・・・━━━━━━━━━━━●○
#️⃣ #PhysicalTherapy #ClinicalResearch #Research #Rehabilitation #EnglishPaper #LiteratureReview #EnglishLiteratureReview #Evidence #Science #DailyUpdate #RecentLearning