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Falls and Fall-Related Injuries in Older Dialysis Patients

Wendy L. Cook^*, George Tomlinson, Meghan Donaldson, Samuel N. Markowitz, Gary Naglie^,||, Boris Sobolev^¶, and Sarbjit V. Jassal^,||

^* Division of Geriatric Medicine, Faculty of Medicine, Department of Health Care and Epidemiology, and ^¶ Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Division of Clinical Decision-making & Health Care, Toronto General Research Institute, and Departments of Ophthalmology and ^|| Medicine, University of Toronto, Toronto, Ontario, Canada

Address correspondence to: Dr. Sarbjit V. Jassal, University of Toronto and Staff Physician, University Health Network, 8NU-857, 200 Elizabeth Street, Toronto, M5G 2C4, Canada. Phone: 416-340-3196; Fax: 416-340-4999; E-mail: vanita.jassal{at}uhn.on.ca

Dialysis patients are increasingly older and more disabled. In community-dwelling seniors without kidney disease, falls commonly predict hospitalization, the onset of frailty, and the need for institutional care. Effective fall prevention strategies are available. On the basis of retrospective data, it was hypothesized that the fall rates of older (65 yr) chronic outpatient hemodialysis (HD) patients would be higher than published rates for community-dwelling seniors (0.6 to 0.8 falls/patient-year). It also was hypothesized that risk factors for falls in dialysis outpatients would include polypharmacy, dialysis-related hypotension, cognitive impairment, and decreased functional status. Using a prospective cohort study design, HD patients who were 65 yr of age at a large academic dialysis unit were recruited. All study participants underwent baseline screening for fall risk factors. Patients were followed prospectively for a minimum of 1 yr. Falls were identified through biweekly patient interviews in the HD unit. A total of 162 patients (mean age 74.7 yr) were recruited; 57% were male. A total of 305 falls occurred in 76 (47%) patients over 190.5 person-years of follow-up (fall-incidence 1.60 falls/person-year). Injuries occurred in 19% of falls; 41 patients had multiple falls. Associated risk factors included age, comorbidity, mean predialysis systolic BP, and a history of falls. In the HD population, the fall risk is higher than in the general community, and fall-related morbidity is high. Better identification of HD patients who are at risk for falls and targeted fall intervention strategies are required.

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