SUBJECTIVE AGE AND FALLS IN OLDER AGE: EVIDENCE FROM TWO LONGITUDINAL COHORTS

H. Fundenberger¹, Y. Stephan², C. Dupré¹, D. Hupin¹, N. Barth¹, A. Terracciano³, B. Canada⁴

Background: Falls are a common and serious health issue among seniors. Given their impact on health, research on factors associated with increased risk of falls can help identify groups at higher risk and suggest potential targets of interventions. According to this, a growing body of research demonstrated that psychological factors (e.g. fear of falling) contribute to the likelihood of falls. However, no study has investigated the role of subjective age, that is how old or young individuals perceive themselves to be, on falls. Or, subjective age is related to a range of psychological (e.g., depressive symptoms), behavioral (e.g., physical activities), and functional factors (e.g., gait speed) that have been found to contribute to falls.

Purpose: The present study sought to extend existing knowledge by examining the link between subjective age and falls in two large samples of older adults. It was hypothesized that an older subjective age is related to a higher risk of falls.

Methods: Participants aged 65 and older were drawn from the Health and Retirement Study (HRS; n=1,626; mean age=73 years) and the National Health and Aging Trends Study (NHATS; n=3,011; mean age=76 years). Cox proportional hazard ratio regression models were used to test whether subjective age was related to the incidence of falls over time among individual who are not fall at baseline. Falls were tracked for up to 7 and 8 years for NHATS and HRS, respectively. These analyses were adjusted for age, sex, race, educational attainment, depression, handgrip strength, cognitive disorders and chronic diseases. In addition, restricted cubic splines were generated to evaluate the relationship between three subjective age subscore (extremely young; normative young; normative old) and falls.

Results: HRS and NHATS, participants felt on average 12 and 13 years respectively younger than their chronological age.
Cox regression analyses showed that an older subjective age was associated with a higher risk of falls over time, but only in HRS (HR=1.13; 95%CI: 1.02-1.25 , p<.05). Nevertheless, using knots of the selected restricted cubic splines, analyses revealed more specifically that the risk of fall was higher above threshold subjective age values corresponding to the proportional discrepancy score between chronological age and felt age of -9 % for HRS (HR = 1.32; 95%CI: 1.13 - 1.53,p<.001) and -5% for NHATS (HR = 1.20; 95%CI: (1.05, 1.36), p<.001). Results showed also that there is no difference between extremely younger participants and normative younger for the risk of falling.

Conclusion(s): The present study provides evidence for an association between an older subjective age and a higher risk of falls in old age. Furthermore, although feeling excessively younger could apparently be detrimental, this study supports it is preferable to feeling older.

Implications: Consideration should be given to adopting a subjective age screening assessment when evaluating the risk of falling among older people living in the community. Physiotherapist must be aware and take into account that most individuals report a younger felt-age than their actual age and consider it as an adaptative strategy for a successful aging.

Funding, acknowledgements:  The Health and Retirement Study  and  the National Health and Aging Trends  are sponsored by the National Institute of Aging

Keywords: Subjective age, Falls, Cohort

Topic: Older people

Did this work require ethics approval? Yes

Institution: University of Michigan and the Johns Hopkins Bloomberg School

Committee: University of Michigan and Johns Hopkins Bloomberg Review Board

Ethics number: HRS No. NIA U01AG009740 and NHATS NIA U01AG032947