Mild anemia and the risk of falls in older adults from nursing homes and the community

Objectives: The objectives of this study were to determine if a relationship exists between a history of falls and anemia in older adults and to compare the findings by place of residence. Design: The authors conducted a retrospective and observational study. Participants: One hundred forty-five adults (60-97 years of age) from nursing homes and the community hospitalized for hip fracture over a 2-year period were included in this study. Measurements: Laboratory values (hemoglobin [Hb], hematocrit [Hct]), medical history, and demographics were measured. Results: Falls occurred similarly in both nursing home patients and community patients (19% vs. 17%, P = 0.785). Nursing home and community patients also had similar Hb (P = 0.0899), Hct (P = 0.1929), and rates of anemia (P = 0.187). Nursing home residents were older (P = 0.0188) and had lower serum albumin levels (P = 0.0007) than community patients. When the two groups were combined, falls were more common in anemic individuals (30% vs. 13%; P = 0.028). Furthermore, those with a history of falls were older (P = 0.0447), had lower Hb (P = 0.0257) and Hct levels (P = 0.0310). After controlling for age, gender, place of residence, and arthritis in a logistic regression model, anemia predicted a threefold increased risk of falls (P = 0.041), and a 45% decreased risk of falls was predicted for every 1.0-g/dL increase in Hb (P = 0.005). Falls risk increased 7% per year of age (P = 0.040), whereas musculoskeletal disease increased the falls risk 3.2-fold, both increases being independent of Hb levels or anemia. Finally, falls were not associated with gender or other comorbidity, nor did these variables alter the falls risk attributed to low Hb or anemia. Conclusions: These findings suggest a new and potentially important link between anemia and the risk of falls in patients sustaining hip fractures from both nursing homes and the community. Further studies will help determine if this risk is modified or eliminated with treatment of anemia and if the relationship applies to larger samples of older adults in different settings.