How Do Discrepancies between Subjective and Objective Health Predict the Risk of Injurious Falls? A Study of Community-Dwelling Swedish Older Adults

Objectives: Previous studies demonstrated that discrepancies between subjective and objective health measures are associated with physical and mental health-related outcomes in older adults. We investigate whether such discrepancies are also associated with risk of injurious falls in community-dwelling Swedish older adults.

Design: A prospective, observational cohort study.

Setting and participants: Using data from the Swedish National Study on Aging and Care in Kungsholmen, we followed 2222 community-dwelling older adults aged ≥60 years at baseline, across a 10-year period of data collection (2001-2011).

Methods: A "health asymmetry" metric classified older adults into 4 categories, based on the level of agreement between their subjective and objective health scores ("health pessimist", "health optimist", "poor health realist", and "good health realist"). Time-varying Cox proportional hazard and Laplace regressions were employed to investigate if these categories were associated with the risk of injurious falls.

Results: Over a 10-year follow-up, 23.5% of the sample experienced an injurious fall. Health optimists had the greatest risk of experiencing an injurious fall [hazard ratio (HR) 2.16, 95% confidence interval (CI) 1.66, 2.80], compared with good health realists. Poor health realists (HR 1.77, 95% CI 1.50, 2.11) and health pessimists (HR 1.66, 95% CI 1.21, 2.29) also had an increased risk of experiencing injurious falls, compared with good health realists. Being a health pessimist was only associated with the risk of injurious falls within the younger-old (HR 2.43, 95% CI 1.63, 3.64) and among males (HR 1.95, 95% CI 1.14, 3.33).

Conclusions and implications: Older adults with similar objective health levels may differ in terms of their injurious fall risk, depending on their subjective health. Interpreting subjective health alongside objective health is clinically pertinent when assessing injurious fall risk.