# The relationship of perceived discrimination in healthcare and future falls among community-dwelling older persons from an English longitudinal cohort

## TL;DR

This study finds that older adults who feel discriminated against in healthcare are more likely to fall in the next four years.

## Contribution

The novel contribution is identifying a link between perceived healthcare discrimination and increased future fall risk in older adults.

## Key findings

- Older adults who experienced healthcare discrimination had a 64% higher chance of falling 4 years later.
- The effect of discrimination on falling was not significant after 8 years.
- Older age was the only consistent risk factor for falling at both 4 and 8 years.

## Abstract

Background: The objective of this study is to examine the relation between the perceived discrimination suffered by older adults aged 60 and over during a healthcare encounter and its effects on the likelihood of falling 4 and 8 years later.

Methods: To identify discrimination, we used the English Longitudinal Study of Ageing (ELSA) data collected in 2010-2011 (wave 5) that asked respondents about feeling discriminated against by doctors or at hospitals in the past year. Falls were assessed by the question: “Have you fallen down in the last two years?” in subsequent waves. We performed longitudinal analyses using the 2014-2015 (wave 7) and 2018-2019 (wave 9) follow-ups. Multivariable logistic regression was used to estimate the odds ratios of falling.

Results: At baseline, 707 (15.1%) of all respondents experienced healthcare discrimination. Those suffering from discrimination in health care had 64% higher chances of falling 4 years later (odds ratio: 1.637, 95% confidence interval: 1.131-2.368) compared to those who did not, adjusting for age, sex, marital status, wealth, ethnicity, education levels, self-perceived health, depressive symptoms, and difficulties with basic and/or instrumental activities of daily living (ADL/IADL) and difficulties with walking. After 8 years, the effect was not statistically significant. Older age was the only significant detrimental factor at both 4 and 8 years.

Conclusions: Understanding discrimination in health care is important to enable safe and welcoming environments for the timely future use of services. These results remind us of the physical risk and the complex panorama of bio-psychosocial determinants involved in tackling discrimination over time.