# From First Slip to Second Setback: Intracranial Injury Risk after Recurrent Falls in Older Adults: A Retrospective Cohort Study

## TL;DR

Older adults who fall repeatedly are more likely to suffer brain injuries, especially if they are male, older, or take certain medications.

## Contribution

This study identifies specific risk factors for intracranial injuries after recurrent falls in older adults using a large cohort analysis.

## Key findings

- Recurrent falls increased intracranial injury risk by 10.4% compared to initial falls.
- Antihypertensive use nearly doubled the risk of intracranial injuries.
- Males and older adults had significantly higher risks of sustaining intracranial injuries.

## Abstract

Recurrent falls in older adults are a major public health concern, often resulting in severe injuries such as Intracranial Injuries (ICIs). These injuries increase the risk of cognitive decline, disability, and early mortality. While medications like antihypertensives and antidepressants are essential for managing chronic conditions, they may also contribute to fall-related injury risk.

This retrospective cohort study analyzed data from 3760 adults aged 65 to 89 years at the Virginia Commonwealth University Health System (VCUHS) in 2023. Patients were categorized into two cohorts: those with initial falls (n = 2710) and those with recurrent falls (n = 1050). Demographic variables, medication use, and fall-related ICI outcomes were examined. Incidence, prevalence, and measures of association were calculated. Cox regression models assessed the impact of demographic and clinical predictors on ICI risk.

The risk of ICI was 10.4% higher in patients with recurrent falls compared to those with initial falls (HR = 1.104, 95% CI: 0.833–1.463, p = 0.0493). Males were significantly more likely to sustain ICIs (HR = 1.369, 95% CI: 1.054–1.779, p = 0.0186), as were older adults with each additional year of age (HR = 1.021, 95% CI: 1.001–1.041, p = 0.0347). Antihypertensive use nearly doubled the risk of ICI (HR = 1.958, 95% CI: 1.379–2.781, p = 0.0002), and antidepressant use was associated with a 47.1% increase (HR = 1.471, 95% CI: 1.1–1.968, p = 0.0093). Race was not a significant predictor of ICI risk in adjusted models.

Recurrent falls were associated with a higher likelihood of ICIs among older adults, particularly in males, those of advanced age, and individuals prescribed antihypertensive or antidepressant medications. These results point to the importance of identifying patients at increased vulnerability and tailoring fall-related care and medication reviews accordingly to help reduce injury severity in this population.