The “Domino Effect”: Functional decline and increased social care requirements following a fall
Loading...
Files
Published Version
Date
2026-08
Authors
Briggs, Robert
Ward, Mark
van der Velde, Nathalie
Scarlett, Siobhan
Hernandez, Belinda
Romero-Ortuno, Roman
Tysinger, Bryan
May, Peter
Ahern, Emer
Kenny, Rose Anne
Journal Title
Journal ISSN
Volume Title
Publisher
Elsevier BV
Published Version
Abstract
Objectives: Falls represent an important inflection point in later life, increasing the risk of future adverse outcomes. This study aims to examine the association between an index fall, that is, a fall in a participant with no recent history of falls, and subsequent change in functional status, requirements for social care, and falls-related health care utilization.
Design: Longitudinal analysis of population-representative data.
Setting and Participants: Participants (n = 2454) aged ≥65 years from waves 1 to 3 of The Irish Longitudinal Study on Aging.
Methods: Index falls were those reported at wave 2 in participants with no falls reported at wave 1. Falls/fractures, functional status (activities of daily living), and social care (home care, home help, and meals on wheels) were assessed by self-report. Regression models assessed the independent relationship between index falls and outcomes of interest.
Results: Twenty percent of participants (n = 493) reported an index fall. In participants who were functionally independent at baseline, an index fall was associated with functional impairment at 2-year follow-up (odds ratio [OR], 1.71; 95% CI, 1.19-2.47; P = .004). Almost 12% with index falls developed functional impairment. In those not requiring home care at baseline, an index fall was independently associated with an almost 3-fold higher likelihood of requiring home care (OR, 2.87; 95% CI, 1.38-5.97; P = .005) and a higher number of monthly home care hours (β = 0.76; 95% CI, 0.18-1.34; P = .010) at 2-year follow-up. Almost 12% with index falls required “new” social supports. An index fall was independently associated with future falls–related emergency department presentations (OR, 1.69; 95% CI, 1.14-2.49; P = .008), future fractures (OR, 1.52; 95% CI, 1.08-2.15; P = .018), but not more general practitioner visits during follow-up.
Conclusions and Implications: This study demonstrates that even a single fall can signal a significant shift in the health and functional trajectories of community-dwelling older people, reinforcing the need for proactive and coordinated prevention strategies.
Description
Keywords
Geriatric syndromes , Accidental falls , Home care services , Emergency service , Hospital , [CoMHOffice] , [Medicine]
Citation
Briggs, R. et al. (2026) “The ‘Domino Effect’: Functional Decline and Increased Social Care Requirements Following a Fall,” Journal of the American Medical Directors Association, 27(8), (6pp), https://doi.org/10.1016/j.jamda.2026.106324