Rethinking the relationship between ambulatory activity and falls in long-term care: Risk versus reward.

BACKGROUND Ambulatory older residents in long-term care(LTC) have the highest risk of falling. However, the relationship between ambulatory activity (steps per day) and fall risk in LTC is unclear. This study examined whether baseline daily step count, functional capacity and cognitive function predicted falls in LTC residents, and whether functional capacity modified the relationship between step count and fall risk. METHODS 276 LTC residents from New Zealand-based Staying UpRight randomised controlled trial were included (age: 84 ± 7 years;61% female). Baseline daily step count was derived from a lumbar-based accelerometer (3,589 ± 2,379steps). Falls rates were calculated from facilities' falls reports (6 ± 18falls). Residents were categorised as Moderate (n = 71) or Low functional capacity (n = 205) based on Short Physical Performance Battery scores. The Montreal Cognitive Assessment assessed cognition (15 ± 6). Quasipoisson generalised linear models explored associations between steps, cognition and functional capacity with falls rates, including interactions between capacity and steps. Relative risk of falling and fall-related injuries were estimated between activity levels. RESULTS Key results showed a significant interaction (p = 0.036) indicating that only the Moderate functional capacity group had a positive association between steps and falls rates. The Moderate group had a ∼23-24% and ∼6% higher relative risk of falls and fall-related injuries respectively with higher activity, while the Low group showed a lower risk of falls (∼2.7-3.9%) and falls-related injuries (2-4%). Cognitive function was not associated with falls. CONCLUSIONS Findings suggest that higher exposure to ambulatory activity is related to greater falls risk but not falls-related injuries only among residents with moderate functional capacity. This stratification should be considered when shaping falls prevention policies.