DIABETES, PRE-DIABETES, AND FALLS IN OLDER ADULTS

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DESCRIPTION (provided by applicant): In older adults, diabetes may increase the risk of falls and fall injuries, particularly fractures. Diabetes is also associated with lower extremity performance decline, which may contribute to fall risk and difficulty with independent living. Falls and poor lower extremity performance represent serious threats to the health and quality of life for this population, yet there has been little study of the risk factors for these outcomes among older adults with diabetes. Ultimately, trials will be needed to ascertain how these consequences can be prevented or relieved. However, more complete and conclusive data about the relationship between diabetes and risk factors for falls and declining lower extremity performance are needed. Taking measures to prevent these outcomes among older adults with impaired glucose metabolism (pre-diabetes) may also prove prudent. Studies are needed to determine if older pre-diabetic adults have a higher risk of falls and decline in lower extremity performance and what risk factors might account for any increased risk. This group might be especially important to target for preventive interventions. The Dynamics of Health, Aging and Body Composition (HABC), a longitudinal study among 3,075 older adults (70-79 years old at baseline), provides an exceptional resource to assess the influence of diabetes and pre-diabetes on falls and lower extremity performance. HABC includes 681 participants with diabetes and 945 participants with pre-diabetes, approximately equal numbers of men and women, and African-American and white participants. Measurements of falls and lower extremity performance are being collected over five years at annual clinic visits. A wealth of information is available on potential predictors of these outcomes that are related to diabetes, including fasting glucose, HbA[lc], postural hypotension, body composition, peripheral neuropathy, vision, and medications. In addition, data from hospital admissions are available to investigate serious fall injuries associated with diabetes. We propose performing secondary analyses using HABC data to investigate the risk factors for falls and lower extremity performance decline among those with diabetes or pre-diabetes, emphasizing risk factors that might be a target of intervention. These analyses will inform future efforts to design trials to prevent falls and maintain strength and balance in older adults with diabetes or pre-diabetes.