Multi-trajectory patterns of ADL, cognition, and depression with fall risk: evidence from a longitudinal study in China

BACKGROUND: Falls are a common occurrence among older adults and can pose serious health and financial burdens. Several studies have shown that a decline of ADL, cognitive decline, and depression are all associated with an increased risk of falls in older adults. However, there is currently a lack of research examining these three factors in conjunction and their combined effect on the risk of falls. Our study aims to examine the longitudinal associations between distinct trajectories of activities of daily living, cognition, and psychological status among adults and their risk of falls. METHODS: We conducted a longitudinal analysis using data from five waves (2011-2020) of the China Health and Retirement Longitudinal Study (CHARLS). A group-based multiple trajectory model (GBMTM) was employed to identify latent ADL-cognitive-Depression trajectories among 2,938 individuals aged 60 years. Multivariable logistic regression models were then used to assess the odds of experiencing falls between 2018 and 2020 across the identified trajectory groups, with sequential adjustment for demographics, health behaviors, comorbidities, and functional limitations. RESULTS: GBMTM identified five distinct trajectory subtypes: "Pervasive Decline (Severe-ADL-Decline)" (n = 378, 12.87%), "Pervasive Decline (Mild-ADL-Decline)" (n = 449, 15.28%), "Cognitive - Decline & Depressed" (n = 338, 11.50%), "Mild ADL Decline" (n = 351, 11.95%) and "Normal" (n = 1422, 48.40%). Compared to the "Normal" group, all other trajectory groups showed significantly elevated risks of falls in the fully adjusted model. The highest risk was observed in the "Pervasive Decline (Severe-ADL-Decline)" group (OR = 2.83, 95%CI: 2.12-3.77), followed by the "Pervasive Decline (Mild-ADL-Decline)" (OR = 2.13, 95%CI: 1.62-2.80), "Mild ADL Decline" (OR = 1.97, 95%CI: 1.47-2.63), and "Cognitive Decline & Depressed" (OR = 1.47, 95%CI: 1.07-2.02) groups. CONCLUSIONS: Five distinct trajectory groups of ADL, cognitive function, and depressive symptoms were identified. These groups exhibited significant differences in fall risk, with the "Pervasive Decline (Severe-ADL-Decline)" group presenting the highest risk, necessitating multidimensional comprehensive interventions for fall prevention.