J. R. Oliver1, C. J. DiMaggio2,3, P. R. Ayoung-Chee2 1New York University School Of Medicine,New York, NY, USA 2New York University School Of Medicine,Department Of Surgery, Division Of Trauma And Acute Care Surgery,New York, NY, USA 3New York University School Of Medicine,Department Of Population Health,New York, NY, USA
Introduction: Falls are the leading cause of both fatal and nonfatal injuries in adults ≥ 55 years of age. In older adults hearing impairment is associated with an increased risk of falling. This can be due to reduced spatial awareness and coexistent vestibular pathology leading to impaired balance. It has yet to be examined if and how hearing impairment impacts physical function recovery following falls. This study examines the association between hearing impairment and physical function recovery over 6 months following falls in the elderly.
Methods: Data were prospectively collected from patients ≥ 55 years of age admitted to a Level 1 trauma center after falling from standing height. Patients were eligible for the study whether or not they had hearing impairment or sustained an injury (Injury Severity Score (ISS) ≥ 1) from their fall. Hearing ability was self-reported and analyzed dichotomously as impaired or not impaired. A self-reported physical function measure (PROMIS-PF) was administered to patients at four time points (upon admission, immediately post-discharge, 3 and 6 months post-fall) to evaluate physical function recovery. PROMIS-PF scores range from 20 to 100 with a minimally important difference of 4.
Results: There were 144 patients in the cohort; 11 patients died. Follow-up rates post discharge, 3 months post-fall and 6 months post-fall were 47.9%, 43.8%, and 44.4% respectively. 31.3% of patients had impaired hearing. 67.4% sustained an injury from their fall, with a mean ISS of 5.8 (sd = 5.4). Immediately after discharge a similar proportion of hearing impaired (61.5%) and non-impaired (60.0%) patients had significant declines in PF scores (p = 1.00). The average PF decline was similar between both groups (hearing impaired 7.3, sd = 13.4) (non-impaired 9.7, sd = 14.4). Six months post-fall a substantially larger proportion of hearing impaired patients continued to have physical function impairment (62.5%) compared to normal hearing individuals (31.5%, p = 0.05). Multivariable regression demonstrated a significant association between hearing impairment and failure to recovery to pre-injury physical function after adjusting for ISS, Charlson Comorbidity Score, and age (OR = 4.77, 95% CI = 1.33 – 19.91, p = 0.02).
Conclusion: Hearing impairment has been shown to be a potentially modifiable risk factor for falls in the elderly. This study demonstrates hearing impairment is also significantly associated with worse recovery following falls. We should focus on improving hearing in elderly individuals as both an injury prevention and injury recovery strategy.