Falls among older adults can result in injuries ranging from fractures to traumatic brain injuries and joint dislocations. A peer-reviewed study conducted by researchers at Yale School of Medicine and Yale School of Public Health examined serious fall injuries among older adults with hypertension and investigated whether antihypertensive medication use was associated with their occurrence.

Published in JAMA Internal Medicine, the study followed 4,961 community-living adults older than 70 with hypertension for up to three years. The researchers used Medicare Current Beneficiary Survey data and Medicare claims to identify serious fall injuries. The study was observational, meaning it could identify associations but could not establish that antihypertensive medications caused the injuries. (PubMed Central (PMC))

The study provides several important findings about Serious Fall Injuries in older adults.

1. Serious Fall Injuries Included More Than Broken Hips

The researchers used a specific definition of serious fall injuries. These included hip and other major fractures, traumatic brain injuries, and major joint dislocations.

The injuries were identified through emergency department and inpatient Medicare claims. The researchers looked for a fall-related diagnosis or, when that was unavailable, a serious injury without evidence that the injury resulted from a motor vehicle accident.

The study's definition included fractures involving several parts of the body, including the skull, face, cervical spine, clavicle, humerus, forearm, pelvis, hip, fibula, tibia, and ankle. It also included brain injuries and dislocations involving the hip, knee, shoulder, or jaw. (PubMed Central (PMC))

Therefore, Serious Fall Injuries in this research represented a broad category of medically significant trauma rather than simply hip fractures.

2. Nine Percent of Participants Experienced a Serious Fall Injury

Of the 4,961 participants in the study, 446 people, or 9.0%, experienced a serious fall injury during the follow-up period.

The study population had a mean age of 80.2 years, and 61.5% of participants were women.

Among the 446 participants who experienced serious fall injuries, the researchers identified:

• 107 hip fractures

• 345 other major fractures in 312 people

• 72 major head injuries

• 16 major joint dislocations

Some participants experienced more than one type of serious injury during a fall. Fifty-eight participants experienced multiple injury types, such as a hip fracture combined with another fracture. (PubMed Central (PMC))

The numbers demonstrate that serious fall injuries were not limited to one particular type of trauma.

3. Major Head Injuries Were Documented

The study identified 72 major head injuries among participants during the follow-up period.

The researchers specifically included traumatic brain injuries in their definition of serious fall injuries. The study therefore provides direct evidence that traumatic brain injury was among the serious injuries occurring after falls in this population.

However, the study did not report that every major head injury was necessarily a traumatic brain injury, nor did it provide a separate analysis of outcomes for the 72 participants with major head injuries.

That distinction matters. The study establishes that major head injuries were a significant category within the serious fall injuries identified by the researchers, but it does not support assigning additional characteristics to those injuries that the researchers did not report. (PubMed Central (PMC))

4. Participants With a Previous Fall Injury Were at Particular Risk

One of the study's most important findings concerned participants who had already experienced a fall injury.

Among the 503 participants who had a previous fall injury, those taking antihypertensive medications had a higher adjusted risk of experiencing another serious fall injury than those who were not taking antihypertensive medications.

For participants taking moderate-intensity antihypertensive medication, the adjusted hazard ratio was 2.17 with a 95% confidence interval of 0.98 to 4.80.

For participants taking high-intensity antihypertensive medication, the adjusted hazard ratio was 2.31 with a 95% confidence interval of 1.01 to 5.29.

The researchers described this as more than a doubling of risk among participants with a previous fall injury. (PubMed Central (PMC))

This finding is particularly important because the study population consisted of older adults with hypertension and multiple chronic conditions. A history of falling identified a subgroup in which the association between antihypertensive medication use and serious fall injuries was stronger.

5. Antihypertensive Medication Use Was Associated With Serious Fall Injuries

In the full study population, the researchers found an association between antihypertensive medication use and serious fall injuries.

Compared with participants who were not taking antihypertensive medications, the adjusted hazard ratio was:

• 1.40 for moderate-intensity medication use

• 1.28 for high-intensity medication use

The 95% confidence interval for moderate-intensity use was 1.03 to 1.90. For high-intensity use, it was 0.91 to 1.80.

The researchers also calculated adjusted three-year cumulative incidence of serious fall injuries. It was 9.0% among nonusers, 11.6% among moderate-intensity users, and 10.9% among high-intensity users. (PubMed Central (PMC))

Importantly, the researchers did not establish a simple dose-response relationship. The high-intensity group did not have a statistically significant higher risk than the moderate-intensity group.

6. No Specific Antihypertensive Class Was Identified as Responsible

The researchers examined several categories of antihypertensive medications, including renin-angiotensin system blockers, beta-blockers, calcium channel blockers, and diuretics.

They found that no particular antihypertensive medication class was associated with an increased risk of serious fall injuries.

The adjusted hazard ratios for individual medication classes did not demonstrate a statistically significant increased risk. The researchers therefore did not identify one particular class of antihypertensive medication as responsible for the association observed in the study. (PubMed Central (PMC))

This is an important limitation when interpreting the results. The study examined the relationship between antihypertensive medication use and serious fall injuries; it did not establish that a particular drug or medication class causes falls or injuries.

7. The Study Does Not Prove Cause and Effect

The researchers explicitly cautioned that the study could not establish a cause-and-effect relationship between antihypertensive medication use and serious fall injuries.

Because this was an observational study, factors associated with both medication use and injury risk could influence the results. The researchers used propensity-score adjustment and matching and accounted for numerous characteristics, including age, sex, previous fall injury, use of assistive devices, difficulty walking, osteoporosis, Parkinson disease, cognitive impairment, vision impairment, physical function, cardiovascular disease, diabetes, depression, and other factors.

Even with these statistical adjustments, the researchers stated that they could not exclude confounding.

The appropriate conclusion is therefore that antihypertensive medication use was associated with an increased risk of Serious Fall Injuries in this study population, particularly among people who had experienced a previous fall injury. It is not accurate to state that the study proved antihypertensive medications caused those injuries. (PubMed Central (PMC))

What This Yale Study Shows

This Yale study provides a detailed picture of serious injuries associated with falls among community-living adults older than 70 with hypertension.

During the study's three-year follow-up, 9.0% of the 4,961 participants experienced a serious fall injury. Those injuries included hip fractures, other major fractures, major head injuries, traumatic brain injuries, and joint dislocations.

The study also identified an important association between antihypertensive medication use and serious fall injuries. The association was particularly pronounced among participants who had already experienced a fall injury.

At the same time, the researchers were careful not to claim causation. No individual antihypertensive medication class was identified as responsible, and the observational design prevented the researchers from proving that medication use caused the injuries.

The central finding is therefore precise: Serious Fall Injuries are an important clinical outcome among older adults, and in this nationally representative cohort of older adults with hypertension, antihypertensive medication use was associated with an increased risk of these injuries, particularly among those with a previous fall injury.