Modeling the Relationship between Symptom Burden, Falls and Outcomes

Abstract Background Falls constitute a public health crisis for older adults. Almost half of older adults have increased symptom burden that limits function and increases fall risk. Objectives The aims of this study were to determine if the relationship between symptom burden and outcomes are mediated by falls and whether symptoms further moderate outcomes of falls. Methods Data came from the National Health and Aging Trends Study. Path models were used to test the mediation of the relationship between symptom burden in 2015 and outcomes in 2016 by falls in the past year, as well as the moderation of the effect of falls on outcomes by symptom burden. Models were stratified by age. Results There was a significant moderated mediation for participants aged ≥80 years in which higher symptom burden had a direct association with higher risk for hospitalization, an indirect link to higher risk for hospitalization through an increased risk for falls, but a dampening effect on the association between falls and hospitalization. For disability and wellbeing, falls partially mediated the association between symptom burden and outcomes for those <80 years. For ≥80 years, symptom burden was associated with falls and with the outcome, but there was no mediation. Falls consistently mediate the connection between symptoms and outcomes for those aged 65-79, but not for those aged 80 and older. Discussion The results suggest that symptom burden may be a potential assessment tool for identifying the risk for falls in older adults. Further research could explore tailored intervention development for targeting symptom management and fall prevention.