The association between physical multimorbidity and fall-related injury among adults aged ≥ 50 years from low- and middle-income countries

Lee Smith; Guillermo F López Sánchez; Jae Il Shin; Hans Oh; Karel Kostev; Mark A Tully; Yvonne Barnett; Laurie T Butler; Nicola Veronese; Pinar Soysal; Louis Jacob; Ai Koyanagi

doi:10.1007/s10433-025-00848-y

The association between physical multimorbidity and fall-related injury among adults aged ≥ 50 years from low- and middle-income countries

Lee Smith, Guillermo F López Sánchez, Jae Il Shin, Hans Oh, Karel Kostev, Mark A Tully, Yvonne Barnett, Laurie T Butler, Nicola Veronese, Pinar Soysal, Louis Jacob, Ai Koyanagi

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Abstract

Studies from high-income countries have shown that multimorbidity is associated with increased fall risk among older adults. However, studies specifically on this topic from low- and middle-income counties (LMICs) are lacking. Thus, we aimed to assess this association among adults aged ≥ 50 years from six LMICs.

Cross-sectional, community-based data from the Study on Global Ageing and Adult Health (SAGE) were analyzed. Eleven chronic physical conditions were assessed. The presence of past 12-month fall-related injury was ascertained through self-reported information. Multivariable logistic regression and mediation analysis was conducted to assess the association between multimorbidity and fall-related injury.

Data on 34,129 adults aged ≥ 50 years [mean (SD) age 62.4 (16.0) years; males 48.0%] were analyzed. Overall, compared to having no chronic conditions, having 2, 3, and ≥ 4 chronic conditions were significantly associated with 1.67 (95%CI = 1.21–2.30), 2.64 (95%CI = 1.89–3.68), and 3.67 (95%CI = 2.42–5.57) times higher odds for fall-related injury. The association between multimorbidity (i.e., ≥ 2 chronic conditions) and fall-related injury was mainly explained by pain/discomfort (mediated% 39.7%), mobility (34.1%), sleep/energy (24.2%), and cognition (13.0%).

Older adults with multimorbidity in LMICs are at increased odds for fall-related injury. Targeting the identified potential mediators among those with multimorbidity may reduce fall risk in this population.

Original language	English
Article number	12
Pages (from-to)	1-10
Number of pages	10
Journal	European journal of ageing
Volume	22
Issue number	1
Early online date	20 Mar 2025
DOIs	https://doi.org/10.1007/s10433-025-00848-y
Publication status	Published (in print/issue) - 20 Mar 2025

Bibliographical note

Publisher Copyright:
© The Author(s) 2025.

Data Access Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Keywords

Low-and middle-income countries
falls
Multimorbidity
Chronic disease
Epidemiology
Falls
epidemiology
Low-and Middle-income Countries

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1007/s10433-025-00848-y

s10433-025-00848-y (1)Final published version, 490 KBLicence: CC BY

Cite this

Smith, L., López Sánchez, G. F., Shin, J. I., Oh, H., Kostev, K., Tully, M. A., Barnett, Y., Butler, L. T., Veronese, N., Soysal, P., Jacob, L., & Koyanagi, A. (2025). The association between physical multimorbidity and fall-related injury among adults aged ≥ 50 years from low- and middle-income countries. European journal of ageing, 22(1), 1-10. Article 12. https://doi.org/10.1007/s10433-025-00848-y

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abstract = "Studies from high-income countries have shown that multimorbidity is associated with increased fall risk among older adults. However, studies specifically on this topic from low- and middle-income counties (LMICs) are lacking. Thus, we aimed to assess this association among adults aged ≥ 50 years from six LMICs.Cross-sectional, community-based data from the Study on Global Ageing and Adult Health (SAGE) were analyzed. Eleven chronic physical conditions were assessed. The presence of past 12-month fall-related injury was ascertained through self-reported information. Multivariable logistic regression and mediation analysis was conducted to assess the association between multimorbidity and fall-related injury.Data on 34,129 adults aged ≥ 50 years [mean (SD) age 62.4 (16.0) years; males 48.0%] were analyzed. Overall, compared to having no chronic conditions, having 2, 3, and ≥ 4 chronic conditions were significantly associated with 1.67 (95%CI = 1.21–2.30), 2.64 (95%CI = 1.89–3.68), and 3.67 (95%CI = 2.42–5.57) times higher odds for fall-related injury. The association between multimorbidity (i.e., ≥ 2 chronic conditions) and fall-related injury was mainly explained by pain/discomfort (mediated% 39.7%), mobility (34.1%), sleep/energy (24.2%), and cognition (13.0%).Older adults with multimorbidity in LMICs are at increased odds for fall-related injury. Targeting the identified potential mediators among those with multimorbidity may reduce fall risk in this population.",

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Smith, L, López Sánchez, GF, Shin, JI, Oh, H, Kostev, K, Tully, MA, Barnett, Y, Butler, LT, Veronese, N, Soysal, P, Jacob, L & Koyanagi, A 2025, 'The association between physical multimorbidity and fall-related injury among adults aged ≥ 50 years from low- and middle-income countries', European journal of ageing, vol. 22, no. 1, 12, pp. 1-10. https://doi.org/10.1007/s10433-025-00848-y

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T1 - The association between physical multimorbidity and fall-related injury among adults aged ≥ 50 years from low- and middle-income countries

AU - Smith, Lee

AU - López Sánchez, Guillermo F

AU - Shin, Jae Il

AU - Oh, Hans

AU - Kostev, Karel

AU - Tully, Mark A

AU - Barnett, Yvonne

AU - Butler, Laurie T

AU - Veronese, Nicola

AU - Soysal, Pinar

AU - Jacob, Louis

AU - Koyanagi, Ai

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