Critical Falls Among People Aging with Multiple Sclerosis: Getting Help after a Fall

Background: Although falls among people with MS (PwMS) are common, critical falls, defined as falls with an inability to regain upright posture, have not been examined in this population. The inability to get up is associated with decline in ADLs, serious injury, fear of falling, and even death among older adults. Among PwMS, the contribution of critical falls to fall-related morbidity and mortality are unknown.

Objectives: The aim of this study was to determine the proportion of fallers receiving help to get up after a fall, and factors associated with critical falls among PwMS. The study was a secondary analysis of a national, US-based, cross-sectional descriptive study of PwMS. 

Methods: Of the 354 PwMS aged ≥ 55 years interviewed, 322 reported a story about their most recent fall which included information about the consequences of falls and fall-related experiences (e.g. need for assistance to get up after a fall). Data were analyzed descriptively to determine the proportion of fallers receiving help to get up after a fall. Logistic regression was performed to determine factors associated with receiving help to get up after a fall. Age, sex, and other covariates significantly associated with receiving help to get up during initial univariate analysis were considered for the model: live with others, disease duration, number of mobility aids use, fear of falling, fall leading to a fracture, and two MS symptoms: problems with balance or mobility and leg weakness.

Results: A total of 177 fallers (54.1%) received help to get up after their most recent fall. Logistic regression analysis revealed 6 factors associated with receiving help: being female (odds ratio [OR]=1.96, 95% confidence interval [CI]=1.11-3.46), longer disease duration (OR=1.04, CI=1.01-1.06), lives with others (OR=2.48, CI=1.37-4.48), fall lead to fracture (OR=4.21, CI=1.27-13.99), problems with balance or mobility (OR=1.90, CI=1.03-3.50), and leg weakness (OR=2.136, 95% CI=1.133-4.027).

Conclusions: More than half of PwMS received help after a fall, suggesting critical falls in this population are common. Findings support the need for caregiver education on fall management including content designed to help PwMS effectively direct others in how to assist them after a fall, as well as balance and strength training for PwMS to increase the ability to get up safely after a fall. Prospective studies involving PwMS are needed to better understand contributors and the consequences of critical falls.