Alcohol Ingestion Increases Risk Of Falling and Head Trauma In Geriatric Population
Overview
Falls are a prevalent concern among adults aged 65 and older and represent the leading cause of traumatic brain injuries in this age group. Alcohol consumption may elevate the risk of falls and exacerbate the severity of related injuries. This study aimed to explore the link between self-reported alcohol use and the prevalence of intracranial hemorrhage (ICH) in older adults.
The analysis was a secondary examination of data from the Geriatric Head Trauma Short Term Outcomes Project (GREAT STOP), which focused on older adults who experienced blunt head trauma from a fall. The study considered various aspects of each fall event, including patient demographics, medical history, and head trauma-related clinical signs and symptoms. Alcohol use was self-reported and categorized into four groups: none, occasional, weekly, and daily. ICH was defined as any acute hemorrhage detected via computed tomography (CT) scan. The study assessed the relationship between the frequency of alcohol consumption and the occurrence of ICH, adjusting for patient characteristics and head injury risk factors.
Out of 3,128 participants, 18.2% (567 individuals) reported alcohol use, with 10.3% using alcohol occasionally, 1.9% weekly, and 6.0% daily. ICH was more frequently observed among alcohol users, with rates of 20.5% for occasional users, 22.0% for weekly users, and 25.1% for daily users, compared to 12.0% for non-users. The study found that the frequency of alcohol use was independently associated with an increased risk of ICH, even after adjusting for other factors. The adjusted odds ratios for ICH rose progressively with the frequency of alcohol consumption, from 2.0 for occasional users to 2.1 for weekly users, and 2.5 for daily users, indicating a dose-response relationship.
In conclusion, alcohol use among older adults with head trauma is relatively common and appears to be linked to a higher risk of intracranial hemorrhage in a dose-dependent manner. These findings suggest that fall prevention strategies in this population may benefit from addressing alcohol consumption as a modifiable risk factor.
Introduction
Falls are a common and serious issue among adults aged 65 and older, representing the leading cause of injury-related deaths and the primary cause of traumatic brain injuries in this age group. In 2019 alone, over 3 million older adults in the United States sought emergency department (ED) care for fall-related injuries. Alcohol consumption significantly heightens the risk of fall-related injuries among older adults, with recent research indicating a rise in alcohol use and associated ED visits in this demographic. A 2019 study reported that 9% of older adults engaged in heavy alcohol use or binge drinking. Age-related physiological changes amplify the effects of alcohol in older individuals, further increasing their vulnerability to injuries.
Despite the clear risks, limited research has explored the link between alcohol use and the severity of fall-related injuries in older adults. One national study found that alcohol consumption was associated with 2% of falls among older adults and that men who fell were more likely to have consumed alcohol compared to women. Additionally, heavy drinking tends to decrease with age among both men and women. Other studies have shown that higher blood alcohol concentration levels correlate with more severe craniofacial and upper torso injuries.
Given that alcohol use is a modifiable risk factor, there is a critical need to establish a definitive connection between alcohol consumption and the risk of severe traumatic brain injury in older adults. This study specifically aims to investigate the relationship between alcohol use and the incidence of intracranial hemorrhage (ICH) among older adults who sustain head trauma from falls.
Method
This study is a secondary analysis of an existing dataset from a large prospective study focused on older emergency department (ED) patients who sustained blunt head trauma following a fall. Approved by the Institutional Review Board of Florida Atlantic University, this research sought to examine the relationship between alcohol use and the severity of head injuries in geriatric patients.
Alcohol consumption among older adults is on the rise, yet few studies have explored its impact on injury severity within this population. This analysis specifically assessed the frequency of intracranial hemorrhage (ICH) in geriatric patients presenting to the ED with head trauma due to a fall. The study included 3,128 patients, of whom 19% reported alcohol use. The results indicated that ICH was more common in alcohol users (22%) compared to non-users (12%), with daily alcohol consumers showing the highest frequency of ICH. These findings suggest that alcohol use may be a significant, modifiable risk factor in fall prevention strategies for older adults.
The data for this analysis were derived from the Geriatric Head Trauma Short Term Outcomes Project (GREAT STOP), which included a prospective cohort of consecutive patients at two level-one trauma centers in Palm Beach County, Florida, from August 2019. The centers, Delray Medical Center and Bethesda Hospital East, handle annual patient volumes of 50,000 and 69,000 respectively.
Patients aged 65 years and older who sustained blunt head trauma due to a fall were included. Exclusion criteria included injuries from non-fall mechanisms, injuries occurring more than 24 hours before presentation, penetrating injuries, or transfers from other facilities. Research assistants (RAs) screened patients and collected comprehensive data, including demographics, medical history, and alcohol use, which was categorized as none, occasional, weekly, or daily. All data were meticulously recorded in a REDCap database to ensure accuracy.
The primary outcome was the occurrence of ICH related to a fall in patients with a history of alcohol use, with ICH types classified by the attending hospital radiologist. The study utilized multivariable logistic regression models to adjust for potential confounders, including patient demographics, clinical risk factors, and other relevant variables.
Basic demographic and clinical outcomes were compared across different alcohol consumption subgroups, with crude comparisons of ICH prevalence calculated using risk differences (RDs) and adjusted odds ratios (aORs). The study also evaluated trends in ICH incidence related to alcohol use, incorporating adjustments for multiple comparisons and potential confounders.
This study underscores the importance of considering alcohol use as a modifiable risk factor in preventing falls and associated head trauma in the geriatric population. The findings highlight the need for targeted interventions to address alcohol consumption in older adults, particularly those at risk of falls, to reduce the incidence of severe injuries such as intracranial hemorrhage.
Result
In this study, 3,128 participants underwent an initial head CT scan following head trauma from a fall. Among these, 433 (13.5%) were diagnosed with intracranial hemorrhage (ICH), and 561 (18.2%) reported alcohol use. The analysis excluded 375 participants due to missing information on alcohol use frequency and four individuals reporting binge drinking due to the small sample size.
The majority of participants were female, while alcohol use was more frequently reported by males. Younger participants, with an average age of 78, were more likely to consume alcohol weekly or daily, compared to non-users who had an average age of 83 years.
ICH was significantly more common in alcohol users compared to non-users (22% vs. 12%, p < 0.001), with a notable increase in ICH prevalence corresponding to the frequency of alcohol use. The risk difference (RD) for ICH escalated with more frequent alcohol use, ranging from an 8.5% increase in occasional users to a 13.1% increase in daily users.
Multivariable logistic regression models, including those adjusted for patient and head injury risk factors, consistently indicated that alcohol use is an independent risk factor for ICH. Occasional alcohol use was associated with a twofold increase in the odds of ICH (adjusted odds ratio [aOR] 2.0, 95% CI 1.5‒2.8, p < 0.001), while daily use was linked to a 2.5-fold increase (aOR 2.5, 95% CI 1.7‒3.6, p < 0.001). The dose-response relationship between alcohol use frequency and ICH risk was confirmed, with each increase in alcohol use frequency associated with a 40% higher risk of ICH (aOR 1.4, 95% CI 1.2‒1.6, p < 0.001).
However, the study has several limitations. It was based on a secondary analysis of existing data, with no additional information on alcohol use available. The reliance on self-reported alcohol consumption may introduce social desirability bias, potentially underestimating true alcohol use. Additionally, around 33% of participants did not provide detailed alcohol use data, which could skew the findings, particularly since some heavy drinkers might have withheld this information. Furthermore, a significant portion of the participants had cognitive dysfunction, making them less likely to consume alcohol but more susceptible to severe injuries from falls. The study sample predominantly comprised Caucasian, non-Hispanic individuals, limiting the generalizability of the results. Finally, alcohol use was not routinely corroborated with alcohol testing, as this was done at the treating physician’s discretion rather than as part of the study protocol.
Conclusion
The study found a significant correlation between self-reported alcohol use and an increased risk of intracranial hemorrhage (ICH) among older adults who suffered fall-related head trauma. A notable dose-response effect was observed, with higher frequency of alcohol use correlating with greater odds of ICH. This association appears to be an independent risk factor, even when other patient- and injury-related factors are taken into account.
The study is one of the first to explore the link between alcohol consumption and severe head injuries in older adults, a population in which 18.2% of individuals presenting with head trauma in the emergency department reported alcohol use, including 6% who reported daily consumption. These figures align with data from the Florida Behavioral Risk Factor Surveillance System, which reported 8.8% of older adults engaged in heavy alcohol use.
The study utilized a simple self-reported alcohol use scale already in place at the hospital, suggesting its potential clinical utility. While falls are the leading cause of fatal and non-fatal injuries among older adults nationwide, with 3,805 fatalities in Florida alone in 2021, the role of alcohol in these outcomes has not been extensively studied. The strong dose-response relationship between alcohol use and ICH identified in this study suggests a possible causal link, warranting further investigation. This relationship is consistent with findings in other conditions, such as stroke, cardiovascular disease, cirrhosis, and certain cancers, where increased alcohol consumption has been shown to have a similar effect.
Clinically, the findings underscore the importance of considering alcohol use as an independent and modifiable risk factor for falls in older adults. Alcohol may increase fall risk due to its effects on sensorium, balance, and concentration, which are exacerbated in older individuals due to physiological changes associated with aging. These changes include a higher body fat-to-water ratio, leading to higher blood alcohol concentrations, and decreased enzyme function related to alcohol metabolism.
The study was unable to determine whether the increased risk of ICH was due to acute intoxication or chronic alcohol use, even at infrequent levels. Potential risk factors could include dehydration, liver dysfunction, malnutrition, electrolyte imbalances, and seizures related to alcohol withdrawal.
Current fall prevention guidelines, such as those from the CDC’s STEADI initiative and the American Geriatrics Society, do not address the role of alcohol use in fall risk. The study’s findings suggest that alcohol use assessment and mitigation could be valuable additions to these strategies. Future research should investigate whether alcohol screening and reduction programs can decrease the incidence of serious fall-related outcomes. Incorporating alcohol use mitigation into fall prevention campaigns could enhance the effectiveness of these programs.
In conclusion, alcohol use among older adults with head trauma is relatively common and is significantly associated with an increased risk of ICH in a dose-dependent manner. Incorporating alcohol use reduction into fall prevention strategies may provide an important, modifiable approach to reducing fall-related injuries in this population.
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