Falls are the primary cause of both fatal and non-fatal injuries among older adults, leading to traumatic brain injuries. In 2021 alone, falls resulted in the deaths of 36,500 seniors across the United States, including 3,805 in Florida. While there have been speculations regarding the role of alcohol in these incidents, comprehensive studies on this connection are limited.
Consequently, there is a lack of understanding regarding how the frequency of alcohol consumption affects the seriousness of injuries from falls among older adults. A major research effort by Florida Atlantic University’s Schmidt College of Medicine and its partners is among the first to investigate the link between self-reported alcohol usage and significant head injuries in this demographic.
The study utilized data from the Geriatric Head Trauma Short Term Outcomes Project (GREAT STOP), which involved a prospective cohort of consecutive patients arriving at two major trauma centers in Palm Beach County, admitting around 50,000 and 69,000 patients annually.
Participants in the study were individuals aged 65 and older who experienced blunt head injuries due to a fall. Trained research assistants screened older patients in the emergency department to identify those with head trauma. Information collected included factors such as age, race, gender, smoking habits, alcohol consumption, drug use, the use of antiplatelet and anticoagulant medications, the cause of injury, medical history, and instances of loss of consciousness.
Every participant was inquired about their alcohol consumption and asked to categorize it as none, occasional, weekly, or daily. The presence of intracranial hemorrhage (ICH)—a type of head trauma in various brain areas—was assessed through the patient’s head CT scan evaluated by the attending hospital radiologist.
Published in the Journal of the American College of Emergency Physicians Open, the study analyzed 3,128 subjects who underwent initial CT scans following a fall. Among them, 433 (13.5%) were diagnosed with ICH. Notably, 561 (18.2%) of the patients reported alcohol consumption, with 6% engaged in daily drinking.
“Our analysis revealed that occasional drinkers had double the likelihood of suffering from intracranial hemorrhage compared to non-drinkers. Those who consumed alcohol daily demonstrated an increase in risk by 150%,” explained Richard Shih, M.D., the lead author and a professor of emergency medicine at FAU’s Schmidt College of Medicine. “A surprising observation from our research was the notable dose-response relationship between reported alcohol use and the incidence of intracranial hemorrhage.”
Drinkers, whether weekly or daily, were generally younger, averaging 78 years, while non-drinkers had an average age of 83. The incidence of ICH was significantly higher among drinkers compared to non-drinkers (22% versus 12%). Furthermore, the prevalence of ICH escalated with increased alcohol consumption levels. For non-drinkers, ICH risk was already considerable, but the absolute differences in ICH risk connected to alcohol use were substantial, jumping from an 8.5% increase in occasional users to 13.1% in daily users.
Multiple risk factors associated with falls in older individuals have been identified, including polypharmacy, sudden drops in blood pressure, and hazards in home environments. The results from this study support the idea that alcohol consumption should be recognized as an additional significant, modifiable risk factor for falls.
Shih remarked, “Alcohol intake can increase your fall risk as it can impair balance, focus, and situational awareness. It’s also essential to note that aging enhances alcohol’s effects—older adults generally have a higher ratio of body fat to water, raising blood alcohol concentration. Additionally, as we age, the body’s ability to metabolize alcohol deteriorates, intensifying these effects.”
Existing fall prevention programs, such as the Centers for Disease Control and Prevention’s (CDC) Stopping Elderly Accidents, Deaths & Injuries (STEADI) initiative or the American Geriatrics Society’s Clinical Practice Guidelines for Fall Prevention in Older Adults, do not incorporate the connection between alcohol consumption and falls.
“Our findings indicate that evaluating alcohol use and developing strategies to mitigate this risk could be valuable extensions to fall prevention initiatives,” Shih stated.
The study’s co-authors include Alexander Zirulnik, M.D., the first author and an emergency medicine resident at Harvard Medical School and Mass General Brigham; Shan Liu, M.D., an associate professor of emergency medicine at Harvard Medical School; Mike Wells, Ph.D., a research assistant professor at FAU’s Department of Emergency Medicine; Scott Alter, M.D., an associate professor of emergency medicine; Gabriella Engstrom, Ph.D., a project coordinator at FAU; Joshua Solano, M.D., an associate professor of emergency medicine; Lisa M. Clayton, D.O., chair of the FAU Department of Emergency Medicine; Mark Reiter, M.D., from the University of Tennessee Health Science Center; Patrick G. Hughes, D.O.; and Lara Goldstein, Ph.D., from the Department of Emergency Medicine at Memorial Healthcare System.
This study received financial support from the Florida Medical Malpractice Joint Underwriting Association Grant aimed at enhancing the safety of healthcare services (grant RFA #2018-01) and the GREAT STOP award granted to Shih, the principal investigator.
